Ureteral and renal pelvic metastases from renal cell carcinoma

Six patients with ureteral or renal pelvic metastases from renal cell carcinoma (RCC) were studied radiologically. Correlation with surgical and histologic findings confirmed renal venous involvement in 5 and lymphatic invasion in 3 patients. The possible role of nephroureterectomy or secondary ureterectomy in patients with RCC is discussed in the background of our cases, as are prior reports of this finding.     

Cystic renal tumors: US and CT findings

Cystic renal tumors represent a variety of lesions in which both solid and liquid components coexist. These lesions may be either benign or malignant and include the multilocular cystic nephroma (MCN), the renal cell carcinoma (RCC), and the papillary adenocarcinoma (PAC). The MCN is a rare neoplasm formed of multiple loculated cystic masses divided by septa. The tumor is benign, although there are some rare reports of malignant cases. The RCC and the PAC may appear with cystic patterns. This is rather uncommon for the RCC, which inside has a unilocular or multilocular cystic appearance, if the necrotic component is large. PAC is an infrequent renal tumor, which has a greater tendency to appear as a large mass with a unilocular large cystic space. The ultrasonography (US) and computed tomographic (CT) features of 27 cystic tumors are presented. Both US and CT allowed the recognition of the cystic components, the septa, and the vegetations. The two imaging techniques made it possible to distinguish the tumors into “unilocular” and “multilocular” masses: the former correspond to RCC and PAC, the latter to MCN and RCC. CT added some information on calcified or partially calcified tumors. CT more than US enabled the differentiation between the malignant RCC and the benign MCN for which conservative surgery may be indicated. The two techniques did not allow the differentiation between RCC and PAC, which has different prognostic behavior.     

99Tcm-DTPA法肾小球滤过率在肾癌患者术前肾功能评价中的临床意义

目的 探讨99Tcm-DTPA法肾小球滤过率(GFR)在肾细胞癌(RCC)患者术前肾功能评价中的临床意义.方法　 99例RCC患者,其中行根治性肾切除术(RN)者89例,行保留肾手术(NSS)者10例.术前行99Tcm-二亚乙基三胺五乙酸(99Tcm-DTPA)显像测定GFR.比较RCC患者和对照组(正常供肾者)的GF...     

螺旋CT多期扫描对肾细胞癌的诊断价值

目的探讨CT在肾细胞癌诊断中的价值。方法回顾性分析22例经手术、病理证实的肾细胞癌CT表现。结果 CT平扫中5例病灶呈等密度或稍低密度,15例为混杂密度,2例为稍高密度。增强扫描皮质期18例明显强化,4例中等度强化,强化均匀或不均匀。肾实质期所有病灶强化迅速减退,肾盂期病灶强化进一步减低。其中8例肾癌出现肾周邻近脏器侵犯及淋巴结转移。结论肾细胞癌的CT表现具有一定特征性,CT对肾细胞癌的诊断具有很高的价值。     

肾细胞癌的MRI研究进展

肾细胞癌是最常见的成人肾脏恶性肿瘤。近年来，多种功能MRI成像技术（如扩散加权成像、灌注加权成像等）、多参数MRI联合分析以及影像组学等新兴影像处理技术被证实在肾细胞癌的诊断中具有较大的价值。目前，研究热点多集中于良恶性肿瘤的鉴别、组织学亚型的区分、肿瘤分期、预测核分级及判断预后。就MRI新技术及图像处理技术在肾细胞癌中的研究进展予以综述。     

Experimental percutaneous renal embolization using BCG-saturated gelfoam

Adult mongrel dogs (20–25 kg) were used to evaluate the administration of Bacillus Calmette-Guerin (BCG) in conjunction with total renal embolization for possible application in the management of metastatic renal cell carcinoma (RCC). Kidneys were surgically removed at 1, 2, and 3 weeks postembolization, examined grossly and microscopically, and then compared with kidneys embolized in the same manner without BCG. The procedure stimulated the reticuloendothelial system more than did renal embolization alone, and although a high dose (6×10⁸ organisms) of BCG was administered, no complications were encountered. These results warrant a clinical trial of this technique in patients with advanced RCC. Research support was provided by the John S. Dunn Research Foundation and by the George Alfred Cook Memorial Fund.     

