多房囊性肾细胞癌的影像学特征与临床分析

多房囊性肾细胞癌(MCRCC)是肾细胞癌的一种亚型。其临床症状轻微,预后良好,肾脏局部切除即可治愈肿瘤。如果能在术前准确预测MCRCC,将有利于预后判断及临床管理。大多数MCRCC具有典型的影像特征,有利于术前诊断。MCRCC影像表现为多房囊性肿物,囊内见强化的不规则增厚的分隔,无囊内强化的实性结节,Bosniak分级多为Ⅲ级,与其他肾脏囊性肿物的影像表现不同。就MCRCC的临床、病理、影像学表现进行综述,评估影像学检查在MCRCC的术前评估及临床管理中的作用。     

多房囊性肾透明细胞癌的常见螺旋CT征象

目的研究分析多房囊性肾透明细胞癌SCT征象、病理特点及诊断价值。方法回顾性分析经手术病理证实的18例多房囊性肾细胞癌（MCRCC）SCT征象。结果所有肿瘤呈圆形或类圆形，囊壁薄，边缘光整，囊内液性成分密度多略高于水；间隔边缘毛糙。MCRCC间隔菲薄型（6例），间隔增厚型（8例），间隔结节型（4例）。SCT动态增强显示菲薄间隔多呈轻到中度强化，结节型表现为明显均匀强化，增厚型间隔则有上述两种形式强化。结论MCRCC的典型影像特征为多囊液性密度、分隔毛糙和壁结节；囊壁薄而规则，多有轻到中度以上强化。SCT在MCRCC的诊断中具有重要作用，但鉴别时仍有一定难度。     

CT在不同病理亚型肾细胞癌诊断中的价值

目的 探讨WHO病理分类中不同亚型肾细胞癌（renal cee carcinoma,RCC）的CT特征,旨在加深对RCC的认识,提高影像诊断准确率.方法 回顾性分析2008年1月～2013年9月72例经病理证实的RCC患者的临床资料及CT检查结果,其中透明细胞癌58例,乳头状细胞癌7例,嫌色细胞癌4例,多房囊性肾癌3例.结果 透明细胞癌平扫病灶呈等或低密度,增强扫描皮质期肿瘤多呈不均性明显强化,实质期、分泌期强化减退.乳头状细胞癌多呈等密度或囊实性,增强扫描皮质期实性部分轻度强化,实质期、分泌期延迟强化.嫌色细胞癌多位于肾髓质内,密度均匀,增强扫描强化均匀,坏死、囊变少见.多房囊性肾癌位于肾皮质区,由多个囊腔和分隔构成,囊壁及间隔菲薄,无附壁结节,平扫病灶呈低密度,增强扫描囊壁、间隔延迟强化.结论 不同病理亚型肾细胞癌CT特征、手术方案、预后均不同,术前影像学检查准确诊断能够为临床医师选择合理手术方案提供可靠依据.     

多房囊性肾细胞癌的CT表现

目的 :分析多房囊性肾细胞癌(multilocular cystic renal cell carcinoma,MCRCC)的CT表现及临床特点,提高诊断水平。方法:回顾性分析经病理证实的11例MCRCC患者的临床及影像学资料。结果:11例均为单发,左肾5例,右肾6例;最大径17~79 mm,平均53 mm;7例较小呈类圆形,4例较大稍呈分叶状。CT平扫囊壁显示欠清8例,较清晰3例;10例囊液为不均匀较低及稍高密度(稍高于水),囊内分隔为等、稍低或稍高密度,局部显示欠清;1例囊液为较均匀稍高密度,分隔显示不清。动态增强扫描1例囊壁均较薄且相对光整,边界较清楚,呈中度延迟强化,未见明显肿瘤结节;囊内分隔较菲薄光整4例,呈轻到中度延迟强化;局部不均匀稍增厚7例(<5 mm),呈中到明显持续强化;11例均未见明显转移及邻近侵犯。11例均行手术治疗,随访18~51个月,均未见复发及转移。结论 :MCRCC恶性程度低,临床症状多不明显,手术治疗效果好。CT可显示MCRCC的一些病理学特征,对其诊断具有较大价值。     

囊性肾细胞癌13例CT报道并文献复习

目的 探讨囊性肾细胞癌的CT影像特征,旨在提高其诊断与鉴别诊断水平.方法 回顾性分析13例经手术病理证实的囊性肾细胞癌的CT表现特征.结果 8例囊性肾癌其囊液呈水样密度,5例囊液密度增高,不均匀;6例伴位置不同、程度不一的斑点状钙化;10例囊壁增厚或厚薄不均,4例伴囊内厚薄不均分隔,5例伴大小不一的软组织结节;增强扫描10例囊壁及间隔软组织轻中度强化,3例肿瘤实性成分明显强化.结论 CT对囊性肾细胞癌的诊断和鉴别诊断具有一定的临床实用价值.     

