小肾透明细胞癌的CT表现与病理组织对照研究

目的分析小肾透明细胞癌的CT表现及其与病理组织的关系。方法选择小肾透明细胞癌患者42例,其中男性27例,女性15例;年龄34~68岁,平均年龄50.6岁。对42例经手术后病理组织证实的小肾透明细胞癌病例进行CT征象及病理组织结果对照分析。结果 CT平扫32例为低密度,8例为等密度,2例为高密度;增强CT扫描皮质期,肿瘤实性部分明显强化,强化峰值≥100 Hu,排泄期迅速下降,低于正常肾实质,呈快进快出特点;不均匀强化26例,均匀强化16例。病理组织36例可见出血、坏死,细胞呈实性排列,6例呈囊性排列;出现小泡样结构2例,出现不规则钙化2例,出现假包膜38例。结论小肾透明细胞癌的CT表现与病理组织类型及肿瘤结构有关,动态增强扫描对小肾透明细胞癌的诊断及制定手术方案有重要意义。     

透明细胞肾细胞癌中cIAP1、cIAP2、XIAP的表达及其与临床指标的关系

目的：检测肾透明细胞癌中凋亡抑制蛋白cIAP1、cIAP2和xIAP基因表达状况及其与,临床病理指标间的关系。方法：采用RT-PCR方法检测cIAP1、cIAP2和XIAP在透明细胞肾细胞癌中RNA水平的表达。分析其与透明细胞肾细胞癌,临床病理指标间的关系。结果：在透明细胞‘肾细胞癌中cIAP1和cIAP2的mRNA阳性率分别为85％（17／20）和60％（12／20）,均高于正常肾组织。cIAP1 mRNA在Fuhrman核分级1、2级的肾细胞癌中表达高于核分级3和4的肿瘤。XIAP的表达在肾细胞癌与癌旁正常肾组织间无差异,并与TNM分期、Fuhrman分级没有相关性。结论：IAP家族成员cIAP1与肾细胞癌的临床病理指标相关。     

肾肿瘤中受体酪氨酸激酶RON的表达及意义

目的 探讨RON在肾肿瘤中的表达以及RON表达与肾肿瘤局部侵袭和分化程度的关系.方法 利用免疫组化法测定48例肾透明细胞癌、20例嫌色细胞癌、3例嗜酸性细胞腺瘤肿瘤组织RON表达.结果 RON在肾嫌色细胞癌中表达强度最高,透明细胞癌其次,而在嗜酸性细胞腺瘤中最低,但无统计学意义差异;透明细胞Fuhrman核分级3-4级阳性表达强度高于核分级1或2级(P<0.05);肿瘤直径>7 cm的RON表达强度大于<7 cm病例;RON在存在.肾盂侵袭的病例中有较高表达的趋势.结论 RON肾细胞癌的演进中可能起重要作用.     

肾嗜酸细胞腺瘤螺旋CT诊断（附10例分析）

目的：总结肾嗜酸细胞腺瘤螺旋CT表现,为该病的术前诊断和手术方案选择提供依据。方法：分析10例经手术病理证实的肾嗜酸细胞腺瘤的螺旋CT表现。结果：（1）平扫6例最大直径小于3cm的肿瘤平扫时呈等密度,仅表现为肾轮廓局限性隆起;4例最大直径大于3cm的肿瘤密度不均匀。其中2例病灶内见斑点状钙化。（2）增强扫描5例较均匀强化,5例强化不均匀,其中4例在皮髓期病灶出现中央“星状瘢痕”。（3）全部病灶内实质成分强化程度均小于同期肾实质,在肾实质期测量、计算病灶-肾皮质强化比值为0．84（0．73～0．98）。（4）10例增强后行MIP、MPR重建显示9例肿瘤血供来自同侧肾动脉,1例血供来自腹主动脉。结论：肾嗜酸细胞腺瘤CT诊断困难,但是如果出现了一些特征性的征象（如“星状斑痕”征）,应考虑到本病的可能性。结合术中病理检查,可避免不必要的肾脏根治性手术。     

