肾嗜酸细胞腺瘤的临床诊疗特点

王少承; 薛胜; 黄小雨; 张广宇; 周文生

doi:10.16766/j.cnki.issn.1674-4152.003112

肾嗜酸细胞腺瘤的临床诊疗特点

doi: 10.16766/j.cnki.issn.1674-4152.003112

蚌埠医学院第一附属医院泌尿外科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究重点项目 KJ2020A0557

安徽省学术技术带头人后备人选项目 2020H213

安徽省教育厅高校优秀青年人才支持计划重点项目 gxygZD2021117

详细信息

通讯作者:
周文生，E-mail：zhouwensheng66@sina.com

中图分类号: R737.11
计量
- 文章访问数: 102
- HTML全文浏览量: 38
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2022-12-28
- 网络出版日期: 2023-09-13

Clinical diagnosis and treatment of renal oncocytoma

Department of Urology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的为更好地对肾嗜酸细胞腺瘤进行诊疗，总结肾嗜酸细胞腺瘤的临床特点，研究利用辅助检查手段提高肾嗜酸细胞腺瘤的诊治率。方法回顾性分析2009年6月—2021年12月在蚌埠医学院第一附属医院泌尿外科就诊的31例肾嗜酸细胞腺瘤患者的临床资料，其中包括临床症状、辅助检查、影像学资料、治疗方法、病理检查及随访情况等。结果本组31例患者占同期肾肿瘤患者2.35%(31/1 321)，因体检发现肾占位入院的患者20例，其余表现为腰部不适7例，间歇性肉眼血尿2例，发热2例。肾恶性肿瘤和肾嗜酸细胞腺瘤平扫期、皮质期、肾盂期、相对皮质期和相对肾盂期的CT值差异均有统计学意义(均P＜0.05)。7例辅助检查报告考虑为肾嗜酸细胞腺瘤。肾嗜酸细胞腺瘤行保留肾单位手术12例，肾癌根治术19例。术后经病理检查均确诊为肾嗜酸细胞腺瘤。免疫组化分析显示EMA、E-cadherin、CD117等高表达。共随访31例患者，21例预后良好，患者均存活，生存时间最长达12年，4例因为非肿瘤原因或其他肿瘤性死亡，有6例患者失访。结论利用CT值变化结合实验室检查以及穿刺活检和免疫组化结果对于明确术前嗜酸细胞腺瘤诊断有积极意义，治疗上建议根据肿瘤性质及大小决定保留肾单位手术。该病预后良好，但仍需积极复检。
- 肾肿瘤 /
- 嗜酸细胞腺瘤 /
- 诊断 /
- CT值 /
- 免疫组化 /
- 保留肾单位
Abstract: Objective To improve the diagnose and treatment of renal eosinophilic adenoma, to summarize the clinical characteristics of renal eosinophilic adenoma and study the use of auxiliary examination methods to improve the diagnosis and treatment rate of renal eosinophilic adenoma. Methods Retrospective analysis of the clinical data of 31 patients with renal eosinophilic adenoma who were treated in the Department of Urology, the First Affiliated Hospital of Bengbu Medical College from June 2009 to December 2021, including clinical symptoms, auxiliary examinations, imaging data, treatment methods, pathological examinations and follow-up results. Results Thrity-one patients accounted for 2.35% (31/1 321) of kidney tumor patients during the same period. Twenty patients were admitted to the hospital due to renal space occupancy on physical examination, while the remaining 7 patients showed lumbar discomfort, 2 patients showed intermittent gross hematuria, and 2 patients developed fever. The CT values of renal malignancy and renal oncocytoma in plain scan, cortical phase, renal pelvis phase, relative cortical phase and relative renal pelvis phase were statistically different (all P < 0.05). Seven auxiliary examination reports were considered as renal eosinophilic adenoma. Twelve patients underwent nephron-sparing surgery and 19 patients underwent radical nephrectomy for renal cell carcinoma. After surgery, all patients were diagnosed with renal eosinophilic adenoma by pathological examination, and immunohistochemical analysis showed high expression of EMA, E-cadherin, CD117. A total of 31 cases were followed up, and 21 cases had a good prognosis. All patients survived, with a maximum survival time of more than 12 years. Four patients died from non-tumor or other tumor-related causes, and 6 patients were lost to follow-up. Conclusion It is important to confirm the preoperative diagnosis of eosinophilic adenoma using changes in CT values, laboratory examination, puncture biopsies and immunohistochemical results. In treatment, it is recommended to reserve nephron according to the type and size of the tumor. The prognosis of this disease is good, but it still needs active follow-up.
- Renal tumor /
- Oncocytoma /
- Diagnosis /
- CT value /
- Immunohistochemistry /
- Preserve nephron

