肾原发性恶性纤维组织细胞瘤1例

病例 :患者男 ,5 5岁。左上腹包块伴腹痛 5天。查 :腹平软 ,左上腹扪及约 16× 15ｃｍ肿块 ,质硬 ,表面凸凹不平 ,上界扪不清 ,下界平脐、固定。Ｂ超示 :左肾区约 18× 12× 11ｃｍ实质不均质中低回声包块。报告 :左肾巨大实质、不均质占位病变。ＣＴ示 :左肾实质内约 14× 11ｃｍ肿块 ,其内不规则散在砂粒样钙化灶。报告 :左肾胚胎癌。术前一周给予肾内血管栓塞治疗。术后送检标本 :18× 12× 10ｃｍ肾脏 1个 ,有部分肾包膜。沿肾门切开 ,肾实质内见 -约 14× 12ｃｍ的肿物 ,肿物无包膜 ,与周围肾组织无明显界限 ,部分突破肾包膜。切面灰白…     

肾实质肿瘤的超声诊断（附其它影像学检查结果）

断的因素进行了探讨。同时本文较为详细地介绍了肾实质肿瘤的病理学类型。     

儿童肾细胞癌二例

肾细胞癌一般发生于成年,儿童期极为罕见。我院近7年收治二例,报告如下。病例介绍例1.患儿,男,12岁,因腹胀痛3天,加剧一天,于1984年4月23日入院。患儿无血尿病史。入院体检:腹部稍膨,左侧腹肌稍紧张,全腹有压痛,左侧为剧,反跳痛可疑。急诊手术探查,见左腹腹膜后为一巨大肿块占据,其下方见广泛血肿,切除左肾肿瘤约16cm×15cm×8cm大小,与周围组织粘连,质中偏硬,肿瘤下极破溃,下方存积多量暗红血块。术后拟诊为威尔姆氏瘤(肾胚胎瘤),即用长春新碱+更生霉素化疗。     

未分化型肾细胞癌1例

1 病例报告患者男,58岁,左腰闷痛伴乏力于1997年6月4日入院.一般情况良好,肾区无叩击痛,尿常规、肾功能检查正常.B超:左肾外形增大,内前方见10cm×9.7cm中低回声团块影,边缘不整.静脉肾盂造影见左肾区软组织肿物,边界不清,注入造影剂显示左肾下盏、肾盂受压向下移位,左肾中上极肾盏未显影.临床诊断:左肾肿瘤.于1997年6月10日行左肾切除术.术中所见:肾外形增大,肾上极可见一10cm×9.0cm×6.8cm的瘤体.肾脏被压变形并与周围组织严重粘连.病理大体所见:肾近球形(18cm×16cm×14cm大小)表面凸凹不平,切面可见肾皮质受压变薄,皮髓界线不清,肾上极见实性灰白色肿块(9.2cm×9.0cm×6.0cm大小),与周围肾组织界线不清,切面示质松软.光镜:肿瘤细胞弥漫排列,,细胞大小较一致.胞浆少量呈嗜伊红染色,核为     

乳头状肾细胞癌的临床治疗分析——附23例报告

目的总结分析乳头状肾细胞癌的临床特点,提高其治疗水平。方法回顾性分析1980～2000年收治的23例乳头状肾细胞癌患者的临床资料。男14例,女9例。中位年龄48岁（24～71岁）。左侧11例,右侧12例。在19例初治的患者中,临床表现血尿8例（42．1％）,腰痛7例（36．8％）,无症状者4例（21．1％）;肾脏肿瘤中位最大径5．5cm（2．5～10．0cm）。另4例为外院术后出现复发和转移。结果乳头状肾细胞癌占同期收治肾癌的2．4％（23／975）。失随访4例。术后总5年生存率69．6％。其中初治19例,5年生存率为84．2％。14例早期局限性癌（T1a～T2N0M0）患者5年生存率100％,但2例分别于术后7年6个月和10年出现转移,其中1例双肺转移患者行肺转移瘤切除和生物化疗后已生存9年且健在,1例失访。3例局部淋巴结转移和2例远处转移的患者中,1例术后2年6个月出现肺转移瘤和切口转移手术联合生物化疗后生存3年,1例同期肺转移瘤患者行肺转移瘤切除和放疗后生存6年,而余3例中,2例失访,1例生存6个月。而外院初治出现复发的4例中,2例患者再次行复发肿瘤切除,分别生存1年和2年6个月,另2例转移患者中,1例生存9个月,1例失访。结论乳头状肾细胞癌在国内少见。早期局限性乳头状肾细胞癌术后预后良好。对于复发或转移的乳头状肾细胞癌患者,手术切除转移瘤或复发瘤可提高生存期。     