肾透明细胞癌的MSCT表现

目的 :探讨肾透明细胞癌的MSCT表现,以提高其诊断水平。方法 :回顾性分析我院经手术病理证实的23例肾透明细胞癌的MSCT表现,所有患者均行平扫、皮髓交界期、实质期和排泄期增强扫描。结果:23例中,单发21例,多发2例(1例为单侧2个病灶,1例为双侧7个病灶)。23例共30个病灶,左侧10个,右侧20个。肿瘤呈圆形或类圆形,直径1~12 cm,平均4.6cm,其中≤3 cm 12个。CT平扫病灶呈等密度4个,囊性低密度3个,混杂密度23个;钙化6个。增强扫描:除2个较小肿瘤呈均匀强化外,28个强化不均匀;皮髓质期25个病灶明显强化,强化最明显区高于邻近皮质者15个,相似或略低于邻近皮质者10个;实质期肿瘤强化程度降低;排泄期肿瘤与肾实质相比呈明显低密度,病灶边界更清楚;25个病灶内见不同程度坏死、囊变。13个有假包膜。3个囊性肾透明细胞癌,平扫病灶呈囊状,2个表现如单纯性肾囊肿,1个可见网格状分隔;增强扫描1个肾透明细胞癌明显囊变,囊壁及分隔明显不规则强化;2个多房囊性肾透明细胞癌分隔不规则强化。结论:肾透明细胞癌血供丰富,瘤内可有出血、坏死、囊性变、钙化及假包膜,CT表现具有一定特征,大多可准确诊断。     

囊性肾细胞癌:影像表现与病理对照

囊性肾细胞癌(RCC)按病理组织生长方式分为4型:①多腔型。②单腔型。③坏死囊变型。④源于单纯囊肿壁型。作者对经手术证实的23例病人,27个肿瘤进行影像及组织病理回顾性分析。 病理表现:27个囊性RCC,多腔型15个,其中大囊性9个,小囊性(<3cm)6个,单腔型3个,坏死型9个,无一例源于单纯囊肿壁型。3例合并vonHippel病患者两侧均见囊实性肿瘤,共计7个,均为多腔型,实性部分由正常透明细胞组成。多腔型及坏     

多房囊性肾细胞癌的CT分析

目的:探讨多房性囊性肾细胞癌的CT表现特点及诊断价值。方法:回顾性分析13例经手术病理证实的多房性囊性肾细胞癌患者的CT图像及相关临床资料。结果:病变位于右肾8例,左肾5例。病灶直径4~25cm,平均13cm。病灶由多个囊腔和分隔构成,5例伴附壁结节,2例见囊壁钙化,增强后囊壁、分隔和壁结节可有强化。结论:多房囊性肾细胞癌的CT表现有一定特征性。CT在多房性囊性肾细胞癌的诊断中具有重要作用,但在鉴别时仍有一定难度。     

乳头状肾细胞癌临床病理分析

目的探讨乳头状肾细胞癌的组织学特点以及细胞核分级与预后的关系。方法选择13例乳头状肾细胞癌病例的病理切片和临床资料,显微镜下观察组织学改变并对细胞核进行Fuhrman分级,同时对肿瘤组织做免疫组化染色,并分析细胞核分级与患者预后的关系。结果所有肿瘤境界均清楚,最大6．3cm,最小2cm(平均3．5cm),较大肿瘤可见明显出血囊性变。显微镜观察,肿瘤呈乳头或管状乳头状排列,出血、坏死和泡沫细胞多见,其中6例肿瘤为多灶性。细胞核Fuhrman分级Ⅰ、Ⅱ级6例,Ⅲ、Ⅳ级7例。免疫组化肿瘤细胞表达CK7。患者平均随访时间为52个月(28～102个月),其中3例于术后36、41和50个月因肿瘤转移或复发死亡,其余10例均无瘤存活至今。死亡病例均为细胞核Ⅲ和Ⅳ级。结论乳头状肾细胞癌与其他肾细胞癌类型不同,具有独特的组织学特点并且预后较好。细胞核分级是肿瘤预后的重要指标。     