F-18 FDG PET in detecting renal cell carcinoma

Purpose: To assess the role of F-18 FDG imaging with a dual head coincidence mode gamma camera (Co-PET) in the detection of renal cell carcinoma (RCC) in patients with renal masses.

Material and Methods: An F-18 FDG Co-PET study was performed in 19 patients (7 F, 12 M; mean age 58.15±2.5 years, age range 45-79 years) with suspected primary renal tumors based on conventional imaging techniques, including computed tomography (CT) and ultrasonography (US) before nephrectomy or surgical resection of the mass.

Results: Histologically documented RCC was present in 15 patients. Of the 19 patients with suspected primary renal tumors, F-18 FDG Co-PET was true-positive in 13, false-negative in 2, true-negative in 3, and false-positive in 1 patient. Two angiomyolipomas and one renal mass due to infarction and hemorrhage showed a true-negative Co-PET result. The patient with false-positive FDG Co-PET study was diagnosed as xantogranulomatous pyelonephritis. Overall sensitivity, specificity, and accuracy of FDG Co-PET for RCC were 86% (13/15), 75% (3/4), and 84% (16/19), respectively. Positive predictive value for RCC was 92% and negative predictive value 60%.

Conclusion: These findings suggest that F-18 FDG Co-PET may have a role in the diagnostic evaluation of patients with RCC and primary staging of disease. Positive F-18 FDG study may be predictive of the presence of RCC. However, a negative study does not exclude the RCC.     

肾癌患者外周血淋巴细胞CD44的表达

目的:研究细胞表面粘附分子CD44在肾细胞癌外周血淋巴细胞中表达及临床意义。方法:根治术的肾细胞癌59例,男39例,女20例,年龄20～67岁。CD44表达应用流式细胞免疫学方法检测,并与正常对照(n=30)进行比较。结果:肾细胞癌外周血淋巴细胞中CD44表达均明显高于正常对照(P<0.01),手术后2周和12个月表达降低,但仍高于对照(P<0.05)。T3+T4期CD44表达明显高于T1+T2期(P<005),肾癌有转移患者CD44表达均高于无转移者(P<0.01),肾癌不同组织类型的CD44表达无显著性差异(P>005)。结论:肾癌患者CD44表达水平明显高于正常对照,且手术后可以明显下降,其表达水平与肾癌的进展情况及有无转移、预后有一定关系。     

肾细胞癌的CT表现与PCNA和P53表达的相关性探讨

目的分析肾细胞癌的CT表现与增殖细胞核抗原(PCNA)和癌基因蛋白(P53)表达的关系.方法对48例经手术病理证实的肾细胞癌,用LDP免疫组化法测定肿瘤标本中的PCNA和P53表达,并分析其与术前CT表现的关系.结果PCNA和P53的表达与肾细胞癌的组织学类型无关(P＞0.05),PCNA的表达与肿瘤侵犯肾包膜、肾周脂肪间隙、肾筋膜,局部淋巴结转移,邻近器官和脉管受累有关;而P53的表达与上述征象无关.结论肾细胞癌的CT表现中,肿瘤有侵犯肾包膜、肾周脂肪间隙、肾筋膜,局部淋巴结转移及邻近器官和脉管受累征象时,提示肿瘤的恶性程度相对较高.     

