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1 病例报告患者女,53岁.右腰部胀痛不适5月,于1998年10月19日入院.一个月前,B超检查发现右肾上极低回声区;CT扫描显示右肾中上极占位,向肾盂内突出,肿物CT值平扫58Hu,增强71Hu.发病以来无发热、血尿、乏力、消瘦等现象.体检无阳性体征.血生化检查未见异常.IVU显示右肾影增大,右肾盂、上盏压迫变形,左肾正常.术前诊断为右侧肾癌.予行肾癌根治术,术中见右肾上极与周围组织粘连,中上极质地较硬,可见一5cm×4cm×4cm肿块,则行右肾切除并清除肾周脂肪,肾蒂及腹主动脉旁淋巴结无肿大.病理检查右肾大小为11.5cm×6.3cm×6.2cm,表面粗糙,结节状.切面有6个结节,境界尚清楚,大者直径3.5cm,向肾益内压迫,小者如蚕豆,切面灰白或灰黄,部分包膜完整,肿瘤位于肾实质.镜下见肿瘤细胞呈梭形,部分细胞肥胖,核分裂象不多见,胞浆伊红色,瘤组织结构杂乱,可见漩涡状结构,间质内散在淋巴细胞、浆细胞及少量嗜酸细胞浸润.局部瘤组织与肾组织结构不清(见附图).免疫组化染色显示Desmin(+),α-AT(-),LYSO(-),S_100(-),PCNA(-).病理诊断(右)肾平滑肌瘤,有交界低度恶性.随访3个月无复发.
A case report of female patients, aged 53. Right lower back pain discomfort in May, was admitted to hospital on October 19, 1998. A month ago, B ultrasound examination found that the right upper kidney hypoechoic area; CT scan showed the right kidney in the pole Hematoma, hematuria, fatigue, weight loss and other phenomena. Physical examination without positive signs of blood biochemical tests showed no abnormalities .IVU showed the right renal shadow increased Large, right renal pelvis, on the lamp pressing deformation, the left kidney is normal.Preoperative diagnosis of right renal cell carcinoma.For radical nephrectomy, surgery see the right upper kidney and surrounding tissue adhesions, in the very hard texture, showing a 5cm × 4cm × 4cm mass, the line of right kidney excision and removal of perirenal fat, renal pedicle and abdominal aortic lymph nodes without swelling.Pathological examination of the right kidney size of 11.5cm × 6.3cm × 6.2cm, the surface roughness, nodules Shaped section of 6 nodules, the realm is still clear, the larger the diameter of 3.5cm, the pressure to the kidney, the smaller, such as broad beans, gray or gray section, part of the complete capsule, the tumor is located in the renal parenchymal. Fusiform cells, some of the cells obesity, mitotic rare, cytoplasm eosinophilic, tumor tissue structure disorder, visible swirling structure, interstitial scattered (See Figure) .Immunohistochemical staining showed that Desmin (+), α-AT (-), LYSO (-) and S_100 (-), PCNA (-) .Pathological diagnosis (right) of renal leiomyoma, there is a low border of malignancy. No recurrence of 3 months follow-up.