HTML全文

图 1 CT值的ROC曲线图

注：利用绘制ROC曲线图得到平扫期、皮质期、肾盂期、相对皮质期、相对肾盂期的AUC值。

Figure 1. ROC curve of CT values

下载: 全尺寸图片幻灯片

表 1 RO与MTK患者CT平扫及增强特征及外侵征象比较(例)

Table 1. Comparison of CT plain scan、enhanced features and external invasion signs between RO and MTK patients(cases)

组别	例数	中央瘢痕	节段反转征	淋巴结转移	被膜侵犯	肾盂肾盏受压		肾门血管受压
组别	例数	中央瘢痕	节段反转征	淋巴结转移	被膜侵犯	无侵犯	有侵犯	无侵犯	有侵犯
RO组	31	28	5	0	0	9	0	2	0
MTK组	31	7	1	4	15	4	8	2	3
χ²值		16.044	1.317	7.094	34.962	9.692		2.100
P值		＜0.001	0.251	0.008	＜0.001	0.002		0.147

下载: 导出CSV

表 2 RO与MTK患者平扫及三期增强CT值比较(x±s，Hu)

Table 2. Comparison of plain scan and three stage enhanced CT values between RO and MTK patients(x±s, Hu)

组别	例数	平扫	皮质期	实质期	肾盂期
RO组	19	39.87±7.23	106.09±24.51	121.07±24.23	102.63±16.97
MTK组	19	34.99±4.61	119.10±27.40	115.92±24.18	92.08±13.32
t值		3.635	-2.590	1.081	3.254
P值		0.001	0.014	0.287	0.002

下载: 导出CSV

表 3 RO与MTK患者三期相对强化值比较(x±s，Hu)

Table 3. Comparison of the third stage relative reinforcement value between RO and MTK patients(x±s, Hu)

组别	例数	相对皮质期	相对实质期	相对肾盂期
RO组	19	66.22±26.68	81.20±23.47	62.76±9.74
MTK组	19	84.11±28.99	80.93±20.17	57.09±10.51
t值		-4.020	-0.435	2.050
P值		＜0.001	0.666	0.048

下载: 导出CSV

参考文献(25)

