肾透明细胞癌胰腺转移1例

患者，男，76岁。1993年因右肾透明细胞癌行右肾切除术，2003—04再次发现左肾多发癌，于同年5月行左肾手术探查活检，病理诊断为“透明细胞癌(免疫组化：CK ，Vim 、SMA-、HMB-45-、HHF-35-)”。鉴于患者孤肾，为保存肾功能而对左肾癌灶行光动力学射频治疗。并续以IL-2联合CIK的生物治疗。术后每3个月复查腹部CT，示左肾癌灶明显缩小。但于2004—08查腹部CT发现胰腺头增大，体、尾部肿瘤占位病变。患者有食欲减退、进食后轻度腹胀症状，     

肾透明细胞癌的MRI诊断

目的：探讨肾透明细胞癌的MRI表现,提高对该病的认识。方法：搜集临床资料完整并经手术病理证实的肾脏透明细胞癌25例,均行MRI扫描,其中16例行MRI增强扫描。结果：本组25例患者均为单肾发病,其中左肾11例,右肾14例。肿块直径2．0～16．2cm,其中肿块直径小于4．0cm 8例,直径大于40cm17例。平扫在T1WI呈低信号20例,等信号2例,混杂信号3例,T2M呈高信号22例,低信号1例,混杂信号2例。肿块呈膨胀性生长21例,呈浸润性生长4例。肿块内见不规则坏死、囊变区,MR信号显示不均12例。显示假包膜12例。增强显示16例均以边缘强化为主,全瘤均呈不均匀强化;16例中于皮质期明显强化4例,强化程度高于肾皮质,呈轻中度强化11例,不强化1例;实质期明显强化3例,轻度强化13例;肾盂期16例均呈轻度强化。12例肿块内有不规则坏死、囊变区于增强各期中均未见强化。假包膜呈轻中度持续性强化。结论：MRI能观察肾癌生长方式,了解侵犯周围组织及转移情况,根据信号和增强表现能作出较正确诊断。     

肾透明细胞癌碳酸酐酶9表达程度与肿瘤复发关系初探

目的：探讨碳酸酐酶9（ carbonic anhydrase 9,CA9）在肾透明细胞癌组织中表达程度与疾病预后之间的相关性。方法收集军事医学科学院附属医院泌尿外科2011年9月～2014年1月接受手术的53例肾透明细胞癌患者术后癌组织标本,并对患者进行随访,统计患者肿瘤复发情况与无疾病生存率（ DFS）。通过免疫组化检测石蜡切片中CA9的表达并将其与随访结果进行整合分析。结果在随访53例肾透明细胞癌患者中,11例非转移性肾癌患者术后出现了复发病灶, DFS最长为22个月,最短为4个月,中位DFS为10个月。肿瘤复发组与对照组的免疫组化图像累积光密度值（IOD）分别为230879．84±64878．72和444993．31±146946．27,差异具有统计学意义（P＜0．01）。结论肾透明细胞癌组织中CA9的低表达可能与疾病不良预后相关,可作为判断肾癌预后的指标。     

肾透明细胞癌额窦转移1例

患者 女,45岁.以右额部肿痛1月余为主诉入院.既往因右肾透明细胞癌行右肾根治性切除术.查体:右侧额窦区皮肤稍隆起伴压痛,余未见异常.超声检查:右侧额窦区可见1.7 cm×1.1 cm边界欠清晰形态欠规则低回声光团,邻近骨皮质连续性中断,其内可见丰富血流信号,左侧额窦区未见明显肿块回声(图1).外院CT显示右侧额窦...     

B超诊断肾透明细胞癌1例

1　临床资料　患者 ,女 ,5 4岁 ,因阴道不规则出血 ,Ｂ超诊断“子宫肌瘤”入院治疗。入院后临床查体 :腹部平坦 ,软 ,左肋下三指可触及包块 ,上界不清 ,质硬 ,无压痛。血、尿常规化验检查无异常发现。怀疑“脾肿大”申请Ｂ超检查。Ｂ超见 :脾正常大小 ,内回声无异常。而左肾明显增大 (16 .0ｃｍ× 9.5ｃｍ) ,失去正常的肾形态 ,内无正常的肾集合系统回声 ,取而代之的为 9.1ｃｍ× 6 .4ｃｍ实质性肿物 ,呈椭圆型。肿物周边尚清晰 ,似有包膜 ,内回声不均匀并有三个不规则小低回声暗区。右肾未见异常。Ｂ超诊断 :左肾实质性肿物 (恶性可能 )。…     

CYFIP2在肾透明细胞癌细胞增殖及迁移中的作用

目的 探讨CYFIP2基因在肾透明细胞癌(KIRC)增殖及迁移中的作用.方法 利用TCGA数据库分析CYFIP2基因在KIRC中的表达及与临床病理因素的相关性.将KIRC细胞系786-O转染siRNA-CYFIP2对CYFIP2基因进行敲低,并利用携带有CYFIP2基因的病毒颗粒感染786-O细胞构建CYFIP2基因稳...     

