Renal sinus involvement in renal cell carcinomas
Renal sinus involvement in renal cell carcinomas
复制标题
DOI：
10.1097/00000478-200003000-00015
复制
发表时间：
2000-03-01
影响因子：
5.6
通讯作者：
Greene, GF
中科院分区：
文献类型：
--
作者：
Bonsib, SM;Gibson, D;Greene, GF
肾窦是位于肾脏范围内的脂肪室，不通过纤维囊与肾皮质划分。由于它包含大量静脉和淋巴管，侵入该隔室可能会导致肿瘤扩散，否则被认为是肾脏限制性的。研究了 31 例连续肾癌：22 例透明细胞肾细胞癌（3 例多房囊性肾细胞癌）、4 例嫌色肾癌和 5 例乳头状肾癌。肿瘤和窦之间的整个界面被嵌入。 17 例癌未侵犯肾窦，16 例为 pT1 或 pT2 肿瘤。 14 例癌中，13 例为透明细胞肾细胞癌，1 例为嫌色细胞肾癌，侵犯肾窦脂肪，14 例中有 9 例侵犯肾窦静脉腔（均为透明细胞肾癌）。尽管 22 例透明细胞肾癌中有 14 例似乎是肾局限性 pT1 和 pT2 癌，但 14 例中有 6 例侵入窦脂肪，4 例侵入肾窦静脉腔。与9例窦阴性透明细胞肾细胞癌相比，13例窦阳性肾细胞癌体积更大，肾包膜和肾静脉受累更频繁，核分级更高。肾窦侵犯在透明细胞肾细胞癌中最常见，但在另 3 种惰性肾细胞癌中不常见（十二分之一）：多房性囊性肾细胞癌、嫌色性肾细胞癌和乳头状肾细胞癌。随访时间较短（1-17个月），但31例中有4例出现转移。在三例转移病例中，癌已累及窦静脉腔，但未累及主肾静脉，尽管三例中的两例也通过肾包膜侵入。这项研究表明，在似乎肾局限性 (pT1/pT2) 的癌症中，23 例中的 7 例 (30.4%) 严重侵犯了窦脂肪，23 例中的 4 例 (17.4%) 侵犯了窦静脉。我们的结论是，肾窦侵犯，尤其是窦静脉侵犯，即使是假定的肾局限性肿瘤，也可以识别出有转移风险的患者，并建议对所有病例进行这一特征检查。肾窦侵犯值得进一步研究，以确定其预后重要性，并可能纳入肾细胞癌 TNM 分期系统的未来修订。
The renal sinus is the fatty compartment located within the confines of the kidney not delineated from the renal cortex by a fibrous capsule. Because it contains numerous veins and lymphatics, invasion into this compartment may permit dissemination of a tumor otherwise regarded as renal-limited. Thirty-one consecutive renal carcinomas were studied: 22 clear cell renal cell carcinomas (3 multilocular cystic renal cell carcinomas), 4 chromophobe renal carcinomas, and 5 papillary renal carcinomas. The entire interface between the neoplasm and the sinus was embedded. Seventeen carcinomas did not invade the renal sinus and 16 were pT1 or pT2 tumors. Fourteen carcinomas, 13 clear cell renal cell carcinoma and one chromophobe renal carcinoma, invaded the renal sinus fat, and 9 of 14 invaded the lumen of renal sinus veins (all clear cell renal carcinomas). Although 14 of 22 clear cell renal carcinomas appeared to be renal limited pT1 and pT2 cancers, 6 of 14 carcinomas invaded sinus fat and 4 invaded into the lumen of renal sinus veins. Compared with the nine sinus-negative clear cell renal cell carcinomas, the 13 sinus-positive cancers were larger, exhibited more frequent renal capsule and renal vein involvement, and had higher nuclear grades. Renal sinus invasion was most common in clear cell renal cell carcinomas but was uncommon (one in 12) in 3 more indolent renal cell carcinomas: multilocular cystic renal cell carcinoma, chromophobe renal carcinoma, and papillary renal carcinoma. The follow-up period was short (1-17 months), but metastases developed in four of 31 cases. In three cases with metastases, carcinoma had involved the lumen of sinus veins but not the main renal vein, although two of three had also invaded through the renal capsule. This study shows that in carcinomas which appear to be renal limited (pT1/pT2), seven of 23 (30.4%) bad invaded sinus fat and four of 23 (17.4%) had invaded sinus veins. We conclude that renal sinus invasion, especially sinus vein invasion, could identify a patient at risk for metastases even in a putative renal limited tumor, and suggest that all cases be examined for this feature. Renal sinus invasion merits further investigation to establish its prognostic importance and possible incorporation into future revisions of the TNM staging system for renal cell carcinomas.