CT在不同病理亚型肾细胞癌诊断中的价值

目的 探讨WHO病理分类中不同亚型肾细胞癌（renal cee carcinoma,RCC）的CT特征,旨在加深对RCC的认识,提高影像诊断准确率.方法 回顾性分析2008年1月～2013年9月72例经病理证实的RCC患者的临床资料及CT检查结果,其中透明细胞癌58例,乳头状细胞癌7例,嫌色细胞癌4例,多房囊性肾癌3例.结果 透明细胞癌平扫病灶呈等或低密度,增强扫描皮质期肿瘤多呈不均性明显强化,实质期、分泌期强化减退.乳头状细胞癌多呈等密度或囊实性,增强扫描皮质期实性部分轻度强化,实质期、分泌期延迟强化.嫌色细胞癌多位于肾髓质内,密度均匀,增强扫描强化均匀,坏死、囊变少见.多房囊性肾癌位于肾皮质区,由多个囊腔和分隔构成,囊壁及间隔菲薄,无附壁结节,平扫病灶呈低密度,增强扫描囊壁、间隔延迟强化.结论 不同病理亚型肾细胞癌CT特征、手术方案、预后均不同,术前影像学检查准确诊断能够为临床医师选择合理手术方案提供可靠依据.     

Computed tomography of renal cell carcinoma in patients with terminal renal impairment

Purpose

An increased incidence of renal tumors has been observed in patients with end-stage-renal-disease (ESRD). The very strong association with acquired renal cystic disease (ACRD) and increased incidence of the renal tumors (conventional renal cell carcinoma (CRCC), papillary renal cell carcinoma (PRCC) or papillary renal cell adenoma (PRCA)) was reported. This study discusses the role of computed tomography (CT) in detecting renal tumors in patients with renal impairment: pre-dialysis, those receiving dialysis or with renal allograft transplants.

Materials and methods

Ten patients (nine male, one female) with renal cell tumors were enrolled into a retrospective study; two were new dialysis patients, three on long-term dialysis, and five were renal transplant recipients with history of dialysis. All patients underwent helical CT, a total of 11 procedures were performed. Sixteen-row detector system was used five times, and a 64-row detector system for the six examinations. All patients underwent nephrectomy of kidney with suspected tumor, 15 nephrectomies were performed, and 1 kidney was assessed during autopsy. CT findings were compared with macroscopic and microscopic assessments of the kidney specimen in 16 cases.

Results

Very advanced renal parenchyma atrophy with small cysts corresponding to ESRD was found in nine patients, chronic pyelonephritis in remained one. A spontaneously ruptured tumor was detected incidentally in one case, patient died 2 years later. In the present study, 6.25% (1/16) were multiple PRCA, 12.5% (2/16) were solitary PRCC, 12.5% tumors (2/16) were solitary conventional renal cell carcinomas (CRCC's), 12.5% tumors (2/16) were multiple conventional renal cell carcinomas (CRCC's), 25% (4/16) were CRCC's combined with multiple papillary renal cell carcinomas with adenomas (PRCC's and PRCA's), and 25% (4/16) of the tumors were multiple PRCC's combined with PRCA's without coexisting CRCC's. Bilateral renal tumors were found in our study in 60% (6/10) confirmed in six cases, one kidney left on follow-up due to the small tumors.

Conclusions

With the use of a multi-detector row system, it is possible to detect smaller foci suspected to originate in multiple tumors, especially when up to 3-mm thin multi-planar reconstructions are used. Two cases demonstrated the possibility the development of RCC in impaired kidneys may start before dialysis initiation.     

MR Imaging of papillary renal neoplasms: potential application for characterization of small renal masses

The purpose of our study was to evaluate the role of MRI in demonstrating the precise nature of papillary renal tumors (P RCC) and its potential application to select patients for partial surgery. Ninety-seven tumors less than or equal to 3 cm in size [55 papillary renal cell carcinoma - 42 clear cell renal carcinoma (CC RCC)] were preoperatively evaluated by MRI. Imaging findings were assessed with a special focus on the aspect of the tumoral process. Correlations were performed with pathologic staging after surgery. At pathology, 92 tumors were established to be staged p T1 and 5 were p T3 ( 3 cases of CC RCC and 2 cases of P RCC). Ninety-four percent of papillary tumors exhibited low signal intensity with homogeneous pattern on T2-weighted images. All clear cell carcinoma were hyperintense and heterogeneous on T2-weighted sequence. Enhancement was lower and delayed in the papillary type in comparison with the clear cell type. MRI is accurate enough to predict the ‘histologic‘ nature of papillary renal carcinoma. It is an additional argument to propose that the tumor can be removed by partial surgery.     

