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目的:探讨成人肾母细胞瘤的诊疗方法和预后。方法:回顾性分析10例成人肾母细胞瘤患者的临床资料。男8例,女2例,年龄16～62岁,平均29岁。就诊症状为单纯肉眼血尿3例、腰腹部肿块或腰腹痛4例(伴血尿2例)、无症状查体发现3例。患者均行B超、IVU、尿脱落细胞学检查,8例行CT平扫+强化检查。影像学检查提示肾占位6例、肾盂占位3例、输尿管占位1例。CT提示肾门或腹腔淋巴结肿大4例。10例均行手术治疗,根治性肾切除6例,患肾、输尿管全段切除+膀胱输尿管口袖口状切除4例,2例根治性肾切除患者因肿物与周围粘连严重切除部分腹膜。行腹膜后淋巴结清扫5例。结果:所有病例均于术后病理确诊为肾母细胞瘤,预后良好组织型(FH)4例,预后不良组织型(UH)6例,病理证实淋巴结转移3例。按美国国家肾母细胞瘤研究组(NWTS)分期标准,分别为Ⅰ期4例、Ⅱ期3例、Ⅲ期3例。7例患者接受术后辅助放化疗。随访9例患者1～13年,5例无瘤生存,生存时间为1.5～13年,平均4.4年。1例术后1年死于肿瘤肺转移,1例术后1年死于肿瘤脑转移,2例术后2年内局部复发,再次接受手术。结论:成人肾母细胞瘤为罕见的恶性肿瘤,预后较差,确诊主要依靠病理诊断,目前尚无公认的最佳治疗手段。手术治疗并辅以合理、及时的放疗、化疗是改善其预后的有效措施。
Objective: To explore the diagnosis and treatment of adult renal cell tumor and prognosis. Methods: A retrospective analysis of 10 cases of adult Wilms tumor in patients with clinical data. 8 males and 2 females, aged 16 to 62 years, mean 29 years. Visiting symptoms were simple gross hematuria in 3 cases, lumbar and abdominal mass or abdominal pain in 4 cases (with hematuria in 2 cases), asymptomatic examination found 3 cases. Patients underwent B-ultrasound, IVU, urine cytology, 8 patients underwent CT scan + intensive examination. Imaging examination prompted renal occupancy in 6 cases, 3 cases of pelvis, ureter in 1 case. CT prompted hilar or abdominal lymph nodes in 4 cases. All the 10 cases underwent radical nephrectomy in 6 cases, with partial nephroureterectomy and vesicoureteral cuff resection in 4 cases. In 2 cases of radical nephrectomy, some of the peritoneum was severely resected due to the mass and surrounding adhesions. Retroperitoneal lymph node dissection in 5 cases. Results: All the cases were diagnosed as Wilms’ tumor on postoperative pathology. There were 4 cases with good prognosis (FH), 6 cases with poor prognosis (UH) and 3 cases with lymph node metastasis confirmed by pathology. According to the American National Nephroblastoma Study Group (NWTS) staging criteria, there were 4 cases in stage I, 3 cases in stage II and 3 cases in stage III. Seven patients received adjuvant radiotherapy and chemotherapy. Nine patients were followed up for 1 ~ 13 years. Five patients survived without disease and their survival time was 1.5 ~ 13 years with an average of 4.4 years. One patient died of tumor lung metastasis one year after operation, one patient died of tumor brain metastasis one year after operation, two patients had local recurrence within 2 years after operation and received operation again. Conclusion: Adult Wilms’ tumor is a rare malignant tumor with poor prognosis. The diagnosis depends mainly on the pathological diagnosis. At present, there is no recognized best treatment. Surgical treatment supplemented by reasonable and timely radiotherapy and chemotherapy is an effective measure to improve its prognosis.