[1]	KRYVENKO O N, JORDA M, ARGANI P, et al. Diagnostic approach to eosinophilic renal neoplasms[J]. Arch Pathol Lab Med, 2014, 138(11): 1531-1541. doi: 10.5858/arpa.2013-0653-RA
[2]	HAIFLER M, COPEL L, SANDBANK J, et al. Renal oncocytoma: are there sufficient grounds to consider surveillance following prenephrectomy histologic diagnosis[J]. Urol Oncol, 2012, 30(4): 362-368. doi: 10.1016/j.urolonc.2009.11.024
[3]	王冬彪, 陈忠, 王涛, 等. 肾嗜酸细胞腺瘤的诊疗分析并文献复习[J]. 现代泌尿生殖肿瘤杂志, 2014, 6(6): 362-363, 367. https://www.cnki.com.cn/Article/CJFDTOTAL-PXDM201406016.htm WANG D B, CHEN Z, WANG T, et al. Diagnosis and treatment of renal eosinophilic adenoma and literature review[J]. Journal of Contemporary Urologic and Reproductive Oncology, 2014, 6(6): 362-363, 367. https://www.cnki.com.cn/Article/CJFDTOTAL-PXDM201406016.htm
[4]	BENATIYA M A, RAIS G, TAHRI M, et al. Renal oncocytoma: experience of Clinical Urology A, Urology Department, CHU Ibn Sina, Rabat, Morocco and literature review[J]. Pan Afr Med J, 2012, 12: 84.
[5]	AHMAD S, MANECKSHA R, HAYES B D, et al. Case report of a symptomatic giant renal oncocytoma[J]. Int J Surg Case Rep, 2011, 2(6): 83-85. doi: 10.1016/j.ijscr.2010.11.006
[6]	刘雪, 杨崇一, 杨丰强, 等. 彩色多普勒超声联合超声造影用于肾实质性肿瘤鉴别诊断的临床观察[J]. 中华全科医学, 2022, 20(3): 458-460, 472. doi: 10.16766/j.cnki.issn.1674-4152.002377 LIU X, YANG C Y, YANG F Q, et al. Clinical effect of colour Doppler ultrasonography combined with contrast-enhanced ultrasound in the differential diagnosis of renal parenchymal tumour[J]. Chinese Journal of General Practice, 2022, 20(3): 458-460, 472. doi: 10.16766/j.cnki.issn.1674-4152.002377
[7]	黄剑文, 杨旭峰, 李雪华, 等. 肾嗜酸细胞腺瘤的CT征象分析[J]. 中华腔镜泌尿外科杂志(电子版), 2013, 7(3): 58-61. doi: 10.3877/cma.j.issn.1674-3253.2013.03.017 HUANG J W, YANG X F, LI X H, et al. CT findings of renal oncocytoma[J]. Chinese Journal of Endoscopic Urology (Electronic Edition), 2013, 7(3): 58-61. doi: 10.3877/cma.j.issn.1674-3253.2013.03.017
[8]	ANASTASIADIS A, DIMITRIADIS G, RADOPOULOS D. Incidental giant renal oncocytoma: a case report[J]. J Med Case Rep, 2010, 4: 358. doi: 10.1186/1752-1947-4-358
[9]	CHOUDHARY S, RAJESH A, MAYER N J, et al. Renal oncocytoma: CT features cannot reliably distinguish oncocytoma from other renal neoplasms[J]. Clin Radiol, 2009, 64(5): 517-522. doi: 10.1016/j.crad.2008.12.011
[10]	GOKDEN N, DAWSON K, LINDBERG M. Malignant rhabdoid tumor arising in a mixed epithelial, stromal tumor of kidney: report of a male case, review of the literature[J]. Pathol Res Pract, 2020, 216(10): 153151. DOI: 10.1016/j.prp.2020.153151.
[11]	高银, 杨崇一, 何建华, 等. 多层螺旋CT增强扫描与MRI用于肾实性肿瘤鉴别诊断的临床研究[J]. 中华全科医学, 2021, 19(11): 1912-1915. doi: 10.16766/j.cnki.issn.1674-4152.002199 GAO Y, YANG C Y, HE J H, et al. Clinical effect of multi-slice spiral CT enhanced scan and MRI in the differential diagnosis of renal parenchymal tumours[J]. Chinese Journal of General Practice, 2021, 19(11): 1912-1915. doi: 10.16766/j.cnki.issn.1674-4152.002199
[12]	侯卓, 石太峰, 程山忠, 等. 不同剂量多排螺旋CT尿路成像技术对尿路病变诊断效能的对比[J]. 中国临床医学, 2017, 24(5): 755-758. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX201705019.htm HOU Z, SHI T F, CHENG S Z, et al. Comparison of diagnostic value of different doses multi-detector computed tomography urography in patients with urinary tract diseases[J]. Chinese Journal of Clinical Medicine, 2017, 24(5): 755-758. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX201705019.htm