肾脏上皮样血管平滑肌脂肪瘤的CT诊断

目的 探讨肾脏上皮样血管平滑肌脂肪瘤(EAML)的CT表现,以提高对该病的诊断水平.方法 对15例经手术病理证实为肾脏EAML的临床及影像资料进行回顾性分析.15例肾脏EAML均经CT平扫及增强扫描.结果 肾EAML具有一定的特征性表现:(1)CT平扫呈稍低或等高密度,无脂肪成分,边界光整,圆形或类圆形,直径为2～5 cm;(2)病灶可以累及肾髓质部分或向外生长,但实验室检查无血尿;(3)增强扫描动脉期呈明显或较明显均匀强化,少数可不均匀明显强化,部分病灶内有增粗迂曲的血管;(4)强化方式为快进快出.结论 CT特征表现对正确诊断肾脏EAML有重要价值.     

增强CT参数在肾癌术前病理分型中的价值

目的:探讨肾癌(RCC)在增强CT各期中的表现及增强CT参数在肾癌术前病理分型中的价值.方法:回顾性分析149例肾癌(包括透明RCC 131例、乳头状RCC 12例和嫌色RCC6例)患者的四期CT(平扫期、皮质期、实质期及排泄期)扫描图像,结合术后病理进行对比分析,比较各期肾癌绝对增强值、病灶强化百分比、峰值出现时相等参数.结果:透明RCC CT值峰值出现于皮质期,且此期透明RCC的CT值明显高于同期的乳头状RCC和嫌色RCC,差异有统计学意义(P＜0.05);乳头状RCC及嫌色RCC的CT峰值出现于实质期.皮质期透明RCC的CT绝对增强值、病灶强化百分比均明显高于乳头状RCC及嫌色RCC,差异有统计学意义(P＜0.05),而排泄期嫌色RCC绝对增强值高于乳头状RCC,差异有统计学意义(P＜0.05).结论:CT绝对增强值、病灶强化百分比等增强CT参数可与传统CT诊断方法相结合,提高肾癌术前病理分型的诊断准确度.     

Fine-needle percutaneous biopsy of renal masses with helical CT guidance

PURPOSE: To evaluate the feasibility, accuracy, and clinical role of fine-needle percutaneous biopsy of renal masses, with helical computed tomographic (CT) guidance. MATERIALS AND METHODS: In 63 patients (mean age, 62 years), 73 biopsies were performed. The median tumor size was 4.0 cm. Tumor biopsy was performed with an 18-gauge needle by using helical CT guidance in an outpatient setting. Two to four cores per tumor were obtained. RESULTS: Biopsy material was insufficient for analysis in 15 (21%) procedures. The median tumor size of failed or successful biopsies was 3.0 or 4.8 cm, respectively (P =.03). A benign lesion was found at eight biopsies. Two samples were suspicious for renal cell carcinoma (RCC). RCC was found in 38 biopsy samples. The remainder were transitional cell carcinoma, metastasis, lymphoma, or sarcoma. Twenty-six patients underwent nephrectomy. The accuracies of biopsy for histopathologic and Fuhrman nuclear grade evaluation were 89% and 78%, respectively. For tumors of 3.0 cm or smaller or larger than 3.0 cm, 37% (11 of 30) or 9% (four of 43) had failure of biopsy, respectively (P =.006). No substantial morbidity occurred. CONCLUSION: Fine-needle biopsy with helical CT guidance is accurate for the histopathologic evaluation of renal masses without morbidity. Indications are renal lesions that do not have the typical radiologic features of RCC, Bosniak category III or IV cystic lesions, and locally advanced or metastatic RCC.     

