肾脏少见肿瘤的影像学诊断

肾脏肿瘤较常见,其中以恶性居多.WHO根据肾脏肿瘤的临床、病理、免疫、遗传、影像等特点对肾脏肿瘤重新进行了总结分类(表1).在该肿瘤分类中,常见的肾脏恶性肿瘤为肾细胞癌,少见者为肾淋巴瘤、肾恶性纤维组织细胞瘤、肾类癌等.肾脏良性肿瘤常见者为肾血管平滑肌脂肪瘤,少见者为后肾腺瘤、混合性上皮间质肿瘤等.     

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。     

多层螺旋CT鉴别诊断肾脏混合性上皮和间质肿瘤与囊性肾癌

目的探讨肾脏混合性上皮和间质肿瘤与囊性肾癌的多层螺旋CT(MSCT)表现及鉴别诊断要点,以提高二者术前影像诊断的准确性。资料与方法采用盲法研究,回顾性分析6例肾脏混合性上皮和间质肿瘤及14例囊性肾癌的MSCT表现,并与手术病理结果进行对照。结果 6例肾脏混合性上皮和间质肿瘤均为囊实性病变,但实性成分多少不等;其中BosniakⅢ型5例,BosniakⅣ型1例。14例囊性肾癌中,8例为透明细胞癌囊变,BosniakⅢ型7例,BosniakⅣ型1例;6例为多房性透明细胞性肾细胞癌,均为BosniakⅡF型。增强扫描示:肾脏混合性上皮和间质肿瘤实性部分在皮髓期呈轻度或中等程度强化,并随时间延迟强化程度增加;多房性透明细胞性肾细胞癌皮髓期菲薄间隔轻至中度延迟强化;7例BosniakⅢ型透明细胞癌囊变,皮髓期增厚间隔明显强化,1例BosniakⅣ型透明细胞癌囊变增厚间隔及结节皮髓期显著强化,二者强化程度较高,实质期强化程度均减退。结论肾脏混合性上皮和间质肿瘤囊性肾癌MSCT鉴别诊断有一定困难,但肿瘤实性成分的多少、间隔的形态以及增强方式可以为诊断及鉴别诊断提供依据。     

成人肾脏罕少见原发恶性肿瘤的CT表现

目的 分析成人肾脏罕少见原发恶性肿瘤的CT影像表现。方法 回顾性分析26例经手术病理证实为罕少见肾脏原发恶性肿瘤的CT特点。结果 26例中12例嫌色性肾细胞癌、3例集合管癌、3例MiT家族异位性肾细胞癌、2例多房囊性肾细胞癌、2例滑膜肉瘤、2例原发肾淋巴瘤、1例平滑肌肉瘤、1例恶性纤维组织细胞瘤。肿瘤最大径20～141 mm,平均62.5 mm; 23例肿瘤呈实性(其中13例伴囊变坏死)、3例呈囊实性。平扫病灶CT值与正常肾实质相仿或略高,动态增强扫描各期病灶CT值均低于正常肾皮质,病灶增强扫描各期平均绝对强化值分别为51.35 HU、52.69 HU、36.50 HU。5例增强后表现为“快进快出”的强化方式,其余21例均表现为缓慢、持续的强化方式。结论 罕少见肾脏原发恶性肿瘤的CT表现具有一定特征性,认识这些征象有助于提高术前诊断准确率。     

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.     

肾黏液样小管状及梭形细胞癌的CT表现与病理对照分析

肾黏液样小管状和梭形细胞癌(MTSCCa)是2004年WHO泌尿系统和男性生殖器官肿瘤分类中新命名的罕见病理类型[1],为一种独立的区分于肾脏其他肿瘤的肾上皮肿瘤.笔者回顾性分析2005年至2009年期间上海中医药大学附属曙光医院及南京鼓楼医院资料完整的5例MTSCCa资料,结合文献资料分析其影像特征及鉴别诊断要点.     

