肾囊性淋巴管瘤一例报告及文献复习

目的 探讨肾囊性淋巴管瘤的临床诊治特点。方法报告1例肾囊性淋巴管瘤患者临床资料，结合 文献复习讨论。患者男性，38岁。主要临床表现为血尿、腰部钝痛、肾绞痛和肾区肿块，B超、CT、检查显示为囊性病变，内有分隔，囊液回声、密度、信号显示为水性、浆液性、血性。结果患者经开放性手术治疗后痊愈。术后病理检查囊壁内发现平滑肌及内衬上皮细胞，囊壁和囊腔内发现淋巴细胞。患者术后随访6个月未见复发。结论 肾囊性淋巴管瘤B超、CT、MRI检查无特征性改变时，经皮细针穿刺活检和囊液细胞学检查可能有助于诊断。确诊需病理组织学检查。外科治疗效果良好。     

腹膜后囊性淋巴管瘤的诊断与治疗

目的探讨腹膜后囊性淋巴管瘤的诊断与治疗。方法收集经病理证实的成人腹膜后囊性淋巴管瘤5例，回顾性分析其临床表现及影像学特征，并与手术及病理结果进行对照分析。其中男性2例，女性3例，平均年龄38．0岁。患者无特异性临床表现，均为常规体检时经B超检查发现。经CT及MRI检查均考虑：腹膜后囊性淋巴管瘤可能。结果5例均行手术治疗并完整切除，术后恢复顺利，随访3个月至16个月均无复发。结论腹膜后囊性淋巴管瘤多无特异性临床表现，CT及MRI检查对术前协助诊断及对手术均有重要指导意义。手术切除为首选治疗方式，术中应尽可能完整切除病变，以防术后复发。     

后腹腔镜治疗腹膜后囊性淋巴管瘤2例报告并文献复习

目的提高对腹膜后囊性淋巴管瘤的认识,探讨其诊治方法。方法报告2例经本院收治的腹膜后淋巴管瘤患者的临床资料,回顾性分析其临床特征及影像学表现。2例均为女性,年龄分别为39岁及45岁。患者均无特征性临床表现。超声及CT均表现为边缘光整的囊性肿块。2例患者均在全麻下行腹腔镜腹膜后肿物切除术,并检索Pubmed和CBM数据库,对该疾病相关文献进行复习。结果 2例均成功切除病灶并经病理诊断为腹膜后囊性淋巴管瘤。术后随访5和24个月,未发现肿瘤复发。结论腹膜后囊性淋巴管瘤临床上少见,该病多无特征性临床表现,B超及CT检查对协助术前诊断及手术均有重要指导意义。腹腔镜手术治疗腹膜后囊性淋巴管瘤安全有效。     

腹膜后囊性淋巴管瘤的CT诊断及治疗(附5例报道)

目的 探讨腹膜后囊性淋巴管瘤的CT诊断价值和治疗方法.方法 回顾性分析2004年6月至2010年5月期间我院收治的5例经病理检查证实的腹膜后囊性淋巴管瘤患者的临床表现、CT影像特征、手术治疗及术后随访的资料.结果 5例患者术前CT均诊断为囊性淋巴管瘤,均行手术完整切除肿瘤,术后病理结果均证实为囊性淋巴管瘤.术后7 d顺利出院,随访3个月～6年均无复发.结论 CT对腹膜后囊性淋巴管瘤的诊断具有重要意义,手术完整切除整个囊壁是治疗及预防术后复发的最好方法.     

肾炎性肌纤维母细胞瘤2例报告并文献复习

目的:探讨肾炎性肌纤维母细胞瘤(IMT)的临床病理特征。方法:回顾性分析2014年6月及2015年8月收治的2例肾IMT患者的临床资料。例1,女,69岁。主诉左腰部酸胀30d。B超检查示左肾中部一直径约5.5cm液性暗区,囊壁较厚,可见钙化。强化CT检查示左肾中部低密度病变并可见强化,边缘欠光滑,病变内低密度区CT值约为23HU,病变与肾实质边界欠清晰。初步诊断为左肾囊性占位病变,考虑继发感染。行后腹腔镜左肾肿物切除术。例2,男,58岁。主诉左侧腰痛6个月。B超造影检查示左肾窦低回声结构,超声造影低增强。CT检查示左肾盂占位病变,考虑肾盂癌。MRI检查示左肾窦内软组织肿块影,T1WI、T2WI均呈中等信号表现,病变与肾盂分界不清。诊断为左肾窦肿瘤,行根治性左肾切除术。结果:例1术后病理诊断:肾炎性肌纤维母细胞瘤(浆细胞亚型)伴囊性变及感染,免疫组织化学:CD68+,Lambda+,Kappa+。术后随访14个月,未见复发。例2术后病理诊断:肾脏炎性肌纤维母细胞瘤(浆细胞亚型),免疫组织化学:CD68局部+,Vimentin+,bcl2+,SMA+,S100+,Lambda+,Kappa+,Ki-671%瘤细胞阳性,CD117-,Desmin-,CK-,ALK-,P53-。术后随访4个月,未见复发。结论:IMT是一种罕见的交界性肿瘤,临床及影像学表现无特异性,容易误诊;病理学检查是诊断该病的主要依据,需与其他肾区肿瘤相鉴别;手术切除为主要治疗方法,通常预后较好。     