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。     

MDCT对肾透明细胞癌中肾窦脂肪侵犯的诊断价值

目的 探讨术前MDCT评估肾透明细胞癌肾窦脂肪侵犯的可行性,并辨认其影像学特点.方法 回顾性分析经病理证实的113例肾透明细胞癌患者的临床及影像学资料,其中肾窦脂肪侵犯27例,术前均接受MDCT多期增强扫描.由两名放射科医师通过CT图像中肿瘤大小、灌注程度、侵犯肾盂肾盏、肿瘤边缘等征象判定是否存在肾窦脂肪侵犯.通过单因素及多因素分析评价肾窦脂肪侵犯的危险系数.结果 术前MDCT评估肾透明细胞癌肾窦脂肪侵犯的准确性为79.2％(x2=40.85,P＜0.001)、敏感性为66.7％、特异性为91.9％.肿瘤大小、灌注减低、侵犯肾盂肾盏和肿瘤边缘不规则均是肾窦脂肪侵犯的主要预测因素,其中肿瘤大小、侵犯肾盂肾盏可作为评价肾窦脂肪侵犯的重要危险因素.结论 MDCT对检测肾透明细胞癌肾窦脂肪侵犯有较高的诊断价值,有助于临床手术方式的选择及患者预后的评估.     

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。     

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.     

肾透明细胞癌中microRNA21和PDCD4的表达和生物学意义

目的检测microRNA-21(miR-21)和PDCD4在肾透明细胞癌组织和不同侵袭潜能细胞中的表达特点,探讨二者的相关性及临床意义。方法常规提取组织和细胞总RNA和蛋白质,应用定量PCR技术检测肾透明细胞癌组织及癌旁正常组织miR-21表达水平。免疫组织化学方法检测癌组织和癌旁组织中PDCD4蛋白表达水平。统计表达数据,分析二者间表达的相关性。结果对比正常癌旁组织和肾小管上皮细胞系HK-2少量表达,肾癌组织和肾癌细胞系ACHN和786-0中miR-21表达水平显著升高,表达水平随细胞系侵袭力的增高而升高,差异具统计学意义。PDCD4蛋白在肾癌组织和癌旁组织均有表达,癌组织中的表达阳性率30.3%,显著低于癌旁正常组织的阳性表达率95%。中、高分化肿瘤PDCD4蛋白阳性表达率显著高于低分化肿瘤组织,差异具统计学意义。相关性分析结果显示在肾癌组织中,miR-21和PDCD表达呈负相关(r=-0.795,P<0.01)。结论在肾癌组织中,miR-21呈高表达,PDCD4呈低表达,两者呈负相关,其表达与肿瘤的分化程度密切相关。     

透明细胞乳头状肾细胞癌的影像学表现

目的 探讨透明细胞乳头状肾细胞癌(CCPRCC)的影像学表现.方法 分析15例CCPRCC患者CT及MRI影像特征,采用独立样本t检验比较肿瘤与肾皮质之间平扫CT值、ADC值差异.结果 15例均为单发,边界清晰,大小为(3.1±1.9) cm.13例为实性肿瘤,其中11例伴囊变,2例为囊性肿瘤.4例CT平扫呈等或稍低密...     

肾透明细胞癌的CT表现

目的分析肾透明细胞癌的CT影像特点。方法回顾性分析经病理证实的肾透明细胞癌16例,从病灶数目、大小、形态、强化方式及与邻近结构关系等方面总结其CT影像特点。结果本组16例均为单发病灶,多位于肾皮质,形态多为圆形或类圆形,多凸出肾轮廓之外,平均4.7cm(2.2~10cm不等),伴或不伴邻近结构受累;增强扫描大多数(12例)动脉期明显不均质强化,静脉期及分泌期强化程度降低,低于周围肾实质,即典型的"快进快出"式强化,1例动脉期中等度强化,2例仅轻度强化,1例肿瘤内形成动静脉瘘。本组病例其中1例为囊性肾透明细胞癌,内可见多发点状及条状钙化,增强后呈中等强化,囊内容物不强化。结论 CT扫描是肾透明细胞癌的重要检查手段,其较特征性的动脉期强化方式是与其它类型肾癌相鉴别的重要参考依据。     