300例肾细胞癌CT表现分析

目的分析肾细胞癌（RCC）的CT表现，以期提高对该病的诊断正确性。方法回顾性分析300例经病理证实的RCC的CT表现。结果肿瘤长径为1．5～16．0cm，平均4．8cm，左肾125例、右肾175例。根据世界卫生组织（WHO）2004年公布的肾肿瘤组织学分型，分为透明细胞癌238例、多房性透明细胞癌6例、乳头状癌23例、嫌色细胞癌14例、未归类癌19例。上述各型RCC有其特征性的CT表现，透明细胞癌呈不均匀（因出血、坏死、囊变）而富血供；多房性透明细胞癌呈多房囊性肿块，囊壁和间隔薄而均匀，且无膨胀性结节；乳头状癌呈不均匀而少血供；嫌色细胞癌呈较均匀而少血供，未归类癌与透明细胞癌相似，但更具侵袭性生长。结论常见RCC各亚型有其特征性的CT表现，有助于鉴别诊断。     

肾癌亚型的CT表现与病理对照分析

目的 探讨肾癌亚型的影像学特征,提高诊断的准确率.方法 回顾性分析37例肾癌亚型的CT表现,其中透明细胞癌25例,嫌色细胞癌5例,乳头状癌5例,多房囊性肾细胞癌2例.所有病例均进行了SCT多期扫描.结果 25例肾透明细胞癌平扫表现为肾实质均匀或不均匀的等、稍低、稍高或混杂密度肿块,增强皮质期明显不均匀强化,强化程度等或高于肾皮质,髓质期强化程度迅速下降;出血、坏死及囊变23例,肿瘤内钙化3例.5例乳头状肾细胞癌平扫为均匀或不均匀类圆形肿块,呈轻中度较均匀或不均匀强化,皮质期密度低于肾皮质,瘤内出血3例,囊变2例.5例肾嫌色细胞癌平扫为位于肾髓质的类圆形肿块,4例呈均匀密度,1例呈混杂密度,增强后呈轻到中度均匀强化,皮质期密度低于肾皮质.2例多房囊性肾细胞癌表现为中心位于肾皮质的椭圆形囊性肿块,可见少量的实性部分及分隔,增强后间隔呈中度进行性延迟强化,实性部分强化与肾皮质等同.结论 不同的肾癌亚型影像学表现具有一定的特征性,螺旋CT动态增强扫描对诊断有帮助.     

乳头状肾细胞癌的CT表现与病理分析

世界卫生组织(WHO)于2004年制定了新的肾癌分类[1],其中乳头状癌是较为常见的病理类型,其生物学行为和预后不同于透明细胞癌、多房囊性透明细胞癌、髓质癌及未分类癌等亚型[1-3],所以术前正确区分乳头状癌对指导手术有意义.螺旋CT动态增强扫描能更多地反映肿瘤的特征,对肾癌的定性、分型及分期有价值.笔者回顾性分析本院2000年4月至2008年3月经手术病理证实的肾乳头状癌19例,对其动态增强CT表现与病理进行对照分析,探讨其影像特征.     

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.     

Erythropoietin-producing renal cell carcinoma arising from autosomal dominant polycystic kidney disease

Erythropoietin (EPO)-producing renal cell carcinomas (RCC) in patients with chronic renal failure secondary to autosomal dominant polycystic kidney disease (ADPKD) has not previously been reported. We report a case of EPO-producing RCC associated with ADPKD in a 66-year-old woman, and discuss the clinical and radiological findings.     

Imaging findings of ovarian metastasis of primary renal cell carcinoma: A case report and literature review

A 62-year-old woman presented with a tumor in the right kidney. A right partial nephrectomy was performed, and the tumor was diagnosed as clear cell renal cell carcinoma (RCC) on histopathological examination. A right ovarian tumor was detected on follow-up computed tomography (CT) 5 years after partial nephrectomy and pathology proved RCC metastasis. RCC rarely metastasizes to the ovaries. There is limited information on the radiological features of ovarian metastasis in RCC. In this case report, we presented the CT and magnetic resonance images of ovarian metastasis of RCC. In addition, we also presented a literature review with special emphasis on the imaging features of ovarian metastasis of RCC.     

