文章摘要

49例肾转移性肿瘤的临床病理分析

作者: 1,2高大林, 3周敏, 1贺慧颖
1 北京大学医学部病理系/北京大学第三医院病理科,北京 100083
2 北京中医药大学东直门医院通州院区病理科,北京 101121
3 塔夫茨大学医学院病理系,美国马萨诸塞州 波士顿市 02155
通讯: 贺慧颖 Email: huiyinghe@bjmu.edu.cn
DOI: 10.3978/j.issn.2095-6959.2020.10.002

摘要

目的:探讨49例肾转移的肿瘤患者的临床和病理特征。方法:回顾性分析美国克利夫兰医疗中心病理系和北京大学第三医院病理科常规病理检查中转移至肾的实体瘤病例的临床、影像及病理学特征。排除累及肾的淋巴造血系统肿瘤。结果:49例肾转移性肿瘤包括肺癌(20例),胃肠道腺癌(6例),宫颈癌(4例),甲状腺癌(3例),乳腺浸润性导管癌、眼恶性黑色素瘤和睾丸生殖细胞肿瘤(各2例),肝细胞肝癌、子宫平滑肌肉瘤、腹膜后精原细胞瘤、脑血管外皮细胞瘤、口腔鳞状细胞癌、唾液腺导管癌和卵巢浆液性癌(各1例),原发肿瘤不明3例。59.2%(29/49)的病例术前影像检查怀疑转移。大部分为单侧病变。在26例肾根治或部分切除标本中肾窦侵犯发生率高达57.7%,肾静脉侵犯约见于1/4以上病例。转移性肿瘤有时会相似于原发性肿瘤的组织学结构,部分需要使用免疫组织化学染色以确诊。结论:生存期内发现的肾转移瘤约占所有肾肿瘤的0.5%。最常见的原发肿瘤是肺鳞状细胞癌和腺癌及胃肠道腺癌。单侧和单一病灶的转移瘤并不少见。肾静脉瘤栓的存在不能用于区分肾的继发性肿瘤与原发性肿瘤。组织学评估、累及其他器官的临床病史和影像学,对于正确诊断肾转移性肿瘤很重要。
关键词: 肾;转移性肿瘤;实体瘤

Metastatic tumors to kidney: A clinicopathological study of 49 cases

Authors: 1,2GAO Dalin, 3ZHOU Min, 1HE Huiying
1 Department of Pathology, Peking University Health Science Center/Peking University Third Hospital, Beijing 100083, China
2 Department of Pathology, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing 101121, China
3 Department of Pathology, School of Medicine, Tufts University, Boston MA 02155, USA

CorrespondingAuthor: HE Huiying Email: huiyinghe@bjmu.edu.cn

Abstract

Objective: To describe the clinical and pathological features of 49 tumors metastatic to kidney. Methods: Nonrenal solid metastatic tumors to kidneys were retrieved from the surgical pathology files at the authors’ institutions. The clinical, radiological and pathological data were reviewed. The hematopoietic tumors involving the kidney were excluded. Results: Forty-nine cases of metastatic renal tumors including lung carcinoma (n=20), gastrointestinal adenocarcinoma (n=6), cervix carcinoma (n=4), thyroid carcinoma (n=3), breast carcinoma (n=2), eye melanoma (n=2), testis germ cell tumor (n=2), hepatocellular carcinoma (n=1), uterine leiomyosarcoma (n=1), retroperitoneum seminoma (n=1), brain hemangiopericytoma (n=1), oral cavity carcinoma (n=1), salivary duct carcinoma (n=1), and ovary serious carcinoma (n=1). There were 3 cases remained of unidentified primary tumor sites. The preoperative radiological suspicion for metastasis was reported in 59.2% (29/49) of all the cases. A number of the metastatic lesions are unilateral. Of 26 radical or partial nephrectomies, 57.7% cases showed the microscopic renal sinus invasion. Renal vein invasion was presented in more than one-fourth of these cases. The metastatic tumors could resemble the histologic patterns of the primary tumors, immunohistochemical stains was necessary to reach the definitive diagnosis in some cases. Conclusion: Metastatic tumors to kidney accounting for 0.5% of all the renal tumors. The most common primary tumors are lung squamous cell carcinoma and adenocarcinoma, and gastrointestinal tract adenocarcinoma. The unilateral and single disease is not uncommon in these metastatic lesions. The presence of renal vein thrombus cannot be used to distinguish secondary neoplasm of kidney from primary ones. A histological evaluation, along with the clinical history of the malignancy involving the other organs and the radiological image, is important in reaching the correct diagnosis of renal metastatic tumors.
Keywords: kidney; metastatic tumors; solid tumors