肾透明细胞癌与嫌色细胞癌、嗜酸细胞腺瘤CT 表现

目的：探讨C T扫描对肾癌亚型的鉴别诊断价值。方法收集29例经手术病理证实的肾癌患者资料,其中肾透明细胞癌（CCRCC）14例,肾嫌色细胞癌（CRCC）8例,嗜酸细胞腺瘤（OA ）7例,对比分析各亚型肿瘤患者CT 平扫及三期增强扫描表现并与病理对照。结果 CCRCC和OA多数密度不均（分别为12／14和5／7）、常见坏死（11／14和5／7）;CRCC密度多均匀（6／8）。CCRCC淋巴结及远处器官转移最常见（11／14）,CRCC节段增强反转最常见（5／8）。CT 平扫期,CCRCC密度稍高于CRCC、OA及正常肾皮质（45．8±3．6与41．4±2．4与43．7±3．3与41．5±5．1,F值＝2．458, P ＞0．05）。增强CT三期扫描CCRCC强化程度最高,强化模式呈“快进快退”,OA呈中度‐明显强化,CRCC强化程度最轻,两者均呈“渐进性”延迟强化。CCRCC强化程度接近于各期肾皮质强化,OA强化稍低于各期肾皮质强化,CRCC强化程度明显低于肾皮质强化（ P ＜0．01）。OA强化程度高于CRCC（ P ＜0．01）。皮质期及皮髓质期,OA强化高于肾髓质（ P ＜0．01）,但肾盂期低于肾髓质（ P ＜0．01）。皮质期,CRCC强化值高于肾髓质,但皮髓质期及肾盂期低于肾髓质强化。结论 CCRCC、CRCC和OA的CT扫描有一定的特征性表现,与其病理特点密切相关,在肾癌亚型的鉴别诊断中有着较高的临床应用价值。     

Differentiation of renal clear cell carcinoma and renal papillary carcinoma using quantitative CT enhancement parameters

OBJECTIVE: The purpose of our study was to evaluate quantitative multiphasic CT enhancement patterns of malignant renal neoplasms to enable lesion differentiation by their enhancement characteristics. We used a new method to standardize enhancement measurement in lesions on multiphasic CT not being influenced by intrinsic factors like cardiac output. CONCLUSION: The new correction method is a simple tool for excluding intrinsic influences on the enhancement of lesions. Quantitative enhancement evaluation with this method of the influence of intrinsic factors enables accurate differentiation between renal clear cell carcinoma and renal papillary carcinoma.     

Livin及Caspase-3蛋白在肾癌组织中的表达及意义

目的观察Livin及Caspase-3蛋白在肾癌组织中的表达及其临床病理意义。方法采用免疫组化法检测69例肾癌中Livin及Caspase-3蛋白的表达。结果 Livin蛋白在肾癌中的阳性率明显高于肾组织,而Caspase-3则反之。结论 Livin蛋白表达增高与肾癌的临床分期,复发密切相关。检测Livin及Caspase-3有助于提高肾癌侵袭转移能力的评估,并可作为判定肾癌生物学行为的客观指标。     

CT and clinical features for distinguishing endophytic clear cell renal cell carcinoma from urothelial carcinoma

PURPOSEWe aimed to characterize the clinical and multiphase computed tomography (CT) features of the distinguishing endophytic clear cell renal cell carcinoma (ECCRCC) from endophytic renal urothelial carcinoma (ERUC).METHODSData from 44 patients (35 men and 9 women) with ECCRCC and 21 patients (17 men and 4 women) with ERUC were retrospectively assessed. The mean patient age was 55 years (48.25-59.50 years) and 68 years (63.00-73.00 years), respectively. Univariate and multivariate logistic regression analyses were performed to determine independent predictors for ECCRCC and to construct a predictive model that comprised clinical and CT characteristics for the differential diagnosis of ECCRCC and ERUC. Differential diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC).RESULTSThe independent predictors of ECCRCC were heterogeneous enhancement (odds ratio [OR] = 0.027, P = .005), hematuria (OR for gross hematuria = 53.995, P = .003; OR for microscopic hematuria = 31.126, P = .027), and an infiltrative growth pattern (OR = 24.301, P = .022). The AUC of the predictive model was 0.938 (P < .001, sensitivity = 84.10%, specificity = 95.20%), which had a better diagnostic performance than heterogeneous enhancement (AUC = 0.766, P = .001, sensitivity = 81.82%, specificity = 71.43%), hematuria (AUC = 0.786, P < .001, sensitivity = 81.82%, specificity = 66.67%), and infiltrative growth pattern (AUC = 0.748, P = .001, sensitivity = 90.48%, specificity = 59.09%).CONCLUSIONThe independent predictors, as well as the predictive model of CT and clinical characteristics, may assist in the differential diagnosis of ECCRCC and ERUC and provide useful information for clinical decision-making.

