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目的:探讨原发性肾脏类癌的临床特征及诊治方法。方法:总结2例原发性肾脏类癌患者的临床资料结合文献复习讨论。例1,女,48岁。因右腰酸痛1个月入院。B超示右肾中上极中等回声占位,边界清楚,内有血流信号。CT示右肾中上极10.0 cm×7.5 cm实性占位,增强后病灶均匀轻度强化。例2,男,44岁。体检发现左肾占位40天入院。B超示左肾门处中等回声占位,边界清楚,内有血流信号。CT示左肾中极肾门处3.7 cm×3.5 cm实性占位,增强后病灶均匀轻度强化;其内伴一钙化点。结果:2例均行根治性肾切除术。病理检查镜下肿瘤细胞形态为多边形,嗜酸性颗粒状细胞质,边界不清,呈柱状或缎带状排列混合有实性巢状排列;细胞核呈园形大小一致,核分裂像难见。免疫组化:突触素、波形蛋白均为阳性。病理诊断为肾脏类癌伴淋巴结转移。例1术后30个月死于肝骨转移;例2术后随访26个月,未见肿瘤复发转移。结论:原发性肾脏类癌临床罕见,易发生淋巴结转移,确诊依靠病理学检查,根治性肾切除应为治疗原发性肾类癌的首选方法。
Objective: To investigate the clinical features and diagnosis and treatment of primary renal carcinoid. Methods: To summarize the clinical data of 2 cases of primary renal carcinoid patients and review the literature review. Example 1, female, 48 years old. 1 month due to right upper back pain hospitalized. B ultrasound shows the right kidney in the middle of the echo occupy a clear boundary, there are blood flow signals. CT showed that the right upper pole of the middle pole 10.0 cm × 7.5 cm solid occupying place, enhance the lesion even slightly enhanced. Example 2, male, 44 years old. Physical examination found left kidney occupy 40 days admission. B ultrasound showed moderate echo left renal gate occupying a clear boundary, there are blood flow signals. CT showed that the renal pole in the middle of the kidney 3.7 cm × 3.5 cm solid occupying place, enhance the lesion even slightly enhanced; its accompanied by a calcification. Results: Two cases underwent radical nephrectomy. Pathological examination of tumor cells in the shape of polygons, eosinophilic granular cytoplasm, the border is unclear, was columnar or ribbon-like arrangement mixed with a solid nested arrangement; nucleus was uniform circular shape, mitotic images difficult to see. Immunohistochemistry: Synaptophysin, vimentin are positive. Pathological diagnosis of renal carcinoid tumor with lymph node metastasis. Case 1 died of liver metastasis 30 months after operation; Case 2 was followed up for 26 months, no tumor recurrence and metastasis. Conclusion: Primary renal carcinoid tumors are rare and prone to lymph node metastasis. Diagnosis depends on pathological examination. Radical nephrectomy should be the first choice for the treatment of primary renal cancer.