肾癌常见病理亚型的CT表现及强化特点分析

目的 目前根治性肾切除术是治疗肾癌的金标准,但保留肾单位手术已广泛开展.本研究通过对肾癌CT表现及强化特点的分析,探讨动态增强CT对肾癌常见病理亚型鉴别诊断的价值.方法 分析2013-04-10-2015-04-20德州市人民医院收治的136例肾癌患者的动态增强扫描资料,其中透明细胞癌110例,乳头状癌10例,嫌色细胞癌16例.分析不同亚型肿瘤有无钙化、坏死及囊变、边界等方面的差异以及测量增强扫描各期的CT值,计算肿瘤-皮质增强指数,并采用方差分析方法进行比较.结果 透明细胞癌出现囊变坏死率(86.4％)、高于乳头状癌(60.0％)及嫌色细胞癌(12.5％).透明细胞癌、乳头状癌及嫌色细胞癌各期CT值分别为平扫期35.6±5.2、41.2±8.4、36.2±4.6;皮质期118.3±18.4、56.8±7.6、65.5±7.5;实质期106.5±17.6、76.5±9.6、86.2±8.2;排泄期85.6±12.8、75.3±7.4、82.2±6.8.增强各期肿瘤-皮质增强指数:皮质期1.23±0.26、0.38±0.12、0.46±0.14;实质期0.94±0.22、0.41±0.14、0.58±0.18;排泄期0.68±0.21、0.38±0.13、0.61±0.14.各亚型各期CT值进行方差分析,差异均有统计学意义,F值分别为4.91、116.01、23.77和3.71,均P＜0.05;各亚型增强各期肿瘤-皮质增强指数进行方差分析,差异均有统计学意义,F值分别为115.42、44.61和10.81,均P＜0.05.结论 透明细胞癌、乳头状癌及嫌色细胞癌的CT表现及强化参数有一定的特征性表现,与各自的病理特征密切相关,其中强化特征是鉴别3种常见肾癌亚型最重要的参数,不同的CT表现对鉴别诊断有较大的帮助.     

嫌色细胞肾癌CT、MRI表现及少见征象分析

目的 分析嫌色细胞肾癌的CT和MRI表现及少见征象,以进一步提高对疾病的认识.方法 回顾性分析经手术病理证实的16例嫌色细胞肾癌的CT和MRI表现.结果 CT检查13例,包括平扫密度均匀者8例,其中5例平扫病变密度高于正常肾实质,不均匀者5例,增强后密度均匀、不均匀者实质成分强化均明显,皮质期强化程度介于皮髓质间.MRI检查8例,其中2例信号均匀,呈长T1长T2信号,5例平扫出现T1WI高信号,强化模式与CT类似.5例患者同时行CT和MRI检查,密度、信号及强化模式类似.结论 嫌色细胞肾癌属于较少见的恶性肾细胞癌,CT和MRI可以反映其成分及血液动力学改变,平扫密度高或T1WI出现高信号、病变大而坏死少、病变内出现条带状强化等征象时有助于嫌色细胞肾癌的诊断.     

肾癌常见病理类型与CT强化特征的相关性研究

目的:探讨肾癌常见病理类型与CT强化特征的相关性。方法:回顾性分析2010年5月至2015年4月82例肾癌患者,以病理组织为标准,均进行动态增强CT检查,观察不同亚型肾癌CT表现和强化特点情况。结果:透明细胞癌以坏死囊变最明显,占91.49%,和其他病理类型比较差异显著（P<0.05）,嫌色细胞癌在坏死囊变、钙化、均匀上均表现不明显,和透明细胞癌、乳头状癌比较差异显著（P<0.05）;平扫时以透明细胞癌水平最低,而在增强CT皮质期、实质期、排泄期时水平最高,和其他两种比较差异显著（P<0.05）;乳头状癌和透明细胞癌在以上指标上相反,嫌色细胞癌则无明显特异性;肿瘤-皮质增强指数上以透明细胞癌水平最高,以乳头状癌最低,嫌色细胞癌介于两者之间,以上比较差异显著（P均<0.05）。结论:透明细胞癌、乳头状癌、嫌色细胞癌CT强化特征有不同表现。     

肾透明细胞癌磁共振成像与病理表现对照分析

 目的　探讨肾透明细胞癌的磁共振成像（MRI）与病理表现的关系。方法　对23例经术后病理证实的肾透明细胞癌患者术前MRI征象及术后病理结果进行回顾性对照分析。结果　MRI平扫：2例信号均匀,21例信号混杂,见囊变、坏死,11例见出血,12例见假包膜。动态增强扫描:实性部分明显强化,皮质期强化程度低于肾皮质,高于肾髓质,髓质期、延迟期持续强化。术后肿瘤剖面呈黄白色,病灶内见囊性及坏死结构,17例可见出血。光学显微镜下观察,肿瘤细胞常呈实体巢状或腺泡状排列,间质内富含薄壁血管构成网状间隔,14例可见假包膜。结论　肾透明细胞癌的MRI表现与组织结构有关, MRI平扫结合动态增强扫描对肾透明细胞癌的诊断有较高价值。     