[13]	周臣, 杨焕, 王军起. 外周血RDW、MPV和血清CEA联合检测对肾细胞癌和肾良性肿瘤的鉴别诊断[J]. 中国临床研究, 2020, 33(5): 606-610. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202005008.htm ZHOU C, YANG H, WANG J Q. Combined detection of RDW, MPV and CEA in the differential diagnosis of renal cell carcinoma and renal benign tumor[J]. Chinese Journal of Clinical Research, 2020, 33(5): 606-610. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202005008.htm
[14]	HUNZIKER S, CELI L A, LEE J, et al. Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients[J]. Crit Care, 2012, 16(3): R89. DOI: 10.1186/cc11351.
[15]	LIPPI G, TARGHER G, MONTAGNANA M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients[J]. Arch Pathol Lab Med, 2009, 133(4): 628-632. doi: 10.5858/133.4.628
[16]	曹学民. 血清前白蛋白测定对良、恶性肿瘤的鉴别诊断意义[J]. 吉林医学, 2010, 31(34): 6214. doi: 10.3969/j.issn.1004-0412.2010.34.019 CAO X M. The significance of serum prealbumin determination in the differential diagnosis of benign and malignant tumors[J]. Jilin Medical Journal, 2010, 31(34): 6214. doi: 10.3969/j.issn.1004-0412.2010.34.019
[17]	李江涛, 张爱莉. 肾嗜酸细胞腺瘤伴潜在恶性1例报告并文献复习[J]. 临床泌尿外科杂志, 2013, 28(10): 766-768. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMW201310020.htm LI J T, ZHANG A L. Renal oncocytoma associated with potentially malignant: report of one case and review of literatures[J]. Journal of Clinical Urology, 2013, 28(10): 766-768. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMW201310020.htm
[18]	黎德林, 邓耀良. 肾嗜酸细胞腺瘤的诊断进展[J]. 现代泌尿生殖肿瘤杂志, 2014, 6(2): 125-127. https://www.cnki.com.cn/Article/CJFDTOTAL-PXDM201402020.htm LI D L, DENG Y L. Progress in the diagnosis of renal eosinophilic adenoma[J]. Journal of Contemporary Urologic and Reproductive Oncology, 2014, 6(2): 125-127. https://www.cnki.com.cn/Article/CJFDTOTAL-PXDM201402020.htm
[19]	LANE B R, SAMPLASKI M K, HERTS B R, et al. Renal mass biopsy: a renaissance?[J]. J Urol, 2008, 179(1): 20-27.
[20]	张伟, 李玉军, 刘燕, 等. 肾嗜酸细胞腺瘤10例临床病理分析[J]. 诊断病理学杂志, 2011, 18(1): 5-8. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDBL201101004.htm ZHANG W, LI Y J, LIU Y, et al. Renal oncocytoma: a clinicopathologic study of 10 cases[J]. Chinese Journal of Diagnostic Pathology, 2011, 18(1): 5-8. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDBL201101004.htm
[21]	YUSENKO M V. Molecular pathology of renal oncocytoma: a review[J]. Int J Urol, 2010, 17(7): 602-612.
[22]	TRPKOV K, YILMAZ A, UZER D, et al. Renal oncocytoma revisited: a clinicopathological study of 109 cases with emphasis on problematic diagnostic features[J]. Histopathology, 2010, 57(6): 893-906.
[23]	陈以明, 刘强, 许雁萍, 等. 嫌色细胞肾细胞癌和肾嗜酸细胞腺瘤CD117的表达及意义[J]. 上海医学, 2009, 32(8): 731-733, 762. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYX200908033.htm CHEN Y M, LIU Q, XU Y, et al. CD117 expression in chromophobe renal cell carcinoma and renal oncocytoma and its significance[J]. Shanghai Medical Journal, 2009, 32(8): 731-733, 762. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYX200908033.htm
[24]	肖成武, 盛佳雁, 杨庆. 腹腔镜肾部分切除术治疗完全内生型肾癌的临床疗效及手术技巧[J]. 中国临床医学, 2018, 25(4): 581-583. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX201804015.htm XIAO C W, SHENG J Y, YANG Q. Laparoscopic partial nephrectomy for complete endophytic renal cell carcinoma: clinical efficacy and surgical technique[J]. Chinese Journal of Clinical Medicine, 2018, 25(4): 581-583. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX201804015.htm
[25]	时佳子, 王杰, 王志向, 等. 肾嗜酸细胞腺瘤27例诊疗分析[J]. 临床泌尿外科杂志, 2016, 31(9): 803-805. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMW201609007.htm SHI J Z, WANG J, WANG Z X, et al. Diagnosis and treatment of renal oncocytoma (Report of 27 cases)[J]. Journal of Clinical Urology, 2016, 31(9): 803-805. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMW201609007.htm