分子靶向治疗后肾透明细胞癌肺转移灶囊样薄壁空洞形成(附2例报告及文献复习)

目的 探讨肾透明细胞癌肺转移灶经分子靶向治疗后发生薄壁空洞改变的CT表现和临床意义.方法 回顾性分析2例肾透明细胞癌经分子靶向药物Pazopanib治疗后肺转移灶出现薄壁空洞改变的相关病例临床及影像学资料.结果 2例肾透明细胞癌原发灶切除术后,双肺多发实性转移灶,增强扫描多数病灶呈环形强化;经Pazopanib治疗3个月后大多数转移灶呈薄壁空洞样改变.病例1病情进展缓慢;病例2出现自发性气胸,2个月后死亡.结论 分子靶向药物治疗促进了肾透明细胞癌肺转移灶坏死,有助于囊样薄壁空洞形成,但这种变化对预后的影响具有不确定性.     

A renal cell carcinoma extending into the renal pelvis simulating transitional cell carcinoma

A case of renal cell carcinoma with unusual extension is reported, in which the radiographic findings have a close resemblance to those of transitional cell carcinoma of the renal pelvis. We emphasize that it is occasionally difficult to draw a distinction between transitional cell carcinoma with renal invasion and renal cell carcinoma with renal pelvic extension even by computed tomography (CT) and angiography.     

肾透明细胞癌与肾乳头状癌、嫌色细胞癌MRI表现的对照研究

目的 探讨MR动态增强扫描对肾癌亚型的鉴别诊断价值.方法 搜集77例经病理证实的肾癌患者资料,其中透明细胞癌(CCRCC)55例,乳头状癌(PRCC)14例,嫌色细胞癌(CRCC)8例,回顾性分析各亚型肿瘤患者MR平扫及动态增强扫描表现并与病理对照,根据肿瘤及肾皮质增强前后的皮质期、实质期及延迟期信号变化,分别进行百分比测量、肿瘤-肾皮质增强指数计算,并采用单因素方差分析和LSD法进行比较.结果 CRCC多数信号均匀(7/8);CCRCC及PRCC多数信号不均(分别为51/55和13/14)、常见坏死(36/55和7/14),PRCC最常见出血(9/14)及囊变(9/14).动态增强各期CCRCC强化程度最高,强化模式呈"快进快退",CRCC轻至中度强化,PRCC强化最轻,两者均呈渐进性延迟强化.CCRCC、PRCC及CRCC皮质期信号变化分别为(296.15±60.27)%、(79.70±18.84)%和(119.56±40.76)%,实质期分别为(236.33±58.31)%、(122.81±27.35)%和(163.06±33.91)%,延迟期分别为(216.83±46.72)%、(117.55±20.63)%和(179.72±32.89)%;三者皮质期的肿瘤-皮质增强指数分别为1.26±0.34、0.33±0.12及0.54±0.10,实质期分别为0.92±0.23、0.41±0.23及0.62±0.15,延迟期分别为0.76±0.14、0.35±0.11及0.69±0.12,各亚型增强各期的信号变化(F值分别为940.931、124.515、38.194,P值均＜0.01)、肿瘤-皮质增强指数(F值分别为798.625、78.308、73.699,P值均＜0.01)差异均有统计学意义.3种亚型的MRI表现与病理学所见基本相符.结论 CCRCC、PRCC及CRCC的MRI动态增强有一定特征性的表现,与其病理特点密切相关,在肾癌亚型的鉴别诊断上有着较高的临床应用价值.

