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目的:探讨肾集合管癌(CDC)的临床、病理特点及诊治方法。方法:回顾性分析2例CDC患者的临床资料。2例分别为男性44岁和女性60岁,分别因间断右腰痛1个月和间断无痛肉眼血尿1周入院。彩超和CT检查发现肾门部位肿物,与周围肾组织界限不清晰,CT增强扫描肿物仅轻微强化。2例均于全麻下行肾根治性切除术。结果:大体标本见肿物位于肾门部位,无包膜,呈浸润性生长,与周围组织无明确分界。镜下见肿瘤细胞排列成不规则腺管或腺管乳头状结构,Fuhrman细胞核分级3～4级。免疫组化反应1例高分子量细胞角蛋白(CK)和花生凝集素(PNA)均呈阳性,另1例PNA阴性,但高分子量CK呈阳性。患者分别于术后8个月、13个月死亡。结论:CDC发病率低,临床罕见。CT对术前诊断可提供帮助,确定诊断依赖病理学检查。转移早、预后差是CDC的特征之一。
Objective: To investigate the clinical and pathological characteristics of renal aggregate carcinoma (CDC) and its diagnosis and treatment. Methods: The clinical data of 2 patients with CDC were retrospectively analyzed. Two cases were male 44 years old and female 60 years old, respectively, due to intermittent right lower back pain for 1 month and intermittent painful hematuria, 1 week admission. Color Doppler ultrasound and CT examination found that the tumor of the renal hilar region, with the boundaries of the surrounding renal tissue is not clear, CT enhanced scan only slight enhancement of the tumor. 2 cases underwent radical nephrectomy under general anesthesia. Results: The gross specimen was located in the renal part of the tumor, no capsule, showing invasive growth, no clear boundaries with the surrounding tissue. Microscopic see tumor cells arranged in irregular duct or duct papillary structure, Fuhrman nuclear grade 3 to 4. One case of immunohistochemical reaction was positive for high molecular weight cytokeratin (CK) and peanut agglutinin (PNA), the other was negative for PNA, but high molecular weight CK was positive. Patients were killed at 8 months and 13 months after surgery. Conclusion: The incidence of CDC is low and clinically rare. CT can help with preoperative diagnosis, confirm the diagnosis depends on pathological examination. Early metastasis, poor prognosis is one of the characteristics of CDC.