纳武利尤单抗联合伊匹木单抗治疗伴骨转移的黏液性管状和梭形细胞肾细胞癌后行细胞减灭性肾切除术：一例报告。
Cytoreductive Nephrectomy After Combination of Nivolumab Plus Ipilimumab for Mucinous Tubular and Spindle Cell Carcinoma of the Kidney With Bone Metastases: A Case Report.
机构信息
Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan;
Department of Pathology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
出版信息
In Vivo. 2022 Jan-Feb;36(1):510-521. doi: 10.21873/invivo.12732.
BACKGROUND/AIM: Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare subtype of renal cell carcinoma and generally considered a low-grade renal epithelial neoplasm. However, MTSCC with distant metastases often shows a poor prognosis. This is the first reported case of cytoreductive nephrectomy after nivolumab plus ipilimumab combination treatment.
CASE REPORT
A 26-year-old man had a 72-mm tumor at the left kidney with multiple osteolytic bone metastases. A biopsy of the renal tumor and bone metastases resulted in the diagnosis of MTSCC of the kidney with bone metastases. After nivolumab plus ipilimumab combined treatment, he underwent cytoreductive nephrectomy. The excised specimen showed higher PD-L1 expression in the spindle components than in the tubular components, but CD4- and CD8-positve T-cells showed greater infiltration in the tubular components than the spindle components.
CONCLUSION
Combination immunotherapy of nivolumab and ipilimumab may be an effective treatment option for metastatic MTSCC of the kidney.
背景/目的：黏液性管状和梭形细胞癌（MTSCC）是一种罕见的肾细胞癌亚型，通常被认为是一种低级别的肾上皮肿瘤。然而，伴有远处转移的 MTSCC 往往预后不良。这是首例报告的纳武利尤单抗联合伊匹单抗治疗后行细胞减灭性肾切除术的病例。
病例报告
一名 26 岁男性左肾有一个 72mm 的肿瘤，伴有多处溶骨性骨转移。肾肿瘤和骨转移的活检结果诊断为肾 MTSCC 伴骨转移。纳武利尤单抗联合伊匹单抗治疗后，他接受了细胞减灭性肾切除术。切除标本显示梭形成分中 PD-L1 的表达高于管状成分，但 CD4 和 CD8 阳性 T 细胞在管状成分中的浸润程度大于梭形成分。
结论
纳武利尤单抗联合伊匹单抗的联合免疫治疗可能是转移性肾 MTSCC 的有效治疗选择。
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