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。     

100例小肾癌螺旋CT多期扫描分析

目的评价螺旋CT多期扫描在小肾癌诊断和鉴别诊断中的价值。方法回顾性分析100例经病理证实的小肾癌（≤3．0cm）在螺旋CT多期（平扫、皮髓、排泄）扫描时的表现。结果100例小肾癌患者中,左肾38例,右肾62例,肿瘤长径为1．0-3．0 cm,平均2．5 cm。根据WHO 2004年公布的肾肿瘤组织学分型,透明细胞癌76例,多房性透明细胞癌4例,乳头状癌9例,嫌色细胞癌4例,未归类癌7例。上述各亚型小肾癌有其特征性的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。结论常见小肾癌各亚型螺旋CT多期扫描时有其特征性的表现,有助于鉴别诊断,各亚型应分别与肾嗜酸细胞瘤、囊性肾瘤、复杂性肾囊肿、肾少脂肪血管平滑肌脂肪瘤、肾浸润性泌尿上皮癌等病变相鉴别。     

不同亚型肾细胞癌的微血管密度与临床病理因素的关系

目的 探讨 CD34和CD31在不同亚型肾细胞癌(RCC)中的表达,及其标记的微血管密度(MVD)与RCC临床病理因素之间的关系.方法 采用免疫组化SP法,检测CD34和CD31在149例RCC组织(肾透明细胞癌76例,肾乳头状癌42例,肾嫌色细胞癌31例)中的表达情况.结果 肾透明细胞癌、肾嫌色细胞癌和肾乳头状癌组织中CD34 标记的MVD分别为128.04±46.44、48.55±14.09和38.12±10.98,CD31标记的MVD分别为98.35±55.05、30.70±17.72和21.60±9.38,肾透明细胞癌组织中CD34标记的MVD和CD31标记的MVD均明显高于肾非透明细胞癌组织(均P<0.01).在肾嫌色细胞癌和肾乳头状癌组织中,CD34标记的MVD均明显高于CD31 标记的MVD(均P<0.01).CD34和CD31标记的MVD均与肾透明细胞癌的组织学分级呈负相关(r_(CD34)=-0.618,P<0.01;r_(CD31)=-0.442,P<0.01),也与临床分期呈负相关(r_(CD34)=-0.283,P<0.05;r_(CD31)=-0.256,P<0.05),其中CD34的相关性较强;但与肾非透明细胞癌的组织学分级和临床分期无明显的相关性(均P>0.05).结论 CD34 和 CD31均能清晰地、选择性地显示RCC的MVD,但CD34比CD31更敏感.肾透明细胞癌的MVD显著高于肾非透明细胞癌.肾透明细胞癌的MVD与组织学分级和临床分期呈负相关,而肾非透明细胞癌的MVD与组织学分级和临床分期并无相关性.     

肾细胞癌生物治疗研究进展

肾细胞癌（renal cell carcinoma,RCC）是一种常见的肿瘤,大约占人类癌症的3％。RCC主要的细胞亚型包括：透明细胞癌,乳头状细胞癌,嫌色细胞癌和集合管细胞癌。转移性RCC（metastatic RCC,mRCC）对常规的化放疗和激素治疗不敏感,主要依靠手术治疗。随着基础与临床研究的进展,     

肾癌的CT表现及其病理新分型21例分析

[目的]提高基于新病理分型的肾细胞癌的CT诊断认识。[方法]回顾性分析经病理证实的21例肾细胞癌CT表现和病理结果。[结果]11例透明细胞癌,1例颗粒细胞癌,4例混合细胞癌,1例多房囊性肾细胞癌,1例乳头状癌,2例嫌色细胞癌,1例集合管癌。新分型中颗粒细胞癌和多房囊性肾细胞癌均归于透明细胞癌,此型血供丰富,增强扫描后强化明显,不复杂性囊变为其特征;而乳头状癌和嫌色细胞癌相对少血供,易于坏死囊性变,强化程度低于透明细胞癌;集合管癌较少见,CT表现缺乏特异性。[结论]各型肾细胞癌CT表现特异性不强,组织学类型确诊仍依靠病理。了解其CT表现与病理之间的关系有助于CT诊断与鉴别诊断。     

