Xu Xiaofeng, Zhong Jing, Zhou Xiumin, Wei Zhifeng, Xia Qiuyuan, Huang Pengfei, Shi Changjie, Da Jianping, Tang Chaopeng, Cheng Wen, Ge Jingping
Department of Urology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
Department of Radiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
Front Oncol. 2022 Apr 11;12:865263. doi: 10.3389/fonc.2022.865263. eCollection 2022.
To describe the clinical, imaging, pathological features and oncologic outcomes of mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney.
Twenty-two cases of MTSCC were pathologically identified between January 2004 and April 2021 at our institution. The clinical and imaging findings, pathological features, treatment methods and outcomes of the patients were reviewed.
These cases included 17 women and 5 men, with a median age at diagnosis of 52.5 years. On contrast-enhanced CT, MTSCC was less enhanced than the adjacent renal parenchyma. Tumor attenuation values were 33.3 ± 6.8HU, 44.0 ± 9.1HU, 54.4 ± 13.9HU and 67.1 ± 11.8HU in the non-contrast, corticomedullary, nephrographic and excretory phases of CT, respectively. Contrast-enhanced ultrasonography and MRI also showed hypovascular features of the masses. On MRI, the tumors were isointense on T1-weighted images and slightly hypo- or hyperintense on T2-weighted images. Diffusion-weighted imaging revealed a low apparent diffusion coefficient of the tumor. The patients were managed with laparoscopic partial nephrectomy (n=5), radical nephrectomy (n=16), or robotic-assisted laparoscopic partial nephrectomy (n=1). The median follow-up time was 59.5 months. All the patients were free of local recurrence or distant metastasis.
MTSCC is generally indolent and has favorable outcomes. The imaging features of MTSCC are generally hypovascular, which is significantly different from clear cell renal cell carcinoma. However, it is still difficult to distinguish MTSCC from other hypovascular renal tumors preoperatively because their imaging features overlap. Further studies are essential to fully characterize the features of this rare RCC variant.
描述肾黏液性小管状和梭形细胞癌（MTSCC）的临床、影像学、病理特征及肿瘤学转归。
2004年1月至2021年4月期间，我院经病理确诊22例MTSCC。回顾患者的临床及影像学表现、病理特征、治疗方法及转归。
这些病例包括17例女性和5例男性，诊断时的中位年龄为52.5岁。在对比增强CT上，MTSCC的强化程度低于相邻肾实质。CT平扫、皮髓质期、肾实质期和排泄期肿瘤的衰减值分别为33.3±6.8HU、44.0±9.1HU、54.4±13.9HU和67.1±11.8HU。对比增强超声和MRI也显示肿块的低血供特征。在MRI上，肿瘤在T1加权像上呈等信号，在T2加权像上呈轻度低信号或高信号。扩散加权成像显示肿瘤的表观扩散系数较低。患者接受了腹腔镜部分肾切除术（n=5）、根治性肾切除术（n=16）或机器人辅助腹腔镜部分肾切除术（n=1）。中位随访时间为59.5个月。所有患者均无局部复发或远处转移。
MTSCC通常生长缓慢，预后良好。MTSCC的影像学特征通常为低血供，这与透明细胞肾细胞癌有显著差异。然而，术前仍难以将MTSCC与其他低血供肾肿瘤区分开来，因为它们的影像学特征存在重叠。进一步研究对于全面描述这种罕见的肾细胞癌变体的特征至关重要。
