Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney: a detailed study of radiological, pathological and clinical outcomes
Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney: a detailed study of radiological, pathological and clinical outcomes
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DOI：
10.1111/bju.12992
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发表时间：
2015-07-01
影响因子：
4.5
通讯作者：
Karam, Jose A.
中科院分区：
文献类型：
--
作者：
Kenney, Patrick A.;Vikram, Raghunandan;Karam, Jose A.
目的探讨粘液管状和梭形细胞癌（MTSCC）的临床、影像学和组织学特征及其预后。患者和方法这是一项对2002年至2011年所有MTSCC患者的单机构回顾性分析。如果病理复查不能证实MTSCC，则排除患者（4例）。我们回顾了19例患者的临床特征、病理、影像学和预后。结果诊断年龄中位数（范围）为59岁（17-71岁），女性占78.9%。对比增强计算机断层扫描显示，在皮质-髓质期，MTSCC的增强程度低于皮层。在对比前、皮质髓质、肾造影和排泄期，肿瘤衰减的平均（范围）分别为36（24-48）、67（41-133）、89（49152）和76（52-106）个Hounsfield单位。共有16例患者接受了pT1（62.5%）、pT2（31.3%）和pT3a疾病（6.3%）的部分（5例）或根治性肾切除术（11例）。一名患者接受了主动监测。3例患者（13.0%）接受能量消融治疗，1例复发患者接受挽救性手术治疗。1例患者（5.3%）在诊断时有转移性疾病，64.7个月后死于疾病。一名pT2bN0M0 MTSCC伴肉瘤样去分化的患者在诊断后9.5个月发生骨转移，存活19.0个月。其余患者无复发或进展。结论mtscc是一种罕见的肾细胞癌（RCC）变体。在这个迄今为止最大的系列中，MTSCC出现在广泛的年龄范围内，并显示出女性的偏好。MTSCC的影像学和病理表现与乳头状细胞癌有一定的重叠。MTSCC总体上与良好的预后相关，但并非普遍无痛。
ObjectiveTo characterise the clinical, radiological and histological features of mucinous tubular and spindle cell carcinoma (MTSCC), as well as oncological outcomes.Patients and methodsThis is a single institution retrospective analysis of all patients with MTSCC from 2002 to 2011. Patients were excluded if MTSCC could not be confirmed on pathology re-review (four patients). Clinical characteristics, pathology, imaging, and outcomes were reviewed for the 19 included patients.ResultsThe median (range) age at diagnosis was 59 (17-71) years with a female predominance (78.9%). On contrast-enhanced computed tomography, MTSCC enhanced less than the cortex during the corticomedullary phase. The mean (range) tumour attenuation was 36 (24-48), 67 (41-133), 89 (49152), and 76 (52-106) Hounsfield units in the pre-contrast, corticomedullary, nephrographic and excretory phases, respectively. In all, 16 patients were treated with partial (five patients) or radical nephrectomy (11) for pT1 (62.5%), pT2 (31.3%), and pT3a disease (6.3%). One patient underwent active surveillance. Of three patients (13.0%) managed with energy ablation, there was one recurrence that was treated with salvage surgery. One patient (5.3%) had metastatic disease at diagnosis and died from disease 64.7 months later. A patient with a pT2bN0M0 MTSCC with sarcomatoid dedifferentiation developed bone metastases 9.5 months after diagnosis and was alive at 19.0 months. The remainder were free of recurrence or progression.ConclusionMTSCC is a rare renal cell carcinoma (RCC) variant. In this largest series to date, MTSCC presented at a broad range of ages and displayed a female predilection. Imaging and pathological features of MTSCC display some overlap with papillary RCC. MTSCC is associated with excellent outcomes overall, but is not universally indolent.