Main points

• Endophytic clear cell renal cell carcinoma (ECCRCC) and endophytic renal urothelial carcinoma (ERUC) have different computed tomographic (CT) characteristics and clinical features.
• ECCRCC can be distinguished from ERUC by using CT characteristics and clinical data.
• A predictive model may improve the differential diagnosis of ECCRCC and ERUC.

Renal cell carcinoma (RCC) is the most common malignant renal tumor,¹ and 70%-80% of RCC cases are clear cell renal cell carcinoma (ccRCC).^2-5 ccRCCs are usually exophytic renal masses, wherein the tumor center is located in the renal parenchyma or extrarenal fat. However, ccRCCs may also be endophytic masses and may mimic endophytic renal urothelial carcinoma (ERUC).^6,7 Because of their different treatments⁸ and prognoses, the preoperative differentiation of endophytic clear cell renal cell carcinoma (ECCRCC) and ERUC via computed tomography (CT) is challenging for urologists. Similarly, the same location of tumors makes it difficult to distinguish ECCRCC from ERUC before surgery using CT.^9,10 Raza et al.9 expanded the definition of central RCC. Their study included some exophytic RCCs and RCCs in the renal pelvis. Moreover, their study included RCC subtypes other than ccRCC. Bata et al.10 compared the CT values of dynamic enhancement between urothelial carcinoma (UC) and ccRCC, without considering the morphological characteristics of CT imaging.Moreover, endophytic RCCs represent collecting system invasion (CSI), which reportedly results in a poor prognosis.^11-14 A few radiologists have begun to study the CT features of CSI. Karlo et al.¹¹ compared the results of CT-based diagnosis and pathological diagnosis of CSI. Takamatsu et al.¹⁵ explored the correlation between the CT signs of CSI and the survival rate. However, to the best of our knowledge, there are no published studies specifically on CT-based diagnosis to differentiate between ECCRCC and ERUC.The clinical history and the patient’s symptoms are important in the diagnosis of RCC and upper urinary tract UC. Smoking is a risk factor for both RCC and upper urinary tract UC.^16,17 Further, kidney stones may be associated with upper urinary tract UC.^18,19 Flank pain and hematuria are considered typical symptoms of both ccRCC²⁰ and upper urinary tract UC.^21,22 Neither Raza et al.⁹ nor Bata et al.¹⁰ determined the correlation between clinical data and CT for the differential diagnosis of ECCRCC and ERUC.Therefore, we aimed to retrospectively assess and adequately describe the CT characteristics of ECCRCC and ERUC and to determine their correlations with clinical data.     

CT相对强化比值鉴别肾嗜酸性细胞瘤与肾透明细胞癌的应用价值

目的:探讨CT相对强化比值(病灶/肾皮质密度比值)鉴别肾嗜酸性细胞瘤(RO)与肾透明细胞癌(RCC)的应用价值.方法:回顾性分析经手术病理证实的14例RO和32例RCC的CT强化特征.分别测量两组病例CT增强各时相病灶强化区域及相邻肾皮质密度,比较各时相病灶CT值和病灶/肾皮质密度比值.采用独立样本t检验及卡方检验对测量结果进行统计学分析.结果:RCC于CT增强皮质期、髓质期和肾盂期测得的病灶CT绝对值均高于RO,但差异无统计学意义(P均＞0.05);27例RCC(27/32,占84％)皮质期病灶/肾皮质密度比值＞1,仅1例RO(1/14,占93％)病灶/肾皮质密度比值＞1,两者间差异具有统计学意义(P＜0.05);10例RO(10/14,占71％)髓质期病灶/肾皮质密度比值高于皮质期,呈“延迟强化”表现,仅1例RCC(1/32,占3％)髓质期病灶/肾皮质密度比值高于皮质期,呈“延迟强化”表现,两者间差异具有统计学意义(P＜0.05).以皮质期病灶/肾皮质密度比值＜1为标准,诊断RO的敏感度、特异度、阳性预测值、阴性预测值、准确性分别为93％、84％、72％、84％和87％;以髓质期病灶/肾皮质密度比值高于皮质期为标准,诊断RO的敏感度、特异度、阳性预测值、阴性预测值、准确性分别71％、97％、91％、91％和89％.结论:应用CT相对强化比值(病灶/肾皮质密度比值)分析法有助于鉴别RO与RCC.