肝内胆管细胞癌的CT表现与病理对照分析

目的 对比研究肝内胆管细胞癌的CT表现与临床病理特征。方法 回顾性分析经病理证实的肝内胆管细胞癌19例,均行CT平扫和动态增强扫描。将肝内胆管细胞癌CT表现及病理进行对照分析。结果 肿瘤在CT上表现为不规则软组织肿块,伴远侧胆管扩张,病理上肿瘤外周主要由大量恶性肿瘤细胞分布,中央区由大量纤维组织构成,形成肿瘤延迟期强化的病理基础。临近肝包膜的肿块引起癌脐征。结论 肝内胆管细胞癌的临床表现缺乏特异性,动态增强是CT诊断和鉴别诊断要点。增生纤维组织形成肿瘤延迟强化的病理基础;排列成腺管的癌细胞引起肿瘤早期强化。肿块边缘不清,增强后边缘不规则,反映肿瘤多无包膜的病理特征。肿瘤浸润生长,内部大量纤维组织存在,出现牵拉,CT表现为癌脐征。     

能谱CT在肺部磨玻璃结节良恶性鉴别中的应用价值

【摘 要】 目的:探讨肺混合性磨玻璃结节能谱计算机断层扫描成像（CT）特异性征象,通过对各种结节成分和征象的分析对肺微浸润癌（MIA）、浸润性腺癌（IPA）及肺结核腺泡结节（AN）进行鉴别诊断。 方法:回顾性分析156例肺混合磨玻璃结节及肺结核腺泡结节患者的能谱CT扫描图像及临床资料,并结合病理结果进行对比讨论。 结果:156例患者共有221个结节,均经过手术及送病理检查,包括62个MIA、76个IPA、78个AN、3个硬化性血管瘤及2个炎性假瘤。其中,MIA组结节CT值较低,约为（-221±101） HU,其征象主要为空泡征,占45.16％;IPA组CT值较MIA组高,约为（-102±54） HU,主要征象为分叶征,占47.36％;AN组CT值最高,约为（-40±27） HU,CT征象结节边缘平滑,占70.51％。3组病例CT值及CT征象存在统计学差异（P<0.05）。 结论:能谱CT形态学特征能在一定程度上鉴别MIA、IPA及AN,为临床早期诊疗不同疾病提供相关依据。     

肾脏特异性钙黏蛋白在肾上皮性肿瘤的表达及其临床病理意义

目的探讨肾脏特异性钙黏蛋白（Ksp—cadherin）的新抗体在肾细胞癌和肾嗜酸细胞腺瘤中的表达意义。方法收集166例肾脏肿瘤标本,其中肾原发性透明细胞癌120例、乳头状肾细胞癌20例（I型乳头状肾细胞癌15例,Ⅱ型乳头状肾细胞癌5例）、嫌色细胞癌18例、嗜酸细胞腺瘤8例。使用Ksp—cadherin、CD10、波形蛋白、上皮细胞膜抗原（EMA）、CK7进行免疫组织化学（EnVision法）染色。结果Ksp-cadherin的表达率分别是透明细胞癌23％（27／120）,乳头状肾细胞癌20％（4／20）,嫌色细胞癌18／18,嗜酸细胞腺瘤6／8。CD10、波形蛋白在透明细胞癌和乳头状肾细胞癌有高表达,CK7主要表达于嫌色细胞癌和乳头状肾细胞癌,EMA在这4种肿瘤均有高表达。此外,CDl0在肾嫌色细胞癌中也有表达,但其表达于胞质,而在其他肿瘤的表达在细胞膜。Ksp—cadherin在肾透明细胞癌的表达程度与其分期分级呈正相关。结论Ksp—cadherin局限表达于远端肾小管及其起源的肾脏肿瘤。在嫌色细胞癌和嗜酸细胞腺瘤中有高度的特异和敏感性,在透明细胞癌中的表达和分期分级有关,在肾脏常见的上皮性肿瘤中具有鉴别诊断和预后价值。     

肾嫌色细胞癌的MDCT多期增强模式及影像学分析

目的 探讨肾嫌色细胞癌的多排螺旋CT（multi-detector spiral computed tomography,MDCT）平扫及多期增强特征。 方法 回顾性分析67例（68灶）肾嫌色细胞癌的临床资料及MDCT征象,按肿块大小分为两组（最大径≤4 cm及>4 cm组）,比较两组肿块MDCT特征,计算肿块实性部分在平扫、肾皮质期、实质期及肾盂期的CT值及其与同侧邻近肾皮质CT值的比值（La0、La1、Lv1、Lp1）并分度,分析肿块的强化方式;进行统计学分析。 结果 两组肿块内出现钙化、中央瘢痕及皮质期小血管征及肿块邻近肾盏、肾盂受压、肾门血管受压推移的百分比有显著差异（均P<0.05）;肿块实性部分La1、Lv1、Lp1间有显著差异（P<0.05）;强化峰值多出现于皮髓交界期或实质期（42/68）,皮质期次之（23/68）,两者间有显著差异（P<0.05）。 结论 肾嫌色细胞癌的部分MDCT特征与肿块大小有关,其强化方式多样,仔细观察肿块平扫及多期增强特点,有助于术前诊断及鉴别诊断。     

