肾嗜酸细胞瘤螺旋CT特征及鉴别要点分析

目的：观察肾嗜酸细胞瘤的平扫及动态增强扫描特征,并与肾嫌色细胞癌进行比较。方法选择20例肾嗜酸细胞瘤患者为研究对象,另选择30例肾嫌色细胞癌患者为对照组,观察肾嗜酸细胞瘤CT表现,比较肾嗜酸细胞瘤与肾嫌色细胞癌病变形态学特征,病灶强化百分比及肿瘤-肾皮质强化指数。结果肾嗜酸细胞瘤密度于皮髓质期、实质期及排泄期均低于肾脏皮质,差异均有统计学意义（P﹤0.05）;肾嗜酸细胞瘤密度于皮髓质期、肾实质期及排泄期高于肾脏髓质,差异具有统计学意义（P﹤0.05）;肾嗜酸细胞瘤较肾嫌色细胞癌体积小,密度均匀的比例高,存在星芒状瘢痕的比例高,差异均具有统计学意义（P﹤0.05）。动态增强扫描,肾嗜酸细胞瘤与肾嫌色细胞癌强化程度间比较显示,肾嗜酸细胞瘤在皮髓质期、实质期的病灶强化百分比和肿瘤-肾皮质强化指数,均高于肾嫌色细胞癌,差异均具有统计学意义（P﹤0.05）。结论肾嗜酸细胞瘤的CT表现具有一定的特征,形态学特征及动态增强表现有助于鉴别诊断。     

肾血管平滑肌脂肪瘤12例临床分析

肾血管平滑肌脂肪瘤（renal angiomyolipoma,RAML）又称肾错构瘤,由畸形血管、平滑肌、成熟脂肪和结缔组织构成,是较常见的肾脏良性肿瘤。以往很难与肾癌相鉴别,均在施行肾切除后才得以确诊。近10多年来,随着B超及CT在临床上的应用日渐广泛,绝大部分患者在术前就能作出正确诊断,并在治疗上根据不同情况进行随诊观察或只切除肿瘤,尽可能保留肾实质。我院自1998年-2008年共收治肾血管平滑肌脂肪瘤12例,现报告如下。     

低度恶性潜能的多房囊性肾肿瘤与囊性肾瘤的CT影像特征及临床病理分析

  目的  分析低度恶性潜能的多房囊性肾肿瘤（multilocular cystic renal neoplasm of low malignant potential，MCRNLMP）与囊性肾瘤（cystic nephroma，CN）的临床病理特征及CT影像特征，并探讨其诊断价值。  方法  回顾性分析2000年1月至2019年3月经武汉大学人民医院及荆州市中心医院病理证实的20例MCRNLMP与12例CN患者的临床资料，采用受试者工作特征（receiver oper-ating characteristic，ROC）曲线分析肿瘤的增强CT影像特征，免疫组织化学法检测其免疫表型。  结果  MCRNLMP与CN在囊壁及间隔厚度、强化的高密度病灶数量、强化的达峰强度、Bosniak分级上差异具有统计学意义（P < 0.05）。当囊壁及分隔厚度>2.25 mm、强化的高密度病灶数量>1个、强化的达峰强度在中度水平以上时，诊断MCRNLMP的ROC曲线下面积分别为0.879、0.800、0.838，可作为MCRNLMP的最佳诊断界值。免疫组织化学法检测MCRNLMP与CN分别特征性表达肾细胞癌（renal cell rarcinoma，RCC）标记物与雌激素受体（estrogen receptor，ER）和孕激素受体（progesterone receptor，PR）。  结论  囊壁及间隔厚度、强化的高密度病灶数量以及强化的达峰强度在鉴别MCRNLMP与CN中具有较高的诊断价值，确诊依赖于组织病理学和免疫组织化学法检测。      

肾集合管癌1例报道及文献复习

目的:分析起源于肾髓质集合管的集合管癌的临床病理特征及鉴别诊断。方法:对1例肾集合管癌进行大体、光镜及免疫组化观察并结合文献复习。结果:镜下肿瘤呈弥漫性腺管状排列,肿瘤间质纤维性反应性增生。免疫表型肿瘤细胞CK7( ),CK34βE12(-),CEA(-)。结论:肾集合管癌是一种罕见的肾脏恶性上皮性肿瘤,诊断时需与乳头状肾细胞癌、尿路上皮癌及肾髓质癌等鉴别。     

