摘要目的 探讨肉瘤样肾细胞癌的诊治经验.方法 回顾性分析2011年4月至2013年6月收治的5例肉瘤样肾细胞癌患者的资料,男2例,女3例.年龄27 ～71岁,平均49岁.均有腰部疼痛症状,并伴有发热、血尿、尿频等其他临床症状.泌尿系CT检查示肾占位性病变,密度不均一,伴有强化,高度怀疑为恶性肿瘤,肿瘤直径4 ～18 cm,平均9.2 cm.1例经胸部X线片和纤维支气管镜活检确诊为肺转移.5例均行根治性肾切除术,术中可见肿瘤位于肾实质,与周围组织粘连.3例肾上极肿瘤已侵犯周围脏器,其中2例侵犯肝脏,同时行肝叶部分切除术;1例侵犯胰腺,行胰腺部分切除术.结果 5例术后病理检查,肿瘤剖面呈鱼肉样胶冻状,灰白灰红色,与周围组织界限不清,镜下见大量梭形恶性细胞.免疫组化染色检查Vimentin和PCK均为阳性,4例Ki-67指数＞50％.病理诊断均为肉瘤样肾细胞癌,3例肿瘤侵犯周围脏器患者病理诊断分别为肾上腺、肝脏、胰腺转移.病理分期为T2N0M1期1例、T3 N0 M0期1例、T4N0M1期3例.1例术后接受白细胞介素-2免疫治疗.5例均于术后9个月内死亡,平均生存期为3.8个月.4例伴远处转移者免疫组化染色检查Ki-67指数均＞50％,生存期为1～4个月.结论 肉瘤样肾细胞癌发展迅速,预后极差.单纯手术治疗对肉瘤样肾细胞癌疗效不佳.Ki-67指数可以作为肉瘤样肾细胞癌的预后指标.

abstractsObjective Explore the diagnosis experience of sarcomatoid renal cell carcinoma (SRCC).Method There were 5 cases of SRCC from April 2011 to June 2013,3 of them were females and 2 were males,with a mean age of 49 (27-71).All the patients were presented with pain accompanied with other symptoms such as hematuria,fever and polyuria.CT urography suggested renal occupied lesions,withuneven density and enhancement,and malignancy was highly suspected.The mean diameter of tumors was 9.2 cm(4-18 cm).Radical nephrectomy was performed on all patients,tumors were located in renal parenchymal,and with adherence to other tissues.One patient with lung metastasis was found before surgery.Result Pathologic findings of the resected tissues after operation noted SRCC.Under the microscope,a large number of spindle shaped cells were seen,and Vimentin and PCK were all positive in immunohistochemical.Three patients with metastases were found after surgery (adrenal gland,liver,pancreas).Postoperative pathological stages were one T2N0M1,three T4N0M1 and one T3N0M0.One patient received IL-2 immunotherapy.All patients died within 9 months after surgery with a median survival of 3.8 months.Immunohistochemistry in the postoperative,there were four patients with the level of Ki-67 LI ＞ 50％,with distant metastasis and survival time was 1-4 moths.Conclusion The disease develops rapidly,and the prognosis of the patients is very poor.The Ki-67 LI may be considered as a prognosis marker and the patients with sarcomatoid differentiation can benefit little from surgery alone.