肾管状囊性癌临床病理和分子特征

肾细胞癌是一组遗传上、生化上、生物学和形态上异质性的肿瘤。尽管WHO肾肿瘤分类系统将Bellini集合管癌作为肾细胞癌的亚型，但是，由于缺少分子和生化研究的有力支持，Bellini集合管癌仍是有争议的疾病单元。最初，集合管癌分为高级别和低级别肿瘤，肾髓质癌被认为是高级别集合管的特殊亚型（现被认为是肾癌的特殊亚型）。     

乳头状肾细胞癌32例临床病理分析

目的：探讨乳头状肾细胞癌( papillary renal cell carcinoma, PRCC)的临床病理特征、免疫表型、鉴别诊断和预后。方法回顾性分析32例PRCC患者的临床和病理资料,采用免疫组化EnVision法染色,并对患者进行随访。其中21例行根治性肾切除术,11例行肾部分切除术。结果770例肾上皮性肿瘤中32例为PRCC(4.2%)。镜下见PRCC主要由多少不等的乳头状和管状结构组成,被覆单层立方或多层柱状肿瘤细胞,乳头轴心及间质内可见泡沫细胞、砂砾体沉积,部分肿瘤细胞胞质内可见含铁血黄素。Ⅰ型18例,细胞呈立方形,胞质少,嗜碱性,淡染,Fuhrman分级低级别16例;Ⅱ型14例,细胞呈高柱状,胞质丰富,嗜酸性,Fuhrman分级高级别12例。Ⅰ型和Ⅱ型PRCC不同程度地表达vimentin、EMA、CK(AE1/AE3)、CK7、CD10和AMACR,均不表达CK(34βE12)和TFE-3。31例患者获得随访,1例术后肝、肺转移,4个月后死亡,3例术后1年分别出现骨、肺、肝等处转移,2年后死亡;死亡患者中Ⅱ型3例、Ⅰ型1例。其余27例均无瘤生存。高核分级、血管内癌栓、淋巴结转移、高临床分期提示患者预后较差。结论 PRCC国内少见,具有独特的病理形态特征,Ⅱ型PRCC较Ⅰ型患者预后差。 PRCC细胞核分级高、出现肉瘤样成分或有透明细胞癌结构可能提示肿瘤具有侵袭性,预后不良。诊断时需结合病理组织学特征、免疫表型和细胞遗传学分析。     

Subtypes of renal cell carcinoma. Different onset and sites of metastatic disease

Different subtypes of renal cell carcinoma have different genetic features and prognoses. Whether the patterns of metastatic spread of different subtypes of renal cell carcinoma are different is unknown. To assess this, we reviewed the time course and sites of all pathologically confirmed metastatic disease in patients who underwent resection of the primary tumor at Brigham and Women's Hospital, Boston, MA, between 1973 and 1997. In 82 patients, 119 metastatic lesions were identified. Compared with clear cell tumors, papillary tumors were more likely to be Fuhrman grade 3 or 4, to have metastases present at the time of resection, and to involve lymph nodes but not lung. Metastases associated with chromophobe tumors developed in 3 patients, all of whom had Fuhrman grade 2 tumors, and were found only in the liver. We conclude that different subtypes of renal cell carcinoma develop pathologically confirmed metastases at different times and sites. The value of Fuhrman grading may depend on the subtype of renal cell carcinoma.     