Advances of multidetector computed tomography in the characterization and staging of renal cell carcinoma

Renal cell carcinoma (RCC) accounts for approximately 90%-95% of kidney tumors. With the widespread use of cross-sectional imaging modalities, more than half of RCCs are detected incidentally, often diagnosed at an early stage. This may allow the planning of more conservative treatment strategies. Computed tomography (CT) is considered the examination of choice for the detection and staging of RCC. Multidetector CT (MDCT) with the improvement of spatial resolution and the ability to obtain multiphase imaging, multiplanar and three-dimensional reconstructions in any desired plane brought about further improvement in the evaluation of RCC. Differentiation of RCC from benign renal tumors based on MDCT features is improved. Tumor enhancement characteristics on MDCT have been found closely to correlate with the histologic subtype of RCC, the nuclear grade and the cytogenetic characteristics of clear cell RCC. Important information, including tumor size, localization, and organ involvement, presence and extent of venous thrombus, possible invasion of adjacent organs or lymph nodes, and presence of distant metastases are provided by MDCT examination. The preoperative evaluation of patients with RCC was improved by depicting the presence or absence of renal pseudocapsule and by assessing the possible neoplastic infiltration of the perirenal fat tissue and/or renal sinus fat compartment.     

Renal vein to portal vein collaterals in three cases of renal cell carcinoma extending into the inferior vena cava: Consequences for chemoembolization

Three patients with renal vein and inferior vena cava (IVC) tumor thrombus from left renal cell carcinoma (RCC) showed Lipiodol deposits in the liver following selective SMANCS (styrene maleic acid neocarzinostatin)/Lipiodol embolization of the renal tumors. In 2 of the 3 patients, renal-portal communications were demonstrated during selective renal arteriography. In I of these patients, considerable liver dysfunction occurred after the second renal chemoembolization and Lipiodol deposits persisted in the liver for about 1 month. We conclude that these anastomoses need to be considered prior to embolization therapy of patients with RCC and tumor thrombus in the renal vein and IVC. Sclerosing substances or larger particles may be better embolic agents in such patients.     

Erythropoietin-producing renal cell carcinoma arising from autosomal dominant polycystic kidney disease

Erythropoietin (EPO)-producing renal cell carcinomas (RCC) in patients with chronic renal failure secondary to autosomal dominant polycystic kidney disease (ADPKD) has not previously been reported. We report a case of EPO-producing RCC associated with ADPKD in a 66-year-old woman, and discuss the clinical and radiological findings.     

CT灌注成像在肾细胞癌中的应用进展

肾细胞癌(RCC)是泌尿系统常见的恶性肿瘤,其发病率及死亡率近年来逐渐上升。影像检查对RCC的定性诊断、分级与治疗反应评价具有重要价值。CT灌注成像(CTPI)是一种功能成像技术,能无创性反映整个肿瘤的微循环血流灌注情况,RCC的CTPI评估成为研究热点。CTPI灌注参数不仅有助于判断RCC部分亚型,还可以与肾盂癌及乏脂肪肾血管平滑肌脂肪瘤进行鉴别,并且能够预测RCC病理分级、评估非切除治疗及RCC转移灶的疗效,以及判断预后。就CTPI对RCC以上几方面的研究现状及进展予以综述。     

CT引导下经皮穿刺射频消融补救性治疗晚期肾癌

目的探讨射频消融治疗肾细胞癌（RCC）的有效性及安全性。 方法收集56例不适宜外科切除治疗的RCC患者。肿瘤直径为2.6～8.6 cm,平均（5.6±1.2）cm。CT引导下行经皮穿刺射频消融术。随访评估临床效果、肾功能和并发症状况。 结果本组56例患者中,病灶直径<4 cm的35患者射频治疗后1、3、6个月复查时均未见病灶强化,病灶直径>4 cm的21例,在术后3个月复查时13例出现治疗边缘强化,活检证实为复发病灶,再次行射频消融治疗。截止随访时间内,50例存活,6例死于非肿瘤原因。射频治疗前后肾功能变化差异无统计学意义。并发症轻微,无肾脏出血、感染、肾盂损伤等严重并发症。 结论经皮穿刺射频消融治疗可使无外科手术机会的RCC患者生存获益,并能很好的保护患者肾功能,同时并发症轻微,可作为一种重要的治疗手段。