Tuberose sclerosis complex: analysis of growth rates aids differentiation of renal cell carcinoma from atypical or minimal-fat-containing angiomyolipoma

AIM: To study the radiological characteristics of renal masses in individuals with tuberous sclerosis complex (TSC) using serial CT, and to examine how renal cell carcinoma (RCC) may be differentiated from indeterminate cysts or masses. METHODS: This was a retrospective study of 12 cases of TSC in which dedicated renal CT followed after US had demonstrated cystic or sonographically unusual renal masses. The CT density of all masses was measured and the masses categorized as simple cysts, complex cysts, angiomyolipomas or indeterminate solid masses. Subjects were maintained on regular follow-up with repeat CT or MRI and interval renal US. Indeterminate masses that showed rapid growth were considered suspicious for renal cell carcinoma and biopsy or nephrectomy followed. RESULTS: Comparative data were available for a median of 4 years. In each case the renal masses were multiple and bilateral; mean mass diameter was 3.6 cm. Among a total of 206 masses, 18 were simple cysts and 3 were complex cysts. Of the complex cysts, 1 proved to be an angiomyolipoma on histology and the other 2 showed no growth. Of the solid masses, 133 were typical angiomyolipomas (AMLs) and 52 were indeterminate. On follow-up, only 3 indeterminate masses showed rapid growth (>0.5 cm/year), of which only 1 proved to be an RCC on biopsy. The other 2 were minimal-fat AMLs, and the remainder of the masses showed no or slow growth. CONCLUSION: Many renal masses associated with TSC are radiologically indeterminate. A growth threshold of >0.5 cm/year identified the only RCC in this study (0.5% of all masses). Yearly radiological follow-up of indeterminate renal masses is recommended for individuals with TSC.     

Segmental disorders of the nephron: histopathological and imaging perspective

Recent advances in molecular genetics and immunocytochemistry have clarified the cell of origin in many renal disorders. Several renal disorders are thought to involve specific segments of the nephron. Renin-secreting tumours arise from juxtaglomerular cells. Clear cell and papillary renal cell carcinoma (RCC) recapitulate the epithelium of the proximal tubules. Oncocytoma and chromophobe RCC differentiate towards Type A and Type B intercalated cells of the cortical collecting duct, respectively. Medullary collecting ducts are the target sites for the development of autosomal recessive polycystic kidney disease, collecting duct carcinoma and medullary carcinoma. Renal papillae are susceptible to unique changes such as necrosis or papillitis. The purpose of our article is threefold: to illustrate the imaging findings of renal disorders that show segmental involvement of the nephron, to describe proximal and distal nephron disorders and to correlate imaging findings of some entities with histopathological features.     

Staging of renal cell carcinoma

As in other malignant tumors, prognosis in renal cell carcinoma (RCC) depends on tumor extent and metastasis at the time of primary diagnosis. Staging systems formalize the way in which the extent of RCC is being described and classified. Primary staging of RCC aims at evaluating surgical options. Since surgical excision, which is the mainstay of therapy in non-metastatic RCC, and, recently, minimally invasive ablation methods have evolved significantly over the last decades, staging systems continue to evolve along the way. The 40-year-old Robson classification has been replaced with the TNM classification of RCC, because the latter adapts more easily to changing patterns of diagnosis and therapy. Modern cross-sectional imaging methods, such as multidetector-row computed tomography (MDCT), and magnetic resonance imaging (MRI), perform highly in T-staging of local tumor extent and M-staging of distant metastasis. However, both MDCT and MRI perform poorly in N-staging of lymphadenopathy. At present, 18-F-desoxy-glucose positron emission tomography (FDG-PET) appears to be unreliable in the detection of RCC and its metastasis. This overview of current radiological and surgical literature attempts to describe how modern staging systems for RCC are organized, and which radiological and surgical developments currently influence the way in which primary staging and prognosis of RCC depend on one another.     