Abstract：

Objective To investigate the differential diagnostic features of subtypes of renal cell carcinoma(RCC) using dynamic contrast-enhanced MRI(DCE-MRI).Methods The MRI appearances of 77 RCCs, including 55 clear cell RCCs(CCRCC),14 papillary RCCs(PRCC) and 8 chromophobe RCCs(CRCC), were retrospectively analyzed and compared with findings of pathology. DCE-MRI was conducted in each case after intravenous administration of contrast agent. Region of interest measurements (cortical, nephrographic and delayed Phases) of signals within tumor and uninvolved renal cortex were used to calculate percentage signal intensity change and tumor-to-cortex enhancement index, and the data was analyzed by AVONA and t test. Results On unenhanced and enhanced MRI, most CRCCs showed homogeneous signal(7/8). CCRCC and PRCC often show inhomogenous signal with necrosis(36/55, 7/14). Hemorrhage and cystic degeneration were often found in PRCC (9/14). On the cortical, nephrographic and delayed phase images, CCRCCs showed greater signal intensity change[(296.15±60.27)%, (236.33±58.31)% and (216.83±46.72)%,respectively than PRCCs (79.70±18.84)%, (122.81±27.35)% and (117.55±20.63)%, respectively], and CRCCs showed intermediate change [(119.56±40.76)%, (163.06±33.91)% and (179.72±32.89)%, respectively].A phenomenon of quick staining and quick fainting was observed in CCRCCs. Both of CRCCs and PRCCs showed delayed enhancement. The tumor-to-cortex enhancement index at the cortical, nephrographic and delayed phases was highest for CCRCCs (1.26±0.34, 0.92±0.23 and 0.76±0.14, respectively), lowest for PRCCs (0.33±0.12, 0.41±0.23 and 0.35±0.11, respectively), and intermediate for CRCCs (0.54±0.10, 0.62±0.15 and 0.69±0.12, respectively,P＜0.01). The degree of enhancement was significantly different among the 3 subtypes at the every contrast enhanced phase (F=940.931, 124.515 and 38.194, P＜0.01), so was the tumor-to-cortex enhancement index(F=798.625,78.308 and 73.699, P＜0.01). There was a good consistency between MR appearances of the 3 RCC subtypes and pathological characteristics. Conclusion DCE-MRI could distinctly show imaging features of CCRCC, PRCC and CRCC, which were related to their pathological characteristics, and these features were helpful in predicting a specific subtype of RCC.     

Computed tomography of renal cell carcinoma in patients with terminal renal impairment

Purpose

An increased incidence of renal tumors has been observed in patients with end-stage-renal-disease (ESRD). The very strong association with acquired renal cystic disease (ACRD) and increased incidence of the renal tumors (conventional renal cell carcinoma (CRCC), papillary renal cell carcinoma (PRCC) or papillary renal cell adenoma (PRCA)) was reported. This study discusses the role of computed tomography (CT) in detecting renal tumors in patients with renal impairment: pre-dialysis, those receiving dialysis or with renal allograft transplants.

Materials and methods

Ten patients (nine male, one female) with renal cell tumors were enrolled into a retrospective study; two were new dialysis patients, three on long-term dialysis, and five were renal transplant recipients with history of dialysis. All patients underwent helical CT, a total of 11 procedures were performed. Sixteen-row detector system was used five times, and a 64-row detector system for the six examinations. All patients underwent nephrectomy of kidney with suspected tumor, 15 nephrectomies were performed, and 1 kidney was assessed during autopsy. CT findings were compared with macroscopic and microscopic assessments of the kidney specimen in 16 cases.

Results

Very advanced renal parenchyma atrophy with small cysts corresponding to ESRD was found in nine patients, chronic pyelonephritis in remained one. A spontaneously ruptured tumor was detected incidentally in one case, patient died 2 years later. In the present study, 6.25% (1/16) were multiple PRCA, 12.5% (2/16) were solitary PRCC, 12.5% tumors (2/16) were solitary conventional renal cell carcinomas (CRCC's), 12.5% tumors (2/16) were multiple conventional renal cell carcinomas (CRCC's), 25% (4/16) were CRCC's combined with multiple papillary renal cell carcinomas with adenomas (PRCC's and PRCA's), and 25% (4/16) of the tumors were multiple PRCC's combined with PRCA's without coexisting CRCC's. Bilateral renal tumors were found in our study in 60% (6/10) confirmed in six cases, one kidney left on follow-up due to the small tumors.

Conclusions

With the use of a multi-detector row system, it is possible to detect smaller foci suspected to originate in multiple tumors, especially when up to 3-mm thin multi-planar reconstructions are used. Two cases demonstrated the possibility the development of RCC in impaired kidneys may start before dialysis initiation.     

Ureteral and renal pelvic metastases from renal cell carcinoma

Six patients with ureteral or renal pelvic metastases from renal cell carcinoma (RCC) were studied radiologically. Correlation with surgical and histologic findings confirmed renal venous involvement in 5 and lymphatic invasion in 3 patients. The possible role of nephroureterectomy or secondary ureterectomy in patients with RCC is discussed in the background of our cases, as are prior reports of this finding.     