不同亚型囊肿相关性肾细胞癌的临床特点

目的:研究不同病理亚型囊肿相关性肾细胞癌临床特点,总结诊治经验。方法:回顾性分析1991~2000年我院经手术治疗的39例囊肿相关性肾细胞癌的临床资料,根据不同的病理类型归纳其特征。结果:多囊肾基础上发生的肾细胞癌2例,囊肿内肾细胞癌20例,囊性肾细胞癌17例。3例行肾部分切除术,36例行肾癌根治术。RobsonⅠ期16例,Ⅱ期23例。透明细胞癌38例,嫌色细胞癌1例。随访5~14年,1、3、5年存活率分别为100%、100%、94.8%(37/39)。结论:囊肿病例需定期复查。囊肿相关性肾细胞癌多为低期透明细胞癌。增强CT扫描和肾动脉造影是术前确立临床诊断的主要方法。手术治疗远期效果好。     

Dynamic computed tomography and color Doppler ultrasound of renal parenchymal neoplasms: correlations with histopathological findings

BACKGROUND: We evaluated whether color Doppler ultrasound (US) had diagnostic accuracy equal to dynamic computed tomography (CT) and whether performing dynamic CT and Doppler US together would be more informative in preoperative diagnosis of renal solid tumors. METHODS: A total of 110 renal solid tumors smaller than 7 cm were evaluated with dynamic CT and Doppler US. We compared the enhancement and the color flow patterns with the histopathological subtypes. RESULTS: Eighty-seven (95.6%) of 91 clear cell carcinomas showed rich enhancement in the cortical nephrographic phase (CNP) and 82 (90.1%) of them had color flow in the Doppler US. Of the total of 110 tumors, nine (8.1%) did not show color flow in spite of rich enhancement in the CNP. Conversely, eight (7.2%) of the 110 tumors showed color flow in spite of poor enhancement, including two chromophobe cell carcinomas and two metastatic renal tumors. CONCLUSIONS: The enhancement pattern in dynamic CT and the color flow pattern in Doppler US were different among the subtypes of RCC. Color Doppler US had diagnostic accuracy equal to dynamic CT in most patients with renal solid tumors. Although Doppler US may play a unique role in the diagnosis of some renal parenchymal solid tumors, it is sufficient to perform dynamic CT alone for diagnosis of clear cell carcinoma.     

Molecular subclassification of kidney tumors and the discovery of new diagnostic markers

We analysed the expression profiles of 70 kidney tumors of different histological subtypes to determine if these subgroups can be distinguished by their gene expression profiles, and to gain insights into the molecular mechanisms underlying each subtype. In all, 39 clear cell renal cell carcinomas (RCC), seven primary and one metastatic papillary RCC, six granular RCC from old classification, five chromophobe RCC, five sarcomatoid RCC, two oncocytomas, three transitional cell carcinomas (TCC) of the renal pelvis and five Wilms' tumors were compared with noncancerous kidney tissues using microarrays containing 19,968 cDNAs. Based on global gene clustering of 3560 selected cDNAs, we found distinct molecular signatures in clear cell, papillary, chromophobe RCC/oncocytoma, TCC and Wilms' subtypes. The close clustering in each of these subtypes points to different tumorigenic pathways as reflected by their histological characteristics. In the clear cell RCC clustering, two subgroups emerged that correlated with clinical outcomes, confirming the potential use of gene expression signatures as a predictor of survival. In the so-called granular cell RCC (terminology for a subtype that is no longer preferred), none of the six cases clusters together, supporting the current view that they do not represent a single entity. Blinded histological re-evaluation of four cases of 'granular RCC' led to their reassignment to other existing histological subtypes, each compatible with our molecular classification. Finally, we found gene sets specific to each subtype. In order to establish the use of some of these genes as novel subtype markers, we selected four genes and performed immunohistochemical analysis on 40 cases of primary kidney tumors. The results were consistent with the gene expression microarray data: glutathione S-transferase alpha was highly expressed in clear cell RCC, alpha methylacyl racemase in papillary RCC, carbonic anhydrase II in chromophobe RCC and K19 in TCC. In conclusion, we demonstrated that molecular profiles of kidney cancers closely correlated with their histological subtypes. We have also identified in these subtypes differentially expressed genes that could have important diagnostic and therapeutic implications.     

Identification of copy number alterations and its association with pathological features in clear cell and papillary RCC

We report and characterize the copy number alterations (CNAs) in 35 clear cell and 12 papillary renal cell carcinomas (RCC) using Affymetrix 100K SNP arrays. Novel gain and loss regions are identified in both subtypes. In addition, statistically significant CNA are detected and associated with the pathological features: VHL mutation status, tumor grades, and sarcomatoid component in clear cell RCC and in types 1 and 2 of papillary RCC. Florescence in situ hybridization confirmed the copy number gain in the transforming growth factor, beta-induced gene (TGFBI), which is a possible oncogene for clear cell RCC.     