腹腔镜辅助下小儿腹膜后囊性淋巴管瘤药物灌注治疗

目的探讨腹腔镜辅助下小儿腹膜后囊性淋巴管瘤药物灌注治疗的疗效。方法 2004年3月～2010年12月,腹腔镜辅助下药物灌注治疗12例小儿腹膜后囊性淋巴管瘤。先腹腔镜下探查肿瘤大小、范围、与邻近脏器关系,平阳霉素4～8 mg加适量注射用生理盐水配制成浓度为0.3～1.0 mg/ml溶液备用,剂量0.2～0.5 mg.kg-1.次-1,腰椎穿刺针经腹壁进入腹腔,行腹膜后囊性淋巴管瘤瘤体药物灌注,隔2～3周灌注一次,共1～2次。结果 12例患儿腹腔镜下顺利完成操作,几乎没有出血,手术时间15～45 min,平均30 min。第1次灌注术后2～3周复查B超,7例腹膜后淋巴管瘤完全消失,未见明显的腹膜后囊性葡萄样结构;5例B超示腹膜后囊性葡萄样结构,再重复注射治疗1次,术后半年B超复查腹膜后囊性葡萄样结构全部消失。12例患儿随访6～60个月,平均33个月,肿瘤无复发,无肠粘连、肺组织纤维化、骨髓抑制、血象异常等并发症。结论腹腔镜辅助下小儿腹膜后囊性淋巴管瘤药物灌注治疗操作简单,安全,创伤小,出血少,疗效满意。     

马蹄肾峡部自发破裂一例报告

患者,男,56岁.因左腰部绞痛10h于2008年4月入院,无外伤史.查体左肾区压痛,叩痛,左输尿管走行区压痛,肌紧张.B超检查示双肾畸形,马蹄肾,左肾周积液,左腰大肌旁积液;CT检查示左肾周积液,CT值8.5 HU,马蹄肾,未见肿瘤及结石影;IVU示双肾旋转不良,左输尿管上段扩张,左肾下极外缘条片状高密度影为造影剂外漏;逆行造影并监视器动态观察输尿管未见充盈缺损和畸形,造影剂进入肾盂后从肾下极向肾周弥散.     

腹膜后囊性淋巴管瘤的诊断与治疗

目的探讨腹膜后囊性淋巴管瘤的诊断与治疗。方法收集经病理证实的成人腹膜后囊性淋巴管瘤7例,回顾性分析其临床特征及影像学表现,并与手术、病理结果对照。其中男2例,女5例,平均年龄51岁。患者均无特征性临床表现。超声及CT均表现为边缘光整的囊性肿块,病变大小约6cm×7cm～20cm×21cm,部分囊内有分隔,且壁与分隔可部分强化。术前诊断腹膜后囊性占位病变4例,腹腔囊肿2例,仅1例患者经CT引导下穿刺抽液确诊。结果7例均行手术治疗,完整切除肿瘤者6例,1例因肿瘤浸润肝脏及胰腺仅行大部切除。术后病理报告证实为:(腹膜后)囊性淋巴管瘤。7例随访9个月～10年,完整切除者均未见复发,大部切除者于术后5个月出现局部复发。结论超声及CT对腹膜后囊性淋巴管瘤定位、定性诊断具有重要价值,手术切除是治疗首选。     

原发性腹膜后巨大淋巴管瘤1例报告并文献复习

目的：提高原发性腹膜后淋巴管瘤的诊治水平。方法：报道1例原发性腹膜后淋巴管瘤患者的诊治过程,术前诊断腹膜后囊肿,行单孔腹腔镜双侧腹膜后囊肿切除术。结果：术后病理（腹膜后囊肿）检材由扩张的淋巴管组成,囊壁由内皮细胞、平滑肌及纤维组织组成,符合腹膜后淋巴管瘤。术后随访6个月未见复发。结论：原发性腹膜后淋巴瘤是一种良性病变,临床罕见,确诊需结合术后病理和影像学表现,手术切除是最佳治疗方式。     

