肾髓质癌1例报告及文献复习
| 作者: |
1张良荣,
2李欣遥,
3吴斌,
1崔颢,
1张墨,
1殷波,
3白松,
3李方舟,
1宋永胜
1 中国医科大学附属盛京医院第二泌尿外科，沈阳 110004 2 中国医科大学附属盛京医院第一神经内科，沈阳 110004 3 中国医科大学附属盛京医院第一泌尿外科，沈阳 110004 |
| 通讯: |
张良荣
Email: 339185140@qq.com 李欣遥 Email: 993424309@qq.com 宋永胜 Email: zhanglr261@gmail.com |
| DOI: | 10.3978/j.issn.2095-6959.2015.09.027 |
| 基金: | 辽宁省自然科学基金, 201102286 |
摘要
目的：探讨起源于肾盏及肾乳头上皮细胞的恶性肿瘤肾髓质癌，分析其流行病学、临床、病理、影像、鉴别诊断及分子生物学特征，以提高对该病的认识、诊疗水平和预后。方法：对1例肾髓质癌的诊治过程进行回顾性分析。结合国内外文献对本病的诊断、治疗和预后进行总结分析。 结果：本病好发于伴有镰状红细胞特征(sickle cell trait，SCT)或镰状细胞血红蛋白病(sickle cell disease，SCD)的青少年。与其他肾肿瘤相比影像学上没有明显的特异表现。Cam5.2、CK、Vim和EMA均(+)有助于同肾集合管癌等相鉴别。分子靶向治疗有望成为提高肾髓质癌预后的突破方向。结论：髓质癌是一种罕见的强侵袭性恶性肿瘤，影像学上无特异性，确诊主要靠病理组织学诊断，肾集合管癌等应与其相鉴别。探索该病新的治疗靶点，提高患者预后，但早期诊断和疾病意识增强仍是提高其疗效的关键。
关键词：
肾肿瘤
肾髓质癌
高恶性
预后
Renal medullary carcinoma: a case report and review of the literature
CorrespondingAuthor: ZHANG Liangrong Email: 339185140@qq.com
DOI: 10.3978/j.issn.2095-6959.2015.09.027
Abstract
Objective: To discuss the renal medullary carcinoma which originatesd in the calyceal or the epithelial papillary cells, analyse the characteristics of its epidemiology, clinical, pathological, imaging, differential diagnosis and molecular biology. And so as to improve the level of the recognize, diagnosis, treatment and prognosis of the disease. Methods: A retrospective study was done in one case of RMC. Combing with the latest domestic and foreign literature, the diagnosis as well as treatment and prognosis were analyzed. Results: The disease associating with the sickle-cell disease or trait as its main features primarily affects the young. There is no significant specific performance in the imaging of RMC compared with the other renal tumors. Immunohisto chemical studies, such as the tumor cells were positive for Cam5.2, CK, Vim, and EMA, can be helpful in distinguishing renal medullary carcinoma from other poorly differentiated kidney tumors, except for collecting duct carcinoma. The molecular and genetic factors implicated with this rare disease is progressively opening doors to promising targeted therapies. Conclusion: Renal medullary carcinoma is a rare aggressive and malignant tumor which has no specific feature in imaging and depends mainly on pathological diagnosis, primarily identifies with the renal collecting duct carcinoma. The recognize of disease, early diagnosis and treatment are the key to improve its efficacy, exploring a new target for the tumor also being urgent.