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目的:探讨肾炎性肌纤维母细胞瘤(IMT)的临床病理特征。方法:回顾性分析2014年6月及2015年8月收治的2例肾IMT患者的临床资料。例1,女,69岁。主诉左腰部酸胀30d。B超检查示左肾中部一直径约5.5cm液性暗区,囊壁较厚,可见钙化。强化CT检查示左肾中部低密度病变并可见强化,边缘欠光滑,病变内低密度区CT值约为23HU,病变与肾实质边界欠清晰。初步诊断为左肾囊性占位病变,考虑继发感染。行后腹腔镜左肾肿物切除术。例2,男,58岁。主诉左侧腰痛6个月。B超造影检查示左肾窦低回声结构,超声造影低增强。CT检查示左肾盂占位病变,考虑肾盂癌。MRI检查示左肾窦内软组织肿块影,T1WI、T2WI均呈中等信号表现,病变与肾盂分界不清。诊断为左肾窦肿瘤,行根治性左肾切除术。结果:例1术后病理诊断:肾炎性肌纤维母细胞瘤(浆细胞亚型)伴囊性变及感染,免疫组织化学:CD68+,Lambda+,Kappa+。术后随访14个月,未见复发。例2术后病理诊断:肾脏炎性肌纤维母细胞瘤(浆细胞亚型),免疫组织化学:CD68局部+,Vimentin+,bcl2+,SMA+,S100+,Lambda+,Kappa+,Ki-67<1%瘤细胞阳性,CD117-,Desmin-,CK-,ALK-,P53-。术后随访4个月,未见复发。结论:IMT是一种罕见的交界性肿瘤,临床及影像学表现无特异性,容易误诊;病理学检查是诊断该病的主要依据,需与其他肾区肿瘤相鉴别;手术切除为主要治疗方法,通常预后较好。
Objective: To investigate the clinicopathological features of nephritis myofibroblastoma (IMT). Methods: The clinical data of 2 patients with renal IMT admitted in June 2014 and August 2015 were retrospectively analyzed. Example 1, female, 69 years old. Chief complaint left sore 30d. B-ultrasound showed a middle diameter of the left kidney about 5.5cm liquid dark area, thick wall, visible calcification. Enhanced CT examination showed low-density lesions in the middle of the left kidney and can be seen enhanced, less smooth edges, low-density lesions within the CT value of about 23HU, lesion and kidney parenchyma border is not clear. Initial diagnosis of left renal cystic lesions, consider secondary infection. Laparoscopic left renal tumor resection. Example 2, male, 58 years old. Chief complaint left lumbago 6 months. B-ultrasound showed left hyoid sinus hypoechoic structure, enhanced low contrast ultrasound. CT examination showed left renal pelvis lesions, consider renal pelvis cancer. MRI showed the left renal sinus soft tissue mass, T1WI, T2WI were moderate signal performance, lesions and renal pelvis unclear. Diagnosis of left renal sinus tumors, radical nephrectomy. Results: 1 cases postoperative pathological diagnosis: nephritis myofibroblastoma (plasma cell subtype) cystic degeneration and infection, immunohistochemistry: CD68 +, Lambda +, Kappa +. The patients were followed up for 14 months without recurrence. Example 2 Postoperative pathological diagnosis: renal inflammatory myofibroblastoma (plasma cell subtype), immunohistochemistry: positive for CD68 +, Vimentin +, bcl2 +, SMA +, S100 +, Lambda +, Kappa +, Ki- 67 <1% , CD117-, Desmin-, CK-, ALK-, P53-. After 4 months of follow-up, no recurrence was found. Conclusion: IMT is a rare borderline tumor with no specific clinical and imaging findings and is easily misdiagnosed. Pathological examination is the main basis for the diagnosis of this disease and needs to be differentiated from other neoplastic tumors. Surgical resection is the main treatment The prognosis is usually good.