腹膜后苗勒管残留囊肿腺癌一例报告

患者 ,女 ,5 1岁 ,因左侧腰部及下腹部疼痛 3个月余 ,加重 1个月于 2 0 0 4年1月 2日入院。查体 :体温 :37℃ ,血压 :12 0 / 80mmHg ,腹部软 ,脐左可触及一约6cm× 10cm包块 ,质硬 ,活动性差 ,腹部无明显压痛。妇检 :左侧附件可及一包块 ,压痛不明显 ,活动度差。B超示子宫后方不均质包块 ,左侧中下腹囊性包块 ,左肾积水。腹部CT检查示左侧卵巢占位性病变累及子宫 ,左肾输尿管积水 ,盆腔少量积液 ,左腹膜后囊性占位 ,胆囊结石。初步诊断为 :①左腹膜后囊性占位 ,②左肾输尿管积水 ,③左侧卵巢占位。经术前准备 ,在硬膜外麻醉下经腹行探查手…     

原发性肾窦肿瘤三例报告

目的 总结原发性肾窦肿瘤的临床特点及治疗方法.方法 原发性肾窦肿瘤患者3例.女2例,男1例.平均年龄40(33～55)岁.临床表现为腰痛伴血尿1例,单纯腰部疼痛2例.肿瘤位于右侧2例,左侧1例.直径平均5.5(3.5～8.5)cm.3例均经行手术治疗. 结果行右肾窦肿瘤探查术1例,术中病理提示良性肿瘤,单纯切除肿瘤,病理报告为血管平滑肌瘤,随访3年未见复发.1例术中因肿瘤出血及肾盂破坏严重,行右肾切除,病理报告为血管平滑肌脂肪瘤,随访10个月未见复发.1例因肿瘤包绕肾动静脉,局部严重黏连,行左肾切除术,病理报告为脂肪瘤,随访4年未见肿瘤复发.结论 原发性肾窦肿瘤临床罕见,多为良性,易误诊为肾盂肿瘤,CT、MRI、IVU检查有助于鉴别;良性肿瘤直径<4 cm且无症状者可密切随访,有症状或直径>4 cm者可行肿瘤切除;肿瘤累及肾蒂并严重破坏肾盂者可行单纯肾切除;恶性肿瘤应行根治性肾切除.     

Right perinephric abscess: a rare presentation of ruptured retrocecal appendicitis

Perinephric abscess commonly arises from rup- ture of an intrarenal abscess into the perinephric space. It rarely results from gastrointestinal pathology. We report two pediatric patients with retrocecal appendicitis that presented with perinephric abscess. A 3-year-old girl presented with high fever and right flank pain for more than 1 week. Ultrasonography showed a right perinephric fluid collection with normal renal parenchyma and collecting system. A perinephric abscess extending from a ruptured retrocecal appendix was diagnosed by ab-dominal computed tomographic (CT) scan. Her hospital course was complicated with empyema, peritonitis, and pericardial effusion. A 6-year-old girl had lower abdominal pain for 3 days and high fever on the day of admission. Ultrasonography showed a right perinephric abscess with a normal renal contour and a fecalith in the enlarged appendix in the right lower quadrant of the abdomen. Appendectomy and drainage of the perinephric abscess were performed in both cases. We suggest that a ruptured retrocecal appendix must be considered in cases of perinephric abscess, especially in patients with gas bubbles in the abscess and a normal urogenital appearance. Ultrasonography and abdominal CT scan are the preferred diagnostic tools. Prolonged antibiotics and drainage of the abscess are mandatory to decrease morbidity and mortality. Received: 30 August 2001 / Reviesd: 15 November 2001 / Accepted: 17 November 2001     

A case of acute focal bacterial nephritis

Acute focal bacterial nephritis refers to a renal mass caused by acute focal infection. We report a case of acute focal bacterial nephritis, herein. The case was in a 56-year-old woman, who was hospitalized with the chief complaint of left flank pain, chills and fever. Intravenous pyelography suggested the presence of a mass in the upper pole of the left kidney. Ultrasonography showed a hypoechoic mass, CT scan revealed a round, low density mass. Antibiotic therapy resulted in resolution of symptoms, and a follow-up CT scan and ultrasonography showed complete resolution of the renal mass.     