超声造影与增强CT对小肾癌诊断价值及不同病理类型超声造影表现的研究

目的 通过对比超声造影与增强CT在小肾癌中的诊断准确率及不同病理类型超声造影的表现,探讨超声对小肾癌及不同病理类型的诊断价值,提高小肾癌的诊断水平。方法 回顾性分析2010年6月~2017年12月我院收治的60例直径小于4 cm肾占位性病变患者的超声造影和增强CT检查资料,并根据病理检查结果进行对比研究,比较两种检查方法对小肾癌的诊断准确率、灵敏度、阳性预测值和阴性预测值,同时对比不同病理类型的小肾癌在超声造影下的灌注特点。结果 超声造影诊断准确率为96.67%,高于增强CT的95.00%,差异无统计学意义（P＞0.05）。肾透明细胞癌主要以快进快退为主（42.86%）,其次为快进慢退（36.73%）、等进等退（8.16%）和其他（8.16%）、慢进慢退（4.08%）;乳头状肾细胞癌主要以慢进慢退（57.14%）,其次为快进快退为主（42.86%）;嫌色细胞癌均为快进快退（100.00%）;错构瘤为慢进慢退（100.00%）;嗜酸性粒细胞瘤为快进慢退（100.00%）。结论 肾癌的病理类型以透明细胞癌为主,透明细胞癌的超声造影表现主要以快进快退为主,乳头状肾细胞癌以慢进慢退为主,嫌色细胞癌以快进快退为主。通过超声造影提示基本可以评估小肾癌的病理类型,超声造影、增强CT对小肾癌的诊断都具有较高的价值,但增强CT可以为小肾癌精确定位诊断提供重要参考。若两者联合使用,有助于提高诊断准确率,为临床的诊断及临床手术方案的拟定提供更大的帮助。     

The post-operative pathological prognostic parameters of clear cell renal cell carcinoma in pT1a cases

There has been a recent increase in the number of small clear cell renal cell carcinoma (ccRCC) cases, particularly in pT1a cases. The prognostic parameters for small ccRCC, however, are not well described. Herein, we assess the pathological parameters of pT1a patients. Various clinicopathological parameters were analyzed in 293 patients with pT1a ccRCC without pre-operative metastasis to predict the disease-free survival rate (DFS) and the cancer-specific survival rate (CSS). Clinicopathological parameters included age, tumor location, Fuhrman grade, lymph-vascular invasion (LVI), tumor necrosis, and growth pattern (expansive or infiltrative). In the univariate analysis, Fuhrman grade (grade 1 + 2 vs. 3 + 4), LVI, growth pattern, and tumor necrosis were parameters associated with a worse prognosis (P < 0.0001) in both the DFS and CSS. In the multivariate analysis, Fuhrman grade (P = 0.0048), growth pattern (P = 0.0275), and tumor necrosis (P = 0.0188) were statistically significant in the DFS. Fuhrman grade (P = 0.0189) and growth pattern (P = 0.0016) were also statistically significant in the CSS. Fuhrman grade, tumor necrosis, and growth pattern were independent prognostic parameters in pT1a ccRCC. Growth pattern, a previously unrecognized parameter for prognosis, can be considered a new prognostic parameter in ccRCC.     

Multilocular cystic renal cell carcinoma : a report of 45 cases of a kidney tumor of low malignant potential

The 2004 World Health Organization (WHO) classification of kidney tumors recognizes multilocular cystic renal cell carcinoma (MCRCC) as a rare variant of clear cell renal cell carcinoma with a good prognosis. Available information on its clinical significance is limited. The study cohort included 45 MCRCC cases classified according to 2004 WHO criteria obtained through a multi-institutional international search. Most patients had unilateral MCRCC with no side predominance that was found incidentally; 62% were men, but women had tumors at an earlier age (P = .385). MCRCC occurred slightly more often in men than in women (1.7:1). At diagnosis, 82% of patients had stage T1 and 16%, stage T2; 1 patient had stage T3. The Fuhrman grade was 1 (62%) or 2 (38%), with smaller tumors (相似文献   

Morphologic subtyping of papillary renal cell carcinoma: correlation with prognosis and differential expression of MUC1 between the two subtypes.

Papillary renal cell carcinoma is now a well-established entity with distinct histological and cytogenetic features. A subdivision has been proposed in correlation with prognosis. Type 1 is the most frequent subtype and appears to have a better prognosis than Type 2. The subdivision is based on microscopic criteria. To investigate these 2 types of papillary renal cell carcinoma, we have compared the clinical features, ancillary factors (TNM stage, Fuhrman grade), survival and MUC1 expression in 25 Type 1 and 12 Type 2 papillary renal cell carcinomas. Type 2 tumors were significantly associated with a higher Fuhrman grade (Grade III frequent; P <.001). Type 2 tumors were also associated with a poorer prognosis than Type 1 (P <.005). Fuhrman grade was significantly associated with prognosis (P <.005). The type and the prognosis were not correlated with the TNM stage. We have shown a differential expression of MUC1 between Type 1 and Type 2 with a polarized expression in Type 1 and a rare expression in Type 2. In conclusion we confirm that the morphologic sub-typing and Fuhrman grade are valuable factors of outcome of papillary renal cell carcinomas and that MUC1 immunostaining is useful in differentiating Type 1 and Type 2 tumors.     