偶发性肾细胞癌29例诊治报告

目的 通过回顾性分析提高偶发肾癌的诊治水平。方法 回顾性分析本院29例偶发肾癌的诊治及预后。结果29例中按Robson分期为I期17例，Ⅱ期10例，Ⅲ期2例；21例行开放性肾癌根治术，8例行腹腔镜下肾癌根治术。其中28例至今仍健在，平均生存35个月。偶发肾癌生存时间高于症状性肾癌，其分期较低。结论 定期B超检查是早期发现偶发肾癌的重要手段。肾癌根治术是最有效的方法。腹腔镜肾癌根治术适合于早期肾癌。其预后主要取决于早期诊治。     

肾细胞癌保留肾实质手术的临床探讨

目的：探讨保存肾实质手术在肾细胞癌治疗中的临床价值。方法：1995年2月～2002年12月，对14例肾细胞癌病人施行保留肾实质手术，其中双侧肾癌3例，对侧肾有病变或潜在功能受损的肾癌5例，对侧肾功能正常的肾癌6例。肿瘤直径2．0～5．8cm，平均3．9cm。病理分期：T1期8例、T2期6例。9例行肾部分切除术，5例行肿瘤剜出术。结果：本组14例术后无并发症，随访13例，6个月～7年10个月，平均为50个月，1例术后3年发现肺转移，12例无瘤生存，本组均无肿瘤局部复发。1例失访。结论：根治性肾切除术是肾癌手术的金标准，而保留肾实质的手术一般只用于双侧肾癌及解剖或功能上的孤立肾肾癌患者。近年来，随着医学影像学的不断发展、外科技术的日益提高以及偶发肾癌病例的增加，选择保留肾实质的手术也日渐增多。保留肾实质手术是治疗局限性肾细胞癌患者的有效手段，能安全有效地保存肾功能，而手术效果与肾癌根治手术相当。     

64排CT动态扫描对肾细胞癌分期及远期生存率的诊断价值

目的评价64排CT动态扫描对肾细胞癌分期及远期生存率的的诊断作用。方法选取2010年1月至2012年5月间收治的110例肾细胞癌患者,均经手术病理证实。术前均行64排CT动脉扫描,观察CT扫描表现及分期结果,并将CT分期结果与术后临床分期结果进行比较。术后随访3个月至2年,统计CT对不同分期肾细胞癌患者1和2年生存率的评价结果。结果 CT表现显示肿瘤分布在肾实质内或突出肾轮廓者大部分为椭圆或圆形;边界不清晰且边缘不规则占67.3%;均为低密度或等密度;增强扫描皮质期肿瘤病变明显增强、实质期、肾盂期轻度强化74.5%。CT分期显示Ⅰ期27例,Ⅱ期26例,Ⅲ期51例,Ⅳ期6例。与病理分期比较,CT对肾细胞癌临床分期诊断准确率分别为93.1%、92.0%、90.2%和80.0%。术后定期CT复查,Ⅰ期、Ⅱ期患者的1和2年生存率均明显高于Ⅲ期、Ⅳ期患者,差异有统计学意义(P<0.05)。结论 64排CT动态扫描术前临床分期准确率高,可有效评价肾细胞癌术后远期生存率,临床需进一步提高多层螺旋CT扫描技术。     

Imaging findings of renal cell carcinoma

There are many imaging modalities used in the diagnosis of renal cell carcinoma, the most common cancer of the kidney, which accounts for approximately 2–3% of adult malignancies. Early detection of this tumor with the correct diagnostic approach using various cross-sectional imaging is very important, as are the clinical and laboratory findings. Familiarity with the spectrum of imaging findings of renal cell carcinoma will enable clinicians to consider appropriate treatment for patients and eliminate unnecessary further imaging studies.     

Renal cell carcinoma presenting as a huge simple renal cyst

Simple renal cysts are the most common renal masses, accounting for roughly 65–70% of cases. Transformation of a simple renal cyst into a renal cell carcinoma (RCC), however, is extremely rare. We reported a 48-year-old man with a right huge simple renal cyst from which about 800 ml of dark yellowish fluid with elevated protein and lactic dehydrogenase (LDH) levels was aspirated. Cytological examination disclosed negative for malignant cells. Nephrectomy was performed because of intractable flank pain 3 months after aspiration. The pathology examination confirmed RCC. While this is an extremely unusual finding, one must not exclude the possibility of malignancy in an apparently simple cyst.     

Aneurysmal bone cyst of the temporal bone

Aneurysmal bone cyst (ABC) of the temporal bone is rare. The nature of the underlying disorder that converted into the ABC might, however, be difficult to ascertain on imaging as well as on histopathology. The unusual CT and MRI findings in a case of ABC of the temporal bone are presented. This had transdural intracerebral spread with a large component of solid enhancing matrix but no peripheral calcific rim. The patient was an adult of 45 years with a history of headache for more than 1 year.     

