肾母细胞瘤40例临床病理分析.docVIP

肾母细胞瘤40例临床病理分析 　　作者：封琳,靳丹,潘毅,张连郁　　作者单位：焦作市第二人民医院病理科，河南 焦作 ;天津医科大学附属肿瘤医院病理科，天津 　　【摘要】 目的 探讨肾母细胞瘤的临床病理学特征及其对患者预后的影响。方法 对40例肾母细胞瘤患者的临床及病理资料进行回顾性分析。结果 肿瘤细胞呈小管状、乳头状、肾小球状及基底细胞状排列，并可见幼稚的黏液样细胞和纤维母细胞样梭形细胞，还可见平滑肌、横纹肌、骨、软骨及脂肪组织。40例中混合细胞性15例，富于间质性10例，囊性部分分化性4例，高分化上皮性1例，有间变成分6例，肉瘤性成分4例。临床分期：I期15例，Ⅱ期20例，Ⅲ期4例，Ⅳ期1例。40例中29例获得随访，10例失访，1例拒访。29例中生存期超过10 a者5例(囊性部分分化性4例，高分化上皮性1例)，超过5 a者10例(混合细胞性6例，富于间质性4例 )，14例复发者中5例(间变成分3例，肉瘤性成分2例)有血行转移而死亡，生存期8～37.5个月，另9例复发后手术切除仍健在。结论 肿瘤组织分化程度、肿瘤复发、血行或淋巴结转移是影响肾母细胞瘤预后的主要因素。 　　【关键词】 肾母细胞瘤，肿瘤，病理特征，预后 　　Clinical pathological analysis of 40 cases of nephroblastoma　　FENG Lin,JIN Dan,PAN Yi,et al　　1.Department of Pathology,the Second People′s Hospital of Jiaozuo City,Jiaozuo 454001;　　2.Department of Pathology,the Affiliated Cancer Hospital of Tianjin Medical University,Tianjin 300060,China 　　Abstract: Objective To probe the clinical pathological features of nephroblastoma,which is also called Wilm′s Tumor(WT).Methods Clinical and pathological data of 40 patients with nephroblstoma were analyzed retrospectively.Results Histologically,tumor cells arranged into forms of tubular,papillary,glomerulus-like or basal cell structures,surrounded by immature mucoid cells and fibroblast-like spindle cells.Smooth muscles,striated muscles,bones,cartilage and adipose tissues could be seen.Of the 40 cases,there were mixed-cellularity nephroblastoma(15 cases),nephroblastoma rich in stroma (10 cases),cystic partially differentiated nephroblastoma (4 cases),well-differentiated epithelial nephroblastoma (1 case),anaplastic nephroblastoma(6 cases),and sarcomatous nephroblastoma (4 cases).The distribution of the 40 patients according to the surgical stage was:stageⅠ15,stageⅡ20,stageⅢ4 and stage Ⅳ1.Twenty cases out of the 40 cases were followed up,10 without follow-up visit,and one refused follow-up visit.Of the 29 cases,five cases had a life span over 10 years(4 cases of cystic partially differentiated nephroblastoma,one case of well-differentiated epithelial nephr