多原发肿瘤含肾神经鞘瘤1例报道并文献复习
Multiple primary neoplasms with renal neurilemmoma: a case report and literature review

多原发肿瘤并不常见，其中包含肾神经鞘瘤者更为罕见。本研究报道1例合并肾神经鞘瘤的多原发肿瘤的诊治。患者为女性，曾患左卵巢皮样囊肿、右后纵隔神经鞘瘤、左前臂神经鞘瘤、甲状腺乳头状癌，并行手术治疗。1个月前体检发现左肾肿物伴左肾上腺肿物，于北京大学第三医院行后腹腔镜左肾上腺结节切除术、左肾部分切除术。手术顺利完成，无中转开放，术中动脉阻断时间18 min，出血20 mL。病理检查示左侧肾富于细胞型神经鞘瘤伴局灶囊性变，肿瘤直径约3 cm。免疫组织化学S-100（+），Ki-67（15%+）。短期随访无复发。本研究患者神经鞘瘤为异时性，分别予手术切除，其肾神经鞘瘤为良性，行腹腔镜肾部分切除术不但创伤小、恢复快，更重要的是可以最大限度的保留肾组织，避免术前病理的不确定性而行根治性肾切除术。
Multiple primary neoplasms are not common, those containing renal neurilemoma are even more rare. Our study involves the diagnosis and treatment of a female patient with multiple primary neoplasms with renal neurilemoma. She was previously diagnosed with left ovarian dermoid cyst, right posterior mediastinal neurilemmoma, left forearm neurilemmoma, and papillary thyroid carcinoma, underwent operation treatment. Physical examination reveals a left renal mass with a left adrenal tumor a month before, and underwent retroperitoneal laparoscopic left adrenal nodule resection and left partial nephrectomy. Operation was successful, without conversions to open. Artery occlusion time was 18 min, and blood loss was 20 mL. Post operation pathologic result shows a left renal cellular leiomyoma neurilemmoma with focal cystic change, and tumor diameter was about 3 cm. Immunohistochemistry reports S-100 (+), Ki-67 (15%+), and short-term follow-up without recurrence. In our case of study, even though the tumors were heterochronism, they were both treated with surgical resection. Renal neurilemoma is benign. Laparoscopic partial nephrectomy is not only minimally invasive, fast in recovery, but most importantly preserves renal tissue to the largest extent. It can prevent preoperative pathological uncertainty, which often undergoes radical nephrectomy.