Multimodality approach to staging renal cell carcinoma

Renal imaging has dramatically improved since the introduction of ultrasound (US), computed tomography (CT), and most recently magnetic resonance (MR) imaging. US and MR imaging are ideal for patients with compromised renal function preventing administration of iodinated contrast material or those who have experienced reactions to contrast. Staging errors occur due to limitations in assessing microscopic tumor invasion of the renal capsule and perinephric fat, detecting metastatic deposits in normal sized lymph nodes and differentiating inflammatory hyperplastic lymph nodes from neoplastic ones. These limitations are shared by US, CT, and MR imaging. Vascular invasion by tumor can be evaluated by all imaging modalities including venography. The advantages and limitations of each examination will be presented.     

Intracaval extension of renal cell carcinoma

Intravenous extension occurs in many patients with renal cell carcinoma. Preoperative recognition is essential as venous involvement alters the surgical approach and clinical staging of the tumors. The venous extension of tumor has a characteristic arteriographic appearance, the recognition of which should prompt venacavography. Computerized body tomography (CBT) may also detect renal vein and caval extension and provide evidence of early ascites from the Budd Chiari syndrome associated with hepatic vein obstruction from intracaval tumor extension. However, it may be difficult to distinguish intracaval blood clot and tumor on the basis of CBT criteria alone. Of the four patients with intracaval growth of renal cell carcinoma, three received preoperative therapeutic tumor embolization, a procedure that carried no additional risk of tumor detachment and embolization.     

肾透明细胞癌与肾嗜酸细胞腺瘤的CT鉴别诊断

目的探讨分析肾透明细胞癌与嗜酸细胞腺瘤的CT表现及鉴别诊断。方法选取我院收治并经手术病理证实为肾透明细胞癌(20例)及肾嗜酸细胞腺瘤(15例)的CT表现,分析两者病灶的大小、形态、密度、CT值及强化方式等。结果肾透明细胞癌与肾嗜酸细胞腺瘤病灶的直径差异不明显(P> 0.05),差异无统计学意义;肾透明细胞癌与嗜酸细胞腺瘤CT平扫均多数为等或稍低密度,增强期多表现为明显强化,但肾透明细胞癌的强化特点为快进快出型,而肾嗜酸细胞腺瘤为快进慢出型,且肾透明细胞癌可有淋巴结转移,而肾嗜酸细胞瘤可有中央瘢痕。结论综合分析肾透明细胞癌与肾嗜酸细胞腺瘤的CT平扫及增强扫描的影像学特点,有助于两者的鉴别诊断。     

肾细胞癌的MRI研究进展

肾细胞癌是最常见的成人肾脏恶性肿瘤。近年来，多种功能MRI成像技术（如扩散加权成像、灌注加权成像等）、多参数MRI联合分析以及影像组学等新兴影像处理技术被证实在肾细胞癌的诊断中具有较大的价值。目前，研究热点多集中于良恶性肿瘤的鉴别、组织学亚型的区分、肿瘤分期、预测核分级及判断预后。就MRI新技术及图像处理技术在肾细胞癌中的研究进展予以综述。     

Spontaneous gas formation in a sterile renal cell carcinoma

Sterile gas formation is a common sequela of therapeutic transcatheter embolization of tumors. We report a patient who spontaneously developed gas collections within an uninfected renal cell carcinoma with a computed tomographic appearance very similar to that seen following embolization. Possible mechanisms for sterile gas formation are discussed.     

肾嫌色细胞癌的CT诊断

目的 探讨肾嫌色细胞癌的CT表现,以提高诊断准确率.方法 回顾性分析经手术病理证实的9例肾嫌色细胞癌的CT表现.结果 CT平扫:肿瘤最大直径2.8～20.0cm,平均5.3cm.肿瘤呈低密度5例,等密度4例,密度均匀3例,不均匀6例.界限清楚4例,不清楚5例.肿瘤内见散在点状、条状或蛋壳样钙化3例,囊变坏死2例,出血2例.CT增强7例:皮质期呈轻至中度强化,界限清楚,平均CT值88HU,其中密度低于肾皮质和髓质3例,密度高于肾髓质而低于皮质4例.髓质期密度均匀减低,明显低于肾皮质和肾髓质,界限显示更清楚,平均CT值85HU.结论 肾嫌色细胞癌CT表现具有一定特征性,有助于鉴别诊断.