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目的总结对肾颗粒细胞癌的诊治经验,提高对此类型肾癌的认识。方法对20例肾颗粒细胞癌的临床资料回顾分析。男13例,女7例,其中合并肾静脉、下腔静脉瘤栓3例,合并肺转移1例,肝、骨转移2例,年龄20～74岁,平均(53.7±5.4)岁,15例行根治性肾切除术+系统性淋巴清扫术,1例在深低温停循环技术行根治性肾癌切除+腔静脉瘤栓取除术,1例行肿瘤剜除术。3例远处转移者均为外院手术后患者,入院后给予行生物治疗。结果 20例术后病理证实为肾颗粒细胞癌。病理分期:pT1aN0M0 2例,pT1bN0M0 4例,pT2N0M0 5例,pT3aN0M0 1例,pT3aN1M0 2例,pT3bN1M0 2例,pT3cN1M0 1例,pT4NxM1 3例,Fuhrman病理分级:G17,例,G2,10例;G3～4,3例。15例获随访,随访6～40月,平均24个月,1例术后7个月死于脑血管意外,4例死于肿瘤复发或转移,10例无瘤生存超过3年。结论肾颗粒细胞癌临床表现与透明细胞相似,CT及MRI特殊表现可与透明细胞癌相鉴别;免疫组化染色Vimentin阳性,CK8及CK18同时阳性,光镜表现为癌细胞胞浆含大量嗜酸性细颗粒,电镜下为丰富的线粒体;根治性肾切除术+腹膜后系统性淋巴结清扫术是治愈和延长生命的首选方法。
Objective To summarize the experience of diagnosis and treatment of renal cell carcinoma and to raise awareness of this type of renal cell carcinoma. Methods The clinical data of 20 cases of renal cell carcinoma were retrospectively analyzed. There were 13 males and 7 females, including 3 cases of renal vein and inferior vena cava tumor thrombus, 1 case of pulmonary metastasis, 2 cases of liver and bone metastases, ranging in age from 20 to 74 years with an average of (53.7 ± 5.4) years and 15 Radical nephrectomy + systemic lymphadenectomy was performed. One case was treated with radical nephrectomy + caval aneurysm thrombectomy in deep hypothermic circulatory arrest, and one case was treated by tumor resection. Three cases of distant metastasis were outside the hospital after surgery, given biologic treatment after admission. Results Postoperative pathology confirmed renal cell carcinoma. Pathological staging: 2 cases of pT1aN0M0, 4 cases of pT1bN0M0, 5 cases of pT2N0M0, 1 case of pT3aN0M0, 2 cases of pT3aN1M0, 2 cases of pT3bN1M0, 1 case of pT3cN1M0, 3 cases of pT4NxM1, 2 cases of Fuhrman pathological grading: G17, 4,3 cases. Fifteen patients were followed up from 6 to 40 months with an average of 24 months. One patient died of cerebrovascular accident 7 months after operation, 4 died of tumor recurrence or metastasis, and 10 patients survived for more than 3 years without tumor. Conclusion The clinical manifestations of renal cell carcinoma are similar to those of clear cells. The special CT and MRI findings can be differentiated from clear cell carcinoma. The immunohistochemical staining of Vimentin, CK8 and CK18 are positive at the same time. The cytoplasm of cancer cells contains many eosinophils Fine particles, electron microscopy is rich in mitochondria; radical nephrectomy + retroperitoneal lymph node dissection is the preferred method of healing and prolonging life.