目的: 肾盂平滑肌瘤的临床特点、诊断及治疗方法,提高肾盂平滑肌瘤的诊治水平。方法: 回顾分析2014年5月22日山西省忻州市中医院收治的1例肾平滑肌瘤患者的临床资料,并复习相关文献。患者,男,50岁。因“进行性血尿,体重减轻伴右下腹疼痛”3个月入院。B超提示:右肾盂及膀胱血凝块,CT提示:右肾盂团块状软组织密度影,不均匀强化,右肾盂占位, 考虑恶性可能。MRI提示右肾盂占位,右输尿管血凝块。尿脱落细胞见尿路上皮细胞,少数细胞异型性。初步诊断为右肾盂占位,右肾盂癌,膀胱镜检查见膀胱内血凝块,右侧输尿管口未见喷尿。遂行右肾及输尿管全长切除术。术中见右肾盂内充满包膜光滑的黄色肿物,大小为3.2 cm×2.0 cm。结果: 手术过程顺利,手术时间3 h,术中出血量约300 ml,病理检查回报,肿物来源于肾盂,肿瘤由簇状排列的梭形细胞组成,未见有丝分裂像。免疫组化显示肿瘤细胞呈梭形,SMA、calponin和vimentin 均为阳性,诊断为肾盂平滑肌瘤。结论: 肾盂平滑肌瘤是一种罕见的起源于平滑肌的间叶组织良性肿瘤,无侵袭性及转移,手术预后好,对于可疑恶性的病例,可行根治性手术。

Objective:To summarize the clinical features, diagnosis and treatment of leiomyomas of renal pelvic.Methods:The clinical data of 1 patient with leiomyomas of renal pelvis were retrospectively analyzed and the related literatures were reviewed. Here we presented a 50-year-old male who presented with increased hamaturia, anorexia and weight loss. Imaging showed a right renal pelvis mass. A renal pelvis carcinoma was suspected clinically.Results:A right nephroureterctomy in renal pelvic carcinoma was performed, which showed a large circumscribed mass in the renal pelvis. Histology revealed a tumor mass arising from the renal pelvis. The tumor was composed of spindle cells arranged in fascicles without mitotic figures. Immunohistochemistry showed tumor cells to be fascicles of long spindle cells and positive for smooth muscle actin (SMA), calponin and vimentin, which confirmed the diagnosis of leiomyoma of renal pelvis.Conclusions:Leiomyomas of renal pelvis are infrequent and benign tumors and thire behaviors are not aggressive. They do not metastasize. In suspicious cases, radical nephroureterctomy remains the recommended treatment.