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摘要: Birt-Hogg-Dubé(BHD)综合征是临床罕见的常染色体显性遗传病,卵泡素基因突变是本病致病原因,常见受累器官包括肺、肾、皮肤等。国内BHD综合征仅有数个家系报道,肺囊肿和气胸为此病常见临床表现,而皮肤损害和肾脏肿瘤则比较少见。本文报道一例BHD综合征合并肾嗜酸/嫌色细胞混合性肿瘤病例,分析其临床特征、实验室检查结果、家系情况、诊治经过,并复习相关文献,提示临床应重视BHD综合征的诊断,对合并肾肿瘤患者,早期发现以及保留肾单位的肾肿瘤切除为处理原则。
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关键词:
- Birt-Hogg-Dubé综合征 /
- 肾肿瘤 /
- 卵泡素 /
- 肾嗜酸/嫌色细胞混合性肿瘤
Abstract: Birt-Hogg-Dubé(BHD)syndrome is a rare autosomal dominant genetic disease that results from the mutation of folliculin gene and commonly affects lungs, kidneys, and skin. In China, only a few families affected by this syndrome were reported. Pulmonary cysts and pneumothorax are common clinical manifestations of this disease, while skin lesions and kidney tumors are relatively rare. Here we reported a case of BHD syndrome with renal hybrid oncocytic/chromophobe tumors, analyzed its clinical features, laboratory examinations, family history, diagnostic methods, and treatment, and reviewed the relevant literature. Clinical attention should be paid to the diagnosis of BHD syndrome. The treatment principle for patients with renal tumors is early detection and to carry out nephron sparing surgery.利益冲突 无 -
表 1 Birt-Hogg-Dubé综合征2009年诊断标准[4]
条目 主要标准:
(1)成年期出现,至少5个毛囊纤维瘤和/或毛囊瘤,且至少有一个被病理证实
(2)DNA序列分析发现FLCN基因种系突变
次要标准:
(1)多发肺囊肿:主要位于肺基底部的双侧多发肺囊肿,排除其他明确原因,伴或不伴有自发性气胸病史
(2)肾癌:早发(<50岁)/多发/双侧肾癌,或病理为嫌色细胞和嗜酸细胞混合型肿瘤
(3)Birt-Hogg-Dubé综合征患者一级亲属确诊:
满足1条主要标准或2条次要标准表 2 Birt-Hogg-Dubé综合征2015年诊断标准[2]
条目 疑诊标准:
(1)存在≥2个临床表现与毛囊纤维瘤和/或毛盘瘤相符的皮肤病变,且≥1个皮肤病变组织学为毛囊纤维瘤
(2)主要位于肺基底部的双侧多发肺囊肿,伴或不伴有40岁之前发生自发性气胸病史,尤其在有相似肺部表现的家族史时
(3)双侧多发性肾嫌色细胞癌,或肾嫌色细胞和嗜酸细胞混合型肿瘤,尤其是在有50岁以下发生肾脏肿瘤家族史的患者中
(4)在患者或家庭成员中,皮肤、肺或肾脏表现联合存在确诊:
DNA序列分析发现FLCN基因种系突变 -
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