后肾腺瘤1例报告并文献复习

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摘要目的:报告1例后肾腺瘤的诊疗经过,结合文献复习探讨后肾腺瘤的诊治。方法:回顾性分析1例后肾腺瘤临床资料。女,29岁,已婚已育,体质指数19.6 kg/m²。因体检发现右肾肿物6个月入院。术前影像学检查提示右肾上极单发肿瘤,外生性生长,大小为2.7 cm×2.4 cm。临床诊断为右肾肿瘤(T_1aN₀M₀),于全麻下行经阴道自然腔道内镜手术(NOTES)辅助腹腔镜下肾部分切除术。结果:手术顺利完成,未新增工作通道或中转开放手术;标本经阴道取出,检查肿瘤包膜完整。手术时间135 min,术中估计失血量250 ml,热缺血时间20 min,无术中和术后并发症发生。术后常规病理示肿瘤细胞呈腺样或乳头状排列,异型不明显,切缘阴性。免疫组化检查示AE1/AE3(+),Vimentin(+),WT1(+),CD57(+),CK7(-),EMA(-),RCC(-)。诊断为后肾腺瘤。患者术后恢复良好,术后1个月瘢痕评估问卷评分为45分;术后3个月恢复正常性生活。随访14个月,未见肿瘤复发和转移。结论:后肾腺瘤与肾恶性肿瘤较难鉴别,了解其临床及病理、影像学特征,有助于诊断及鉴别诊断。后肾腺瘤多采取保留肾单位的手术治疗,对具有适应证的女性患者可采取经阴道NOTES辅助腹腔镜下肾部分切除术。鉴于其生物学行为的不确定性,术后仍需密切随访。

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关键词 ：后肾腺瘤, 病理学, 手术治疗

Abstract：To report the diagnosis and treatment of a case of metanephric adenoma and review related literatures to explore its diagnosis and treatment. Methods: Retrospectively analysed clinical data of a patient with metanephric adenoma. A 29-year-old married and delivered female patient was hospitalized due to right renal tumor discovered by physical examination. BMI 19.6 kg/m². Preoperation imaging studies showed a single exophytic tumor located on the upper pole of right kidney, 2.7 cm×2.4 cm. The patient was diagnosed with right renal tumor(T_1aN₀M₀) and underwent transvaginal natural orifice transluminal endoscopic surgery(NOTES)-assisted laparoscopic partial nephrectomy. Results: The patient was completed successfully without conversion to open surgery and with no additional trocar. Specimen with complete capsule was removed through vaginal. The operation time was 135 min and the warm ischemia time was 20 min. The estimated blood loss was 250 mL. There were no other complications.Postoperative pathological findings indicated no heteromorphism, gland bubble or papillary structures were seen, surgery margin was negative. Immunohistochemical study showed AE1/AE3, Vimentin, WT1, CD57 were positive, CK7, EMA, RCC were negative, diagnosed metanephric adenoma. The patient recovered well. Patient scar assessment questionnaire score was 45 one month after operation. Normal sexual life recovered 3 months after operation. After 14 months of follow-up,the patient had disease-free survival without recurr-基金项目:国家高技术研发计划(863计划)项目(2012AA021100);江西省“赣鄱英才555工程”领军人才培养计划项目;江西省高校“十二五”重点学科建设经费资助项目ence and metastasis. Conclusions: Metanephric adenoma is easily misdiagnosed as renal malignant tumor. The clinical, histopathological, imaging characteristics contribute to diagnosis and differential diagnosis. Nephron sparing surgery is often performed for the treatment of metanephric adenoma, transvaginal NOTES-assisted laparoscopic partial nephrectomy is a choice for female patients with indications. Due to its biological behavior, careful follow-up should be undergone in patients with metanephric adenoma.

Key words： metanephric adenoma pathology operation treatment

收稿日期: 2016-03-12

ZTFLH:

R737.11

基金资助:国家高技术研发计划(863计划)项目(2012AA021100);江西省“赣鄱英才555工程”领军人才培养计划项目;江西省高校“十二五”重点学科建设经费资助项目

通讯作者: 邹晓峰,张国玺,gyfyurology@126.com

引用本文:

张兆林，王晓宁，邹晓峰，张国玺，袁源湖，肖日海，谢天朋，黄若辉，康欢，赖长福，祝家兴. 后肾腺瘤1例报告并文献复习[J]. 微创泌尿外科杂志, 2016, 5(2): 104-107.
Zhang,Zhaolin,Wang,Xiaoning,Zou,Xiaofeng,Zhang,Guoxi,Yuan,YuanhuXiao,Rihai,Xie,Tianpeng,Huang,Ruohui,Kang,Huan,Lai,Changfu,Zhu,Jiaxing. Metanephric adenoma: A case report and literature review. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2016, 5(2): 104-107.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1142.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2016/V5/I2/104

