后肾腺瘤:尿路上皮癌的鉴别诊断。报告个案

David Andrés Castañeda Millán, Juan Camilo Álvarez Restrepo, Víctor Iván Romero Nieto, Diego Camacho Nieto, Wilfredo Donoso Donoso, Jorge Forero Muñoz
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摘要

后肾腺瘤是一种罕见的良性肾脏肿瘤。这些肿瘤患者通常无症状,尽管有12%以上的病例发生红细胞增多症。这些肿块通常在诊断影像上被描述为实心的、单一的、界限清晰的、椭圆形的单侧病变,主要位于肾髓质,未累及肾外。这些肿瘤很难与上尿路的恶性肿瘤区分,因此最终的诊断是通过组织病理学实现的。目前,首选的治疗方法是根治性肾切除术。病例介绍:来自波哥大(哥伦比亚)的51岁妇女因非特异性双侧腰痛被转介到一家三级护理医院的泌尿科。在会诊时,患者无症状。肾脏及尿路超音波显示肾积水及右侧肾肿块。ct尿路造影显示右侧肾盂病变伴实质浸润,提示高危上尿路尿路上皮癌及主动脉旁淋巴结腺病变。患者接受了根治性肾输尿管切除术和膀胱袖,根据组织病理学研究确定了后肾腺瘤的最终诊断。结论:后肾腺瘤是一种罕见的肿瘤,难以通过影像学诊断,因此有必要探索其他工具来建立准确的术前诊断,并保留受影响的肾脏单位。此外,鉴于其非特异性,这些肿瘤应包括在提示上尿路上皮癌病变的鉴别诊断中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Adenoma metanéfrico: diagnóstico diferencial del carcinoma urotelial del tracto urinario superior. Reporte de un caso
Introduction: Metanephric adenoma is a rare benign kidney tumor. Patients with these tumors are usually asymptomatic, although polycythemia occurs in up 12% of cases. These masses are often described on diagnostic imaging as solid, single, well-defined, oval-shaped, unilateral lesions, located primarily in the renal medulla and without extrarenal involvement. These neoplasms are difficult to differentiate from malignant neoplasms of the upper urinary tract, so the definitive diagnosis is achieved by histopathology. Currently, the treatment of choice is radical nephrectomy. Case presentation: A 51-year-old woman from Bogotá (Colombia) was referred to the urology service of a tertiary care hospital due to bilateral lumbar pain of non-specific characteristics. At the time of consultation, the patient was asymptomatic. Renal and urinary tract ultrasound showed hydronephrosis and right renal mass. Computed tomography urography was requested, which revealed a lesion in the right renal pelvis with parenchymal invasion highly suggestive of high-risk upper urinary tract urothelial carcinoma, as well as adenopathies in the para-aortic lymph nodes. The patient underwent a radical nephroureterectomy with bladder cuff, which allowed establishing a final diagnosis of metanephric adenoma according to the histopathological study. Conclusions: Metanephric adenoma is a rare tumor that is difficult to diagnose through imaging, so it is necessary to explore additional tools to establish an accurate pre-surgical diagnosis that allows preserving the affected renal unit. Also, given their non-specificity, these tumors should be included in the differential diagnosis of lesions suggestive of upper tract urothelial carcinoma.
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