多房性囊性肾细胞癌16例临床病理分析

目的：探讨多房性囊性肾透明细胞癌（muhilocular cystic renal cell carcinoma,MCRCC）的临床病理特征、组织发生、诊断与鉴别诊断、治疗及预后。方法：回顾性分析2006年1月-2011年3月间我院收治并诊断的16例囊性。肾透明细胞癌病例的临床病理特点,并结合相关文献进行复习。结果：男性14例,女性2例,发生于左右肾各8例。临床无明显症状,大部分为体检发现肾脏占位性病变而入院,部分有腰酸腰部胀痛表现。术后病理诊断为囊性肾细胞癌。结论：囊性肾透明细胞癌临床上单靠影像学不易被确诊,确诊需依赖术中快速冰冻病理、常规石蜡病理和免疫表型结果。需与透明细胞癌囊性变,单纯性肾囊肿,先天性多囊肾,多房囊肿性肾瘤,肾混合性上皮间质瘤相鉴别。     

多房囊性肾细胞癌1例报告及文献复习

目的：探讨多房性囊性肾细胞癌的临床病理特征及其鉴别诊断。方法：对1例多房性囊性肾细胞癌的临床表现、病理特征及免疫组化表型进行观察分析并文献复习。结果：男55岁,因体检时发现有肾肿瘤伴尿急、尿频和尿痛3天入院,CT示：①右肾上极占位性病变,考虑肾癌;②右肾上腺囊肿;③左肾囊肿。镜下可见囊腔内衬单层或数层异型小的透明细胞,囊壁之间可见透明细胞巢,部分囊腔内有粉染液体,内含大量红细胞。免疫组化CK（＋＋）、EMA（＋＋）CD68（-）。病变符合多房性囊性肾细胞癌。结论：多房囊性肾细胞癌的诊断依赖病理特征及免疫表型,并需与其他肾囊性病变相鉴别。     

肾嫌色细胞癌影像检查与病理检查的诊断价值比较

目的：比较分析肾嫌色细胞癌的影像检查与病理检查的诊断价值。方法回顾性分析经手术病理检查证实的51例肾脏嫌色细胞癌的临床资料。结果51例患者肿瘤大小1．5～18 cm,平均6．1 cm,影像检查与病理检查结果,显示与相似肾肿瘤较为明显的差异表现。其中5例予以肾部分切除,其余46例行根治性肾切除。术后经随访3个月到4年,3例广泛转移,7例失访,其余41例均未见局部肿瘤复发、转移。结论肾脏嫌色细胞癌术前影像学检查具有较大程度的意义,能与大多数相似肾脏肿瘤进行鉴别;确诊主要依据术后病理组织学检查。     

肾细胞癌螺旋CT三期动态增强和MRI特征及其与肿瘤血管形成的相关性

目的探讨肾细胞癌CT和MRI特征及其与肿瘤血管形成的相关性。方法选择2010年3月至2013年3月间接受检查并经病理学确诊的肾细胞癌患者30例(研究组),另外选取10例因肾外伤等原因行肾脏手术的成年患者为对照组,采用螺旋CT三期动态增强检查和MRI三期增强检查,分析肾细胞癌患者的CT、MRI特征性影像表现。免疫组化检测肿瘤微血管密度(MVD)和血管内皮生长因子(VEGF),分析其与肿瘤血管形成的相关性。结果肾细胞癌组织的MVD和VEGF表达高于正常肾组织,且VEGF表达与肿瘤分期具有相关性。病灶中心CT的主要参数△Hu、TBR、斜率(S)、AR与病灶边缘的CT参数差异有统计学意义(P<0.05)。MRI各项参数中,病灶边缘与中心之间的MSI、SER、PEI、MSD及PV差异均有统计学意义(P<0.05)。结论肾细胞癌中心具有明显的三期动态增强CT和MRI特征,与肾细胞癌肿瘤血管具有一定的相关性,螺旋CT三期动态增强和MRI可以作为诊断肾细胞癌及判断肿瘤血管生成的方法。     

