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目的:探讨肾髓质癌的临床表现、诊断和治疗方法及分子生物学特征,以提高对该病的认识水平。方法:回顾性分析2011年7月收治的1例肾髓质癌患者临床资料:男,61岁。体检发现右肾占位病变入院。无血尿、发热、消瘦及其他不适之感。B超及CT检查示右肾上极有3.6cm×3.3cm类园形软组织密度影,边缘欠规则,其内密度不均,强化不均匀,其顶部部分突出于皮质,中心部位有液化,肾上盏受浸。在全麻下行经腹左肾肿瘤根治术,术中见右肾上极有一约3cm×4cm类圆形影,中央有明显坏死的灰白色肿块。结果:病理检查诊断为肾髓质癌。2013年4月出现右胸部隐痛不适,CT检查示第5肋骨多发溶骨性骨质破坏。在全麻下行第5、6肋骨后段切除术,术后病理检查诊断符合肾髓质癌骨转移。2014年3月因咽部不适,扁桃体肿物活检病理检查结果符合肾髓质癌转移,给予局部放疗。2014年6月头颅MRI经查发现T2W1冠状位右侧扣带回可见类圆形高信号占位病变,周边水肿明显,考虑肾髓质癌颅内转移。采用旋转式伽玛刀进行规划治疗。结论:肾髓质癌属罕见的肾脏恶性肿瘤,易转移,术前影像学检查难以与肾癌及肾集合管癌相鉴别。目前有效的治疗方法是尽早手术治疗,术后定期复诊。
Objective: To investigate the clinical manifestations, diagnosis and treatment of renal medullary carcinoma and the molecular biological characteristics in order to improve the level of awareness of the disease. Methods: A retrospective analysis of 1 case of renal cell carcinoma in July 2011 admitted to clinical data: male, 61 years old. Physical examination found the right renal lesions admitted to hospital. No hematuria, fever, weight loss and other discomfort. B ultrasound and CT examination showed that the right upper kidney 3.6cm × 3.3cm type of park-like soft tissue density shadow, the edge of irregular rules, uneven density, uneven reinforcement, the top part of the prominent in the cortex, the central liquefaction, kidney Baptist by light. Under general anesthesia via abdominal radical nephrectomy, intraoperative see the right kidney has a very large about 3cm × 4cm class round shadow, the central obvious necrosis of the gray-white mass. Results: Pathological examination was diagnosed as renal medullary carcinoma. In April 2013, a painful discomfort of the right chest appeared. CT examination showed that the fifth rib had osteolytic osteolytic lesions. Under general anesthesia 5,6 rib resection, postoperative pathological examination consistent with renal medullary bone metastases. March 2014 due to throat discomfort, tonsil mass biopsy pathological findings consistent with renal medullary cancer metastasis, given local radiotherapy. In June 2014, MRI examination of cranial MRI revealed that the right cingulate gyrus of T2W1 coronavirus can be seen with high signal-like mass lesions. The peripheral edema is obvious, and the intracranial metastasis of renal medullary carcinoma is considered. The use of rotary gamma knife planning and treatment. CONCLUSION: Renal medullary carcinoma is a rare malignant nephridial tumor that is easy to metastasize. Preoperative imaging is difficult to differentiate from renal carcinoma and renal tubules. The current effective treatment is as early as possible surgical treatment, regular follow-up after surgery.