Renal angiomyolipoma: report of 2 cases of tuberous sclerosis in female siblings

Two cases of renal angiomyolipomas in female siblings associated with tuberous sclerosis were reported. The first case was a 47-year-old housewife who visited the hospital because of severe right flank pain. Bilateral renal angiomyolipomas and hemorrhage in the right angiomyolipoma were recognized by computerized tomography, ultrasonography and renal angiography. After 2 months she had another episode of left flank pain and was diagnosed to have hemorrhage in the left renal tumor. The pain remissed by conservative treatment. Bilateral nephrectomy and hemodialysis would be necessary if she were to have a third attack. The second case was her 36-year-old sister with the chief complaint of left flank pain and genital bleeding. CT and renal angiography suggested a large angiomyolipoma in her left kidney and a small one in her right kidney. Left nephrectomy, right partial nephrectomy and hysterectomy were performed to prevent intratumoral hemorrhage. The histopathological diagnosis was angiomyolipoma of kidneys, uterus and lymphnodes of right renal hilus. Although pre-operative differentiation of angiomyolipoma from renal cell carcinoma has been difficult, recently diagnosis has become possible by CT, ultra-sonography and angiography.     

A case of infected renal cyst extending to leg abscess

A 45-year-old woman was referred to our hospital with the chief complaint of left flank pain, left leg pain and loss of appetite. Computed tomography scan and magnetic resonance imaging demonstrated a large cystic mass in the left kidney, which we diagnosed as an infected renal cyst. Under ultrasonic guidance, percutaneous puncture and drainage of the renal cyst were performed. After her leg pain worsened, computed tomography revealed abscesses in the left leg, suggesting an infected renal cyst extending to the leg through the obturator foramen. Under general anesthesia, incision and drainage were performed. Cultures from the cyst and abscess fluid showed Klebsiella pneumoniae. Our case is the 82nd case of an infected renal cyst in the Japanese literature.     

A case of xanthogranulomatous pyelonephritis presenting with the flank subcutaneous mass

A 51-year-old female exhibited fever, left flank pain and left flank mass in March, 1993. Drip infusion pyelography (DIP) revealed a non-functioning left kidney with shadows of calculi, and abdominal computerized tomography (CT) showed renal calculi and multilocular cystic lesions in the left kidney extending through the perinephric space into the mass on the left flank. Percutaneous nephrostomy and percutaneous drainage were performed, followed by left nephrectomy. Histopathological findings revealed xanthogranulomatous pyelonephritis. There have been a few case reports of xanthogranulomatous pyelonephritis forming nephrocutaneous fistula in the back.     

A case of renal malacoplakia that was difficult to distinguish from cystic renal cell carcinoma

A 66 years old man visited our hospital with a chief complaint of right flank pain and abdominal palpable mass. Abdominal enhanced computed tomography scan showed a large cystic mass with infiltrating surrounding tissue in the right kidney. We diagnosed it infected cystic renal cell carcinoma because of high grade fever and acute inflammatory response. It was surgically unresectable tumor. Therefore, percutaneous puncture and drainage was performed under ultrasound guidance. In the culture of drainage fluid, Escherichia coli (E. coli) was isolated. Then, we confirmed reduction in the size of the tumor, right radical nephrectomy was performed. Because of tumor invasion to ascending colon, we performed the excision of right kidney together with ascending colon. Histological study confirmed target-shaped Michaelis-Gutmann body, and the definitive diagnosis was malacoplakia of the kidney. We reported a case of renal malacoplakia that was difficult to distinguish from cystic renal cell carcinoma. Our case is 12th case of renal malacoplakia in the Japanese literature.     

A case of retroperitoneal cavernous lymphangioma with the content of chylous fluid

We report a case of retroperitoneal lymphangioma in a 26-year-old man whose chief complaint was lumbar discomfort. Ultrasonography revealed pararenal cyst on his left side. At the operation, we discovered a cystic tumor between peritoneum and Gerota's fascia. Pathological study indicated cavernous lymphangioma containing chylous fluid. There has been no recurrence for a year after the operation.     

Emphysematous perinephric abscess with diabetes mellitus: a case report

A 48-year-old woman was referred to our hospital with high fever and left flank pain. She was diagnosed with diabetes mellitus (DM), and abdominal computed tomography (CT) revealed left perinephric abscess with much emphysema. She underwent drainage of the abscess by left flank incision after treatment with antibiotics and insulin. The pus culture revealed Escherichia coli. Immediately after drainage, the symptoms began to subside. At three months after drainage, abdominal CT revealed no emphysema around the left kidney. At 18 months after the discharge, left perinephric abscess was not seen and DM was well controlled with insulin.