肾脏肉瘤样癌41例病例分析
发布时间：2018-07-21 20:35
【摘要】：目的探讨肾脏肉瘤样癌的临床表现、病理学特征、预后及治疗。 方法回顾性分析本院2007年3月至2013年10月全部肾脏肉瘤样癌41例,男31例,女10例。年龄34～83岁,平均年龄61岁。腰腹部酸胀或疼痛不适19例,无痛性肉眼血尿10例,乏力消瘦4例,发热4例,尿路刺激症状3例,排尿不畅2例,体检发现9例。腰腹部可及肿块5例,肾区叩痛4例,无阳性体征32例。41例患者术前均行B超检查,其中33例同时行CT检查,14例同时行MR检查,肿瘤大小2.5×1.5cm～18.0×14.0cm,平均7.0×4.6cm。3例术前B超与MRA检查显示有肾静脉癌栓,其中2例伴有下腔静脉癌栓。38例行根治性肾切除术并行区域淋巴结清扫,2例行保留肾单位手术,1例仅行肿瘤穿刺活检。15例术后予IFN-α免疫治疗,8例术后予舒尼替尼靶向治疗。 结果本组41例患者术后病理示：肾细胞癌伴部分肉瘤样癌22例,单纯肾肉瘤样癌9例,肾盂尿路上皮癌伴部分肉瘤样癌6例,肾集合管癌伴部分肉瘤样癌2例,肾盂鳞状细胞癌伴部分肉瘤样癌2例。TNM分期：Ⅰ期10例,Ⅱ期11例,Ⅲ期15例,Ⅳ期5例。25例行免疫组化检查,结果显示细胞角蛋白和波形蛋白均呈阳性表达。获得随访39例,28例死亡,11例生存,总生存时间1～61个月,中位生存期14.7个月。亚组中位生存期统计：TNM分期Ⅰ～Ⅱ期组18.1个月,Ⅲ～Ⅳ期组10.6个月；术后予IFN-α免疫治疗组18.0个月；术后予生物靶向治疗组16.2个月；组织学为单纯肾肉瘤样癌组11.5个月。 结论肾脏肉瘤样癌是一种罕见的肾脏恶性肿瘤,恶性程度高。临床症状明显,影像学较难与普通肾癌相区分,确诊主要依赖病理及免疫组化,治疗以根治性肾切除为主,预后差,临床分期及肉瘤样成分含量是影响预后的重要标准。对于临床上怀疑肾肉瘤样癌的患者必须引起重视,尽早明确诊断,尽早行手术治疗的同时可应用化疗或靶向药物行辅助治疗。
[Abstract]:Objective to investigate the clinical manifestations, pathological features, prognosis and treatment of renal sarcomatoid carcinoma. Methods from March 2007 to October 2013, 41 cases of renal sarcomatoid carcinoma were retrospectively analyzed, including 31 males and 10 females. The average age was 61 years. There were 19 cases of abdominal distention or pain, 10 cases of painless hematuria, 4 cases of fatigue and wasting, 4 cases of fever, 3 cases of urinary tract irritation, 2 cases of dysuria, and 9 cases of physical examination. Five cases of accessible lumps in waist and abdomen, 4 cases of knocking pain in renal area, 32 cases without positive signs and 41 cases were examined by B-ultrasound before operation. Among them, 33 cases underwent CT examination and 14 cases underwent Mr examination at the same time. The tumor size was 2.5 脳 1.5cm~18.0 脳 14.0 cm, with an average of 7.0 脳 4.6cm.3. B-ultrasonography and MRA showed renal vein tumor thrombus before operation. Among them, 2 cases were accompanied with inferior vena cava tumor thrombus. 38 cases were treated with radical nephrectomy and 2 cases with nephron-sparing surgery. One case received tumor biopsy only. 15 cases received IFN- 伪 immunotherapy and 8 cases received sunitinib targeted therapy after operation. Results the pathological findings of 41 patients were as follows: 22 cases of renal cell carcinoma with partial sarcomatoid carcinoma, 9 cases of simple renal sarcomatoid carcinoma, 6 cases of renal pelvis urothelial carcinoma with partial sarcomatoid carcinoma, 2 cases of renal collecting duct carcinoma with partial sarcomatoid carcinoma. TNM staging was performed in 2 cases of squamous cell carcinoma of renal pelvis with sarcomatoid carcinoma: 10 cases in stage 鈪，
本文编号：2136781
[Abstract]:Objective to investigate the clinical manifestations, pathological features, prognosis and treatment of renal sarcomatoid carcinoma. Methods from March 2007 to October 2013, 41 cases of renal sarcomatoid carcinoma were retrospectively analyzed, including 31 males and 10 females. The average age was 61 years. There were 19 cases of abdominal distention or pain, 10 cases of painless hematuria, 4 cases of fatigue and wasting, 4 cases of fever, 3 cases of urinary tract irritation, 2 cases of dysuria, and 9 cases of physical examination. Five cases of accessible lumps in waist and abdomen, 4 cases of knocking pain in renal area, 32 cases without positive signs and 41 cases were examined by B-ultrasound before operation. Among them, 33 cases underwent CT examination and 14 cases underwent Mr examination at the same time. The tumor size was 2.5 脳 1.5cm~18.0 脳 14.0 cm, with an average of 7.0 脳 4.6cm.3. B-ultrasonography and MRA showed renal vein tumor thrombus before operation. Among them, 2 cases were accompanied with inferior vena cava tumor thrombus. 38 cases were treated with radical nephrectomy and 2 cases with nephron-sparing surgery. One case received tumor biopsy only. 15 cases received IFN- 伪 immunotherapy and 8 cases received sunitinib targeted therapy after operation. Results the pathological findings of 41 patients were as follows: 22 cases of renal cell carcinoma with partial sarcomatoid carcinoma, 9 cases of simple renal sarcomatoid carcinoma, 6 cases of renal pelvis urothelial carcinoma with partial sarcomatoid carcinoma, 2 cases of renal collecting duct carcinoma with partial sarcomatoid carcinoma. TNM staging was performed in 2 cases of squamous cell carcinoma of renal pelvis with sarcomatoid carcinoma: 10 cases in stage 鈪，
本文编号：2136781
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