[1]Amin MB, Amin MB, Tamboli P, et al. Prognostic impact of histologic subtyping of adult renal epithelial neoplasms: An experience of 405 cases. Am J Surg Pathol, 2002,26(3):281-291.
[2]Eble JN, Sauter G, Epstein JI, et al. 冯晓莉译.泌尿系统及男性生殖器官肿瘤病理学和遗传学.11版.北京:人民卫生出版社, 2006:40-43.
[3]柯琦,谢刚,杨永红,等.后肾腺瘤临床及病理特征分析.四川医学,2015,36(7):931-934.
[4]王晓宁,张国玺,邹晓峰,等.经阴道自然腔道内镜手术辅助腹腔镜下肾部分切除术的临床研究.中华泌尿外科杂志,2015,36(3):192-195.
[5]邹晓峰,张国玺,肖日海,等.经阴道NOTES辅助腹腔镜下肾切除术.中华泌尿外科杂志, 2010,31(12):810-813.
[6]邹晓峰,徐辉,张国玺,等.经脐入路新型腹腔镜下肾上腺快速切除技术探讨.中华泌尿外科杂志, 2014,35(10):795-796.
[7]Brisigotti M, Cozzutto C, Fabbretti G, et al. Metanephric adenoma. Histol Histopathol, 1992,7(4):689-692.
[8]Arroyo MR, Green DM, Perlman EJ, et al. The spectrum of metanephric adenofibroma and related lesions: clinicopathologic study of 25 cases from the National Wilms Tumor Study Group Pathology Center. Am J Surg Pathol, 2001,25(4):433-444.
[9]Lai YQ, Chen DQ, Xu XN, et al. Metanephric adenoma: A report of two cases and review of the literature. Mol Clin Oncol, 2013,1(6):1087-1089.
[10]Davis CJ Jr, Barton JH, Sesterhenn IA, et al. Metanephric adenoma. Clinicopathological study of fifty patients. Am J Surg Pathol, 1995,19(10):1101-1114.
[11]Hu YC, Wu L, Yan LF, et al. The imaging features of metanephric adenoma: a case report and review of literature. Onco Targets Ther, 2015, 8:445-449.
[12]王聪,宋国新,李明,等.后肾腺瘤八例临床病理学特点.中华病理学杂志,2014,43(3):154-157.
[13]Bastide C, Rambeaud JJ, Bach AM, at al. Metanephric adenoma of the kidney: clinical and radiological study of nine cases. BJU Int, 2009,103(11):1544-1548.
[14]Delzongle M, Boukamel S, Kemeny F, et al. Metanephric adenoma MR imaging features with histopathological correlation. DiagnInterv Imaging, 2015,96(4):387-390.
[15]Blanco LZ Jr, Schein CO, Patel T, et al. Fine-needle aspiration of metanephric adenoma of the kidney with clinical, radiographic and histopathologic correlation: a review. Diagn Cytopathol, 2013,41(8):742-751.
[16]Choueiri TK, Cheville J, Palescandolo E, et al. BRAF mutations in metanephric adenoma of the kidney. Eur Urol, 2012,62(5):917-922.
[17]Pinto A, Signoretti S, Hirsch MS, et al. Immunohistochemical staining for BRAF V600E supports the diagnosis of metanephric adenoma. Histopathology, 2015,66(6):901-904.
[18]Udager AM, Pan J, Magers MJ, et al. Molecular and immunohistochemical characterization reveals novel BRAF mutations in metanephric adenoma. Am J Surg Pathol, 2015,39(4):549-557.
[19]牛文杰,赵耀瑞,杨宇明,等.后肾腺瘤8例诊治分析.现代泌尿生殖肿瘤杂志,2013,5(4):205-207.
[20]张国玺,薛义军,邹晓峰,等.经自然腔道内镜手术在泌尿外科的应用.微创泌尿外科杂志,2012,1(1):11-14.
[21]Xue Y, Zou X, Zhang G, et al. Transvaginal Natural Orifice Transluminal Endoscopic Nephrectomy in a Series of 63 Cases: Stepwise Transition From Hybrid to Pure NOTES. Eur Urol, 2015,68(2):302-310.
[22]Conzo G, Sciascia V, Palazzo A, et al. Radiofrequency-assisted partial nephrectomy for metanephric adenoma: a case report and literature review. Surg Innov, 2013,20(1):55-58.
[23]Renshaw AA, Freyer DR, Hammers YA. Metastatic metanephric adenoma in a child. Am J Surg Pathol, 2000,24(4):570-574.
[24]Le Nué R, Marcellin L, Ripepi M, et al. Conservative treatment of metanephric adenoma. A case report and review of the literature. J Pediatr Urol, 2011,7(4):399-403.