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微创泌尿外科杂志  2018, Vol. 7 Issue (2): 122-126    DOI: 10.19558/j.cnki.10-1020/r.2018.02.013
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肾上皮样血管平滑肌脂肪瘤12例临床分析
刘永国1, 黄庆波2, 张磊2, 张志勇2, 陈文政2, 郭刚2
1潍坊医学院附属医院泌尿外科 261000 山东潍坊;
2中国人民解放军总医院泌尿外科
Clinical analysis on 12 cases of renal epithelioid angiomyolipomas
Liu Yongguo1, Huang Qingbo2, Zhang Lei2, Zhang Zhiyong2, Chen Wenzheng2, Guo Gang2
1Department of Urology, Affiliated Hospital of Weifang Medical University, Weifang 261000, China;
2Department of Urology, Chinese PLA General Hospital
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摘要 目的:探讨肾上皮样血管平滑肌脂肪瘤的临床特点,对其临床治疗效果进行评价。方法:收集2012年3月~2017年10月经病理确诊的12例肾上皮样血管平滑肌脂肪瘤患者的临床资料,回顾性分析其临床特征、病理特点、影像学表现及治疗效果。结果:12例肾上皮样血管平滑肌脂肪瘤患者中,男5例,女7例,年龄26~61岁,中位年龄39.5岁。术前均行B超、CT或MRI检查。术前诊断为肾肿瘤4例,肾上腺肿瘤1例,肾癌并腔瘤栓形成2例,肾血管平滑肌脂肪瘤5例。12例中4例接受TSC基因检测,1例为阴性,其余3例为阳性, 1例阳性患者术前诊断为结节性硬化,给予依维莫司治疗3个月后瘤体明显减小并顺利手术。12例患者均经手术治疗:3例行根治性肾切除术,2例行根治性肾切除并腔静脉瘤栓取出术,7例行肾部分切除术。随访1~70个月,中位随访时间20个月,无瘤生存8例,1例根治术后对侧肾肿瘤进展,2例合并瘤栓患者手术时间短尚未复查影像, 1例术后5年后出现复发并多发转移,再次手术后1年因肿瘤进展死亡。结论:肾上皮样血管平滑肌脂肪瘤临床症状缺乏特异性,影像学检查易与肾癌或经典肾血管平滑肌瘤混淆,最终确诊依靠病理,该疾病治疗以手术切除为主,完整的手术切除可提高治疗效果,不能完整切除、无法手术或合并远处转移患者,辅助化疗或分子靶向治疗可能有一定疗效。
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刘永国
黄庆波
张磊
张志勇
陈文政
郭刚
关键词 肾肿瘤肾血管平滑肌脂肪瘤肾上皮样血管平滑肌脂肪瘤    
AbstractObjective:To investigate the clinical characteristics of renal epithelioid angiomyolipomas (REAML) and evaluate the clinical outcomes. Methods:The clinical data of 12 patients with pathologically confirmed REAML from March 2012 to October 2017 were collected, and clinical features, pathological characteristics, image findings and treatment effect were retrospectively analyzed. Results:In the 12 cases, there were 5 males and 7 of females. The median age was 39.5 years (range from 26-61 years). All cases were examined by ultrasound, CT or MRI. There were 4 cases of renal tumors, 1 case of adrenal tumor, 2 cases of renal cell carcinoma with thrombus and 5 cases of renal angiomyolipoma, which were preoperatively diagnosed. Four cases were subjected to TSC gene detection in this group: 1 was negative, and the rest 3 were positive. The one case positive for TSC gene detection was diagnosed as having nodular sclerosis before surgery, and the tumor was significantly reduced and operated successfully after 3 months of treatment with ivermox. All the 12 patients underwent operation, including 3 cases given radical nephrectomy, 2 cases given radical nephrectomy and vena venous carcinoma, and 7 cases given partial nephrectomy. The median follow-up period was 20 months (range one month to 70 months). Eight cases obtained disease-free survival, and one case developed contralateral tumor after radical operation. The two cases of tumor with IVC thrombus have not yet reviewed images in the short term follow-up. One case had recurrence and multiple metastases in five years after surgery, and died one year later after the second operation. Conclusions:The clinical symptoms of REAML have no specificity. It is easily confused with renal carcinoma or classic renal angiomyoma in preoperative image, and is confirmed pathologically. Surgical resection is primary treatment, and complete resection may improve the survival. For the patients with un-complete resection, un-operation or merge distant metastases, adjuvant chemotherapy and molecular targeted therapy may have certain curative effect.
Key wordsrenal neoplasm    renal angiomyolipoma    renal epithelioid angiomyolipomas
收稿日期: 2018-01-09     
ZTFLH:  R737.11  
通讯作者: 郭刚,greenguo@sina.com   
引用本文:   
刘永国, 黄庆波, 张磊, 张志勇, 陈文政, 郭刚. 肾上皮样血管平滑肌脂肪瘤12例临床分析[J]. 微创泌尿外科杂志, 2018, 7(2): 122-126.
Liu Yongguo, Huang Qingbo, Zhang Lei, Zhang Zhiyong, Chen Wenzheng, Guo Gang. Clinical analysis on 12 cases of renal epithelioid angiomyolipomas. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2018, 7(2): 122-126.
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