波形蛋白在不同病理亚型肾癌组织中的表达及其临床意义

目的:检测波形蛋白(vimentin)在不同病理类型肾细胞癌(RCC)组织中的表达并探讨其临床意义.方法:采用免疫组化PV-6000法检测152例手术切除的RCC组织和12例癌旁肾组织中波形蛋白(vimentin)的表达,分析vimentin表达与RCC临床病理特征的相关性.结果:vimentin在正常肾组织的阳性表达率为8.3%,在RCC组织的阳性表达率为76.3%,组间差异有统计学意义(P<0.05).vimentin在透明性肾细胞癌(ccRCC)、乳头状肾细胞癌(PRCC)和嫌色性肾细胞癌(CRCC)组织中阳性表达率分别为88.6%(101/114)、72.2%(13/18)和11.8%(2/17),其在ccRCC和PRCC的阳性表达均高于CRCC,组间差异均具有统计学意义(P<0.05).vimentin阳性表达与ccRCC的组织学分级和临床分期无明显相关性(P>0.05).结论:波形蛋白的表达与肾癌病理类型关系密切,提示vimentin可辅助RCC的病理分型鉴别诊断.波形蛋白在透明性肾细胞癌普遍高表达,提示其在ccRCC的诊断上有一定意义,但尚不足以评估ccRCC的恶性程度.     

多层螺旋CT多期增强扫描在小肾癌诊断中的应用价值

目的探讨多层螺旋CT（MSCT）多期增强扫描在小肾癌诊断和鉴别诊断中的价值。方法回顾性分析32例经手术病理证实的小肾癌（≤3．0cm）术前MSCT多期扫描的影像特征,并与病理对照。结果32例患者中平扫病灶等密度6例,低密度19例,稍高密度5例,3例点状钙化。增强扫描皮质期20例明显强化,8例中度强化,4例轻度强化;均匀强化8例,不均匀强化24例。透明细胞癌25例,主要为不均匀明显强化;乳头状细胞癌3例,为轻度均匀强化;嫌色细胞癌及肉瘤样细胞癌各2例,为中度强化。32例患者中检出率100％,定性诊断正确率93．75％,分期正确率84．38％。结论MSCT多期增强扫描是小肾癌诊断及其亚型鉴别诊断的可靠检查方法。     

Fructose transporter GLUT5 expression in clear renal cell carcinoma

Renal cell carcinomas (RCC) can be subclassified for general purposes into clear cell, papillary cell, chromophobe cell carcinomas and oncocytomas. Other tumours such as collecting duct, medullary, mucinous tubular and spindle cell and associated with Xp 11.2 translocations/TFE 3 gene fusion, are much less common. There is also a residual group of unclassified cases. Previous studies have shown that RCC has high glycolytic rates, and expresses GLUT transporters, but no distinction has been made among the different subtypes of renal cell tumours and their grades of malignancy. In clear renal cell carcinoma (cRCC) glycogen levels increase, glycolysis is activated and gluconeogenesis is reduced. The clear cell subtype of RCC is characterized histologically by a distinctive pale, glassy cytoplasm and this appearance of cRCC is due to abnormalities in carbohydrate and lipid metabolism, and this abnormality results in glycogen and sterol storage. Several isoforms of glucose carriers (GLUTs) have been identified. We show here in a panel of 80 cRCC samples a significant correlation between isoform 5 (GLUT5) and many pathological parameters such as grade of differentiation, pelvis invasion and breaking capsule. GLUT5 expression also appears to associate more strongly with the clear cell RCC subtype. These data suggest a role for the GLUT5 isoform in fructose uptake that takes place in cRCC cells and which subsequently leads to the malignant RCC progression.     

Molekulares Tumorprofiling von Nierenzelltumoren: Relevanz für Diagnostik und Therapie

Molecular biological tumor markers and prognostic parameters are necessary for differential diagnosis, individual prognosis, and therapy in patients with renal cell tumors. By using high throughput technologies, it is possible to characterize tumor samples comprehensively. Based on specific genetic alterations, histopathological subtypes were defined as independent tumor entities. Genetic characteristics can be used for diagnosis of primary tumor samples and also of biopsies. Furthermore, specific molecular patterns of metastatic tumors are known, allowing the determination of the primary tumor’s metastatic potential. The specific protein patterns of serum samples of tumor patients were analyzed, and several candidate proteins have been identified. One of these is SAA-1, which is elevated in patients with clear cell renal cell carcinomas (RCC). New therapeutic options are now available for patients with metastatic RCC. Therefore, it is necessary to select the best therapy for each patient and to detect therapy resistance very early. Biomarkers in tumor tissue and serum were found to correlate with therapy response.