螺旋CT多期扫描对肾细胞癌的诊断价值

目的探讨CT在肾细胞癌诊断中的价值。方法回顾性分析22例经手术、病理证实的肾细胞癌CT表现。结果 CT平扫中5例病灶呈等密度或稍低密度,15例为混杂密度,2例为稍高密度。增强扫描皮质期18例明显强化,4例中等度强化,强化均匀或不均匀。肾实质期所有病灶强化迅速减退,肾盂期病灶强化进一步减低。其中8例肾癌出现肾周邻近脏器侵犯及淋巴结转移。结论肾细胞癌的CT表现具有一定特征性,CT对肾细胞癌的诊断具有很高的价值。     

The abdominal manifestation of von Hippel-Lindau disease and a radiological screening protocol for an affected family

The mortality in von Hippel-Lindau disease (VHL) is due to the development of central nervous system or abdominal malignancies, particularly renal cell carcinomas. The abdominal manifestations of VHL discovered in the radiological screening of 22 members of an affected family are described. We discuss the problems of making the diagnosis and of detecting small renal and pancreatic tumours against a background of multiple cystic disease. A radiological screening and surveillance protocol using ultrasound and computed tomography is described.     

Image-guided radiofrequency ablation of renal cell carcinoma

The incidence of renal cell carcinoma is rising with the increased number of incidental detection of small tumours. During the past few years, percutaneous imaging-guided radiofrequency ablation has evolved as a minimally invasive treatment of small unresectable renal tumours offering reduced patient morbidity and overall health care costs. In radiofrequency ablation, thermal energy is deposited into a targeted tumour by means of a radiofrequency applicator. In recent studies, radiofrequency ablation was shown to be an effective and safe modality for local destruction of renal cell carcinoma. Radiofrequency applicator navigation can be performed via ultrasound, computed tomography or magnetic resonance guidance; however, ultrasound seems less favourable because of the absence of monitoring capabilities during ablation. On-line monitoring of treatment outcome can only be performed with magnetic resonance imaging giving the possibility of eventual applicator repositioning to ablate visible residual tumour tissue. Long-term follow-up is crucial to assess completeness of tumour ablation. New developments in ablation technology and radiological equipment will further increase the indication field for radiofrequency ablation of renal cell carcinoma. Altogether, radiofrequency ablation seems to be a promising new modality for the minimally invasive treatment of renal cell carcinoma, which was demonstrated to exhibit high short-term effectiveness.     

Renal metastases from a squamous cell carcinoma of the larynx

Laryngeal squamous cell carcinoma (SCC) tends to exhibit local spread with a low incidence of distal metastases. The majority of distal metastases are to the lungs and renal involvement is extremely rare. We present a case of laryngeal SCC with metastatic spread to the left kidney presenting as a large, mainly cystic mass. The radiological differentiation of renal metastases from primary renal tumours is discussed.     

Ki-67和VEGF在肾细胞癌中的表达及意义

目的探讨肿瘤细胞核增殖抗原(Ki-67)和血管内皮生长因子(VEGF)在肾细胞癌(RCC)中的表达及在肾癌发生、发展过程中的作用。方法应用半定量RT-PCR技术检测55例肾癌组织和20例正常肾组织Ki-67和VEGFmRNA表达情况。结果Ki-67mRNA和VEGFmRNA在肾癌组织中表达显著高于正常肾组织(χ2=28.010,P<0.05和χ2=15.539,P<0.05),且两者都与肾癌临床病理参数存在相关性。结论Ki-67与VEGF在肾癌组织中高表达,且呈明显的正相关性,两者在肾癌细胞增殖及转移中起了重要作用。