偶发性肾癌的诊治体会(附44例报告)

目的　自 1980年～ 1999年收治的 3 18例肾癌中 44例为偶发癌。其中 3 8例为健康体检时经B超或CT发现 ,6例为其他系统疾病检查或随访时发现的。结果显示B超和CT检查是偶发性肾癌的重要影像学诊断方法 ,肾癌根治术为首选治疗方法。早期诊断是偶发性肾癌预后较好的主要原因 ,它有赖于健康检查的普及。     

多层螺旋CT灌注成像在肾肿瘤中的应用及与分子病理学的相关性

[目的]探讨多层螺旋CT（MSCT）灌注成像在肾肿瘤诊断中的价值。[方法]59例肾肿瘤行MSCT灌注扫描．应用perfusion2软件包计算血流量（BF）、血容量（BV）、表面通透性fPS）及平均通过时间（MTT）．同时检测肾肿瘤及肿瘤旁正常组织中血管内皮生长因子（VEGF）的表达及微血管密度（MVD）,[结果]59例肾肿瘤术后病理证实为。肾癌48例,肾盂癌6例,肾血管平滑肌脂肪瘤5例。在不同级别的肾细胞癌中．其灌注参数BF、BV和PS均明显低于正常肾皮质（P〈0．01）,且高级别的肾癌灌注参数BF、BV和PS均明显高于低级别的肾癌（P〈0．01）。肾血管平滑肌脂肪瘤和肾盂癌的灌注值均明显低于肾癌,有显著性差异（P〈0．01）。肾癌的BF、BV、PS值与肿瘤的VEGF表达呈显著正相关（P〈0．01）,MTT、值与VEGF表达呈显著负相关（P〈0．01）。[结论]MSCT灌注成像能定量评价肿瘤血管生成,血管灌注及血管通透性改变,有助于肾细胞癌的术前分级．并在肾肿瘤的鉴别诊断方面具有一定的临床应用价值。     

Renal cell carcinoma presenting as a single large cyst

A large single renal cyst occurring in a 56-year-old man was found to be a cystic renal cell carcinoma on surgical exploration. Various diagnostic tests preoperatively did not reveal the true nature of the cyst.     

胰腺导管内黏蛋白性乳头状瘤CT、MRI诊断及鉴别诊断（附6例报告)

目的:探讨胰腺导管内黏蛋白性乳头状瘤CT、MRI表现特点及诊断价值。方法:6例经手术和病理证实的胰腺导管内黏蛋白性乳头状瘤均行CT平扫及增强检查。4例行MRI检查,其中2例行MRI增强扫描。结合文献,回顾性分析其临床表现及CT、MRI征象表现。结果:本组患者主胰管型5例,混合型1例。CT表现:主要表现为胰腺主胰管或分支胰管不规则扩张,呈分叶状囊性表现,其中4例显示壁结节。增强扫描肿瘤实性部分轻度强化。MRI扫描:胰腺导管不规则扩张,T1WI扩张胰管呈均匀低信号,2例扩张囊壁上见结节样隆起呈等信号。T2WI扩张胰管呈高信号,壁结节显示不清。压脂T1WI扫描肿瘤结节显示清楚。增强扫描肿瘤结节中度强化。结论:CT、MRI对胰腺导管内黏蛋白性乳头状瘤的诊断具有重要价值。     

Renal cell carcinoma and vasculitis: report of two cases

A 63-year-old caucasian male with systemic leukocytoclastic vasculitis involving the skin, lungs, and gastrointestinal tract was found to have a renal cell carcinoma at autopsy. A 77-year-old-woman with a history of hypertension was felt to have temporal arteritis that was confirmed by biopsy. The autopsy revealed a renal cell carcinoma in association with widespread giant cell arteritis. The possible association of renal cell carcinoma with vasculitis and an assessment of the possible clinical usefulness are presented and cases of vasculitis with renal neoplasms are briefly reviewed.     

The diagnosis of renal cell cancer in relation to hypertension (United States)

Objectives: Renal cell cancer has been associated with hypertension or with drugs to treat it in several studies. We assessed whether the association is explained by more frequent detection of early renal cell cancer among persons being treated for hypertension.Methods: The data were collected in our Case-Control Surveillance Study, in which patients aged 20 to 69 years were interviewed in hospitals in Baltimore, Boston, New York, and Philadelphia during 1976-1996. We compared 134 incident cases of renal cell cancer who were being treated with drugs for hypertension to 193 untreated cases with respect to the route to diagnosis and the stage.Results: The relative risk estimate for having been diagnosed incidentally during a routine examination or workup for another condition, relative to having been diagnosed because of symptoms of renal cell cancer, was 1.3 (95 percent confidence interval, 0.7-2.5). The estimate for diagnosis at stage I or II relative to stage III or IV was 1.2 (0.7-2.1).Conclusion: In Case-Control Surveillance Study data, the relative risk estimate for renal cancer among users of various classes of antihypertensive drugs is 1.8 or 1.9. The present results suggest that this association can, at most, be explained only partially by the selective diagnosis of renal cell cancer among persons being treated for hypertension.     

Neuroenteric cyst of the craniocervical junction

A neuroenteric cyst is a rare cause of an intradural, extramedullary mass. We report the MRI findings in a case of a neuroenteric cyst of the craniovertebral junction without associated abnormalities.