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目的:提高肾脏浆细胞瘤的诊治水平。方法:肾脏浆细胞瘤患者1例,女,55岁。体检B超偶然发现左肾前唇实质内可见一范围约4.7cm×2.6cm的低回声包块;CT检查左肾见一大小约3.0cm×4.0cm×3.5cm低密度影;增强CT示左侧肾脏占位性病变,考虑肾肿瘤性病变不除外。行后腹腔镜左肾根治性切除术。结果:病理报告示左肾上极可见囊实性肿物,大小约4.0cm×3.0cm,腔内含淡黄色的浆液性液体,切面淡黄色,其余肾脏皮髓质分界清楚。镜下肿瘤细胞有大片浆细胞样改变,密集成片,细胞大小不一,多为单核,也可见双核细胞,细胞核为圆形或椭圆形,位于细胞一端,染色质粗糙,呈“车辐”状排列,胞浆成双嗜性,核与胞浆之间可见“月牙状”淡染区。病理诊断:髓外浆细胞瘤。术后随访6个月未见复发和转移。结论:髓外浆细胞瘤是一种发生于骨髓之外的恶性肿瘤,此类患者没有多发骨髓瘤的临床表现,发病率低,组织活检发现单片状浆细胞并且未发现任何多发性骨髓瘤的迹象是诊断的惟一途径;浆细胞瘤对放疗相对敏感,外科手术和放疗联合治疗效果最好。
Objective: To improve the diagnosis and treatment of renal plasmacytoma. Methods: One patient with renal plasmacytoma was female, 55 years old. Physical examination B-supernatural found in the left anterior renal parenchyma within a range of about 4.7cm × 2.6cm low echo mass; CT examination of the left kidney to see a size of about 3.0cm × 4.0cm × 3.5cm low density; enhanced CT showed the left Side of the renal space-occupying lesions, consider kidney neoplasms are not excluded. Retroperitoneal laparoscopic radical nephrectomy. Results: The pathological reports showed cystic solid masses on the left kidney with a size of about 4.0cm × 3.0cm. The cavity contained a light yellow serous liquid with a pale yellow section, and the other demarcation of renal cortex and medulla was clear. Microscopic tumor cells have a large plasma cell like changes, dense into pieces, the cell size varies, mostly mononuclear, but also visible binuclear cells, the nucleus is round or oval, located at the end of the cell, the chromatin rough, was “car Spoke ”-like arrangement, cytoplasm into two tropism, visible between nucleus and cytoplasm “ crescent ”light stained area. Pathological diagnosis: extramedullary plasmacytoma. No recurrence and metastasis were observed after 6 months of follow-up. CONCLUSIONS: Extramedullary plasmacytoma is a malignant tumor that occurs outside of the bone marrow with no clinical manifestations of multiple myeloma with a low incidence of monomorphic plasma cells found on biopsy and no multiple myeloma Of the signs is the only way of diagnosis; plasmacytoma is relatively sensitive to radiotherapy, surgery and radiotherapy combined with the best treatment.