Hereditary and Sporadic Papillary Renal Carcinomas with c-met Mutations Share a Distinct Morphological Phenotype

Germline mutations of c-met oncogene at 7q31 have been detected in patients with hereditary papillary renal cell carcinoma. In addition, c-met mutations were shown to play a role in 13% of patients with papillary renal cell carcinoma and no family history of renal tumors. The histopathology of papillary renal cell carcinoma with c-met mutations has not been previously described. We analyzed the histopathology of 103 bilateral archival papillary renal cell carcinomas and 4 metastases in 29 patients from 6 hereditary papillary renal cell carcinoma families with germline c-met mutations and 6 papillary renal cell carcinomas with c-met mutations from 5 patients with no family history of renal tumors. Twenty-five sporadic renal tumors with prominent papillary architecture and without somatic c-met mutations were evaluated for comparison. All papillary renal cell carcinomas with c-met mutations were 75 to 100% papillary/tubulopapillary in architecture and showed chromophil basophilic, papillary renal cell carcinoma type 1 histology. Fuhrman nuclear grade 1-2 was seen in tumors from 23 patients, and nuclear grade 3 was observed focally in 8 patients. Seventeen patients had multiple papillary adenomas and microscopic papillary lesions in the surrounding renal parenchyma. Clear cells with intracytoplasmic lipid and glycogen were focally present in tumors of 94% papillary renal cell carcinoma patients. Clear cells of papillary renal cell carcinoma had small basophilic nuclei, and clear cell areas lacked a fine vascular network characteristic of conventional (clear) cell renal cell carcinoma. We conclude that papillary renal cell carcinoma patients with c-met mutations develop multiple, bilateral, papillary macroscopic and microscopic renal lesions. Renal tumors with c-met genotype show a distinctive papillary renal cell carcinoma type 1 phenotype and are genetically and histologically different from renal tumors seen in other hereditary renal syndromes and most sporadic renal tumors with papillary architecture. Although all hereditary and sporadic papillary renal cell carcinomas with c-met mutations share papillary renal cell carcinoma type 1 histology, not all type 1 sporadic papillary renal cell carcinomas harbor c-met mutations.     

Renal cell carcinoma with sarcomatoid features and peritumoral sarcoid-like granulomatous reaction: report of a case and review of the literature

Granulomatous inflammation with multinucleated giant cells is observed in various infectious and noninfectious diseases. It has been found in association with malignant tumors and designated sarcoid-like reaction. The distinction between a tumor-related granulomatous reaction and a true sarcoidosis can be a problematic issue. A case of renal cell carcinoma with sarcomatoid features (Fuhrman nuclear grade IV) with an extensive peritumoral sarcoid-like reaction and a critical review of the few cases of this association described in the literature have been reported, and the problematic clinical and pathological assessments of such lesions are discussed.     

Fine‐needle aspiration of renal cell carcinoma: Is accurate Fuhrman grading possible on cytologic material?

The Fuhrman grading system of renal cell carcinoma (RCC) consists of four grades based on nuclear size/contour and nucleolar conspicuousness. Fuhrman grading of histpathologic material is an independent prognostic parameter for RCC. Although widely used in surgical pathology, Fuhrman grading is not routinely performed on cytologic material. Thirty-three cases of renal fine needle aspirations (FNAs) with histologically proven RCC were retrieved from the cytopathology archives at Johns Hopkins Hospital. Fuhrman grade was determined independently and blindly by three faculty cytopathologists and compared with the Fuhrman grade of the subsequent surgical pathology specimen. The 33 resection specimens had the following Fuhrman grades: 0/33, grade I; 24/33 (73%), grade II; 9/33 (27%), grade III; and 0/33, grade IV. After Fuhrman grading was applied to the FNA material, diagnostic sensitivity was 83% for grade II versus 44% for grade III. The specificity and accuracy were 50 and 75%, respectively, for grade II versus 100% and 84% for grade III. Diagnostic sensitivity for grade II tumors ranged from 38 to 83%, grade III 44-62%. Diagnostic specificity for grade II tumors ranged from 50 to 78%, grade III 80-100%. Accuracy ranged from 48 to 75% for grade II and 75-87% for grade III. Using a two-tier grading model, accuracy improved to 84.2%. In our experience, Fuhrman grading of FNA specimens yielded variable results. There was only moderate agreement between cytopathologists, with an overall tendency to undergrade the tumor when compared with the resection specimen. Averaging the participants' grading and using a two-tier instead of four-tier system improved overall performance.