肾嫌色细胞癌5例临床病理学分析

目的探讨肾嫌色细胞癌的临床病理学特征,诊断和鉴别诊断要点及预后情况。方法回顾性分析5例肾嫌色细胞癌患者的临床资料和组织病理学特点,对肿瘤组织进行大体、光镜观察和免疫组化研究及Hale’s胶状铁染色,并复习相关文献和进行随访。结果 5例中男性3例,女性2例;年龄24～61岁,平均43.6岁;肿块直径3.5～10cm。镜下肿瘤由嫌色细胞和嗜酸细胞构成,呈实性片状、梁状和腺泡状分布。免疫组化：CK7（5/5）,EMA（5/5）,CD117（5/5）,Ksp-cadherin（5/5）,CD10（0/5）,Vimentin（0/5）,RCC（0/5）,Ki-67计数〈3%。Hale’s胶体铁染色阳性。随访23～97个月,5例患者均无肿瘤复发及转移,并存活至今。结论肾嫌色细胞癌是1种少见的肾肿瘤,预后较透明细胞型肾细胞癌好,与乳头状肾细胞癌相当;其特征性的组织学形态、免疫表型、Hale’s胶体铁染色和电镜及遗传学改变,为其诊断和鉴别诊断提供依据。     

Renal physiology

The kidneys are responsible for the urinary excretion of uremic toxins and the regulation of several body systems such as intra and extracellular volume status, acid-base status, calcium and phosphate metabolism or erythropoiesis. They adapt quantitative and qualitative composition of the urine to keep these systems in balance. The flow of plasma is filtered in the range of 120 mL/min, and depends on the systemic and renal hemodynamics which is subject to self-regulation. The original urine will then be modified in successive segments of the nephron. The proximal nephron is to lead the massive reabsorption of water and essential elements such as sodium, bicarbonates, amino-acids and glucose. The distal nephron includes the distal convoluted tubule, the connector tube and the collecting duct. Its role is to adapt the quality composition of urine to the needs of the body.     

Renal angiomyolipomas

Renal angiomyolipomas are generally benign tumors which are composed of smooth muscle, fat, and blood vessels. Classically these have been diagnosed with the use of arteriograms; however, since ultrasound and CAT scans have come into use these now are the common modalities for diagnosis. All angiomyolipomas generally can be followed conservatively, whereas larger ones have a tendency to bleed and require intervention. This paper reviews the diagnosis, treatment, and prognosis of patients with angiomyolipomas.     

Renal Echography

Echography is complementary to conventional uroradiological examination. Mass lesions should be examined by ultrasound to discover their nature–cystic or solid–and to determine which definitive diagnostic examination (cyst puncture or angiography) will be indicated. Multiple cystic and polycystic kidneys, hydronephrosis and renal transplants have been demonstrated. Such examinations have been fitted into the routine workload of an obstetrics unit.     

Selective Renal Angiography in Renal Failure Due to Infection

Selective renal angiography was carried out in 9 patients with renal failure due to infection. Six patients had leptospirosis, two had E. coli septicemia and one had falciparum malaria. In all cases the pathological diagnosis was tubular necrosis. Evidence of cortical ischemia, characterized by distinct visualization of fine vascular distribution without veiling of the nephrographic effect, loss of the normal zone of corticomedullary distinction and poor maximum nephrographic density, was demonstrated in all cases. Proximal renal arterial constriction was shown in cases of septicemia, while in leptospirosis and malaria the proximal arterial trees appeared normal. These changes were reversible in 6 cases which were followed. In each case there was positive correlation between the creatinine clearance and nephrographic density.     

肾动脉化疗栓塞结合手术治疗晚期肾癌

目的 :探讨动脉化疗栓塞 (LP TRAE)、手术综合治疗晚期肾癌的价值。方法 :先行肾动脉插管化疗栓塞 ,4周后行手术治疗。结果 :15例患者行根治性切除 9例 (60 .0 % ) ,姑息性切除 6例(4 0 .0 % )。 1、3、5年生存率分别为 10 0 %、66.6%、37.5 %。结论 :LP TRAE结合手术治疗晚期肾癌较单纯化疗、姑息性手术相比 ,疗效高 ,复发率低 ,生存期延长     

Renal cell carcinoma

Renal cell carcinoma (RCC) continues to present a diagnostic and therapeutic challenge. The increased use of abdominal imaging studies does not appear to completely account for the rising incidence of RCC. Alcohol consumption has been found to be a possible protective factor among women in a recent study, but among women with children, RCC risk may increase with each child born when compared with nulliparous women. An alternative staging system shows promise, and two randomized clinical trials clarify the role of removing the primary tumor in the setting of metastatic RCC. New agents have shown promise in early clinical trials such as CCI-779, pegylated interferon, thalidomide, and anti-VEGF antibody.