肾脏交织状血管瘤1例报告并文献复习

目的 探讨肾脏交织状血管瘤的临床特点、诊断及治疗方法. 方法 回顾性分析1例肾脏交织状血管瘤的临床资料,结合相关文献复习,总结该病的诊断和治疗特点. 结果 术前误诊为恶性肿瘤,于全麻下行后腹腔镜右肾根治性切除术,术后病理提示肾脏交织状血管瘤.随访3个月,未见肿瘤复发. 结论 肾脏交织状血管瘤是一种罕见的变异的肾脏毛细血管良性肿瘤.临床及影像学表现无特异性,术前易误诊为恶性肿瘤,确诊有赖于病理,宜行保留肾单位肾部分切除术治疗.     

自身免疫性胰腺炎的影像学研究

目的 研究自身免疫性胰腺炎( autoimmune pancreatitis,AIP)的影像学表现及其临床价值.方法 回顾性研究14例经病理证实或肾上腺皮质激素规范治疗后随访证实的AIP患者临床资料,男13例,女1例,平均58.3岁.12例行CT检查,8例行MRI检查,其中6例同时行CT及MRI检查.结果 胰腺弥漫肿大者7例,局限肿块型5例,混合型2例.CT平扫病变呈等密度(5例)或稍低密度(7例),1例胰腺内及周边见多个囊性低密度灶,MRI病变T1WI序列信号均匀或稍不均匀降低,T2WI序列信号不同程度均匀或稍不均匀升高,DWI序列信号均升高.动态增强扫描,动脉期病变强化降低呈不均匀“雪花状”,后渐进性延迟强化.9例病变周围见“胶囊样”包壳.4例胰管形态不规则,5例胰管轻度扩张;9例胆总管下段管壁规则增厚伴明显强化及“鸟嘴样”管腔狭窄.4例病变周围血管受累,1例肝门区见2枚肿大淋巴结.2例增强后肾脏内见异常低密度灶.经肾上腺皮质激素规范治疗的10例患者随访影像学检查病变胰腺均有明显的好转及恢复.结论 AIP具有特征性的CT和MRI影像表现,对于AIP的诊断和鉴别诊断具有重要意义.     

隆突性皮肤纤维肉瘤影像学表现

目的探讨隆突性皮肤纤维肉瘤(DFSP)的影像学表现。方法回顾性分析9例DFSP患者的影像资料,结合病理分析其影像学特点。结果 9例患者均为单发病灶,均发生于皮肤或皮肤下,其中四肢4例、躯干5例。8例表现为皮下软组织肿块,6例呈圆形或类圆形,边缘较清晰,2例呈分叶状肿块,并沿周围肌肉间隙生长,1例大部分边界模糊;1例悬吊于皮肤外,呈分叶状。2例CT平扫病灶呈中等略低密度,多均匀或略不均匀;MRI示7例病灶呈较均匀等或稍长T1信号,1例呈不均匀稍短T1信号,6例呈不均匀稍长T2信号,可伴小斑片状、条索状稍短T2信号或小斑片状长T2信号,2例呈长T2信号,1例伴环状稍短T2信号;5例增强后明显强化,其中4例强化不均匀。结论 DFSP的影像学表现具有一定特征性,尤其MRI对定性诊断及术前评估有重要的临床应用价值。     

原发性肾脏罕见恶性肿瘤的CT影像学表现分析

目的分析和探讨肾脏罕见恶性肿瘤的CT影像学表现特点。 方法回顾性分析2008年12月至2018年10月，广州市第一人民医院及红十字会医院18例经手术及病理证实的肾脏罕少见恶性肿瘤的CT影像学资料。 结果18例恶性病变分别为恶性纤维组织细胞瘤1例，CT平扫肿瘤边界不清，密度不均，瘤内见片状密度减低区，增强扫描肿瘤轻度延迟强化。平滑肌肉瘤1例，CT平扫肿瘤边界略清，密度不均，瘤内见大片状密度减低区，增强扫描肿瘤轻度延迟强化。肾实质浸润型尿路上皮癌1例，CT平扫双肾多发不规则软组织肿块，平扫密度不均匀，增强扫描强化不均匀。囊性肾癌6例，呈囊性病灶，增强扫描囊性成分未见明确强化，病灶内可见强化分隔及絮状强化影。嫌色细胞癌9例，平扫密度均匀或不均匀，增强扫描6例呈轻中度延迟强化，3例呈"快进快退"表现。CT扫描对18例肿瘤的诊断准确率为72.2%（13/18）。 结论肾脏罕见恶性肿瘤具有一定的CT影像学特点，可为临床诊断及术前评估提供重要依据，但确诊仍需依靠病理学。     

脊柱尤文氏肉瘤CT和MR的表现

目的 探讨脊柱尤文氏肉瘤 (Ewing’s Sarcoma,ES)的CT和MRI表现。方法 回顾性分析经病理证实的7例脊柱ES的影像学资料。 结果 病变累及颈椎、胸椎各3例、腰椎1例。CT检查：2例椎体和/或附件溶骨性骨质破坏,3例椎管内外软组织肿块。MRI检查：7例均表现椎管内外肿物,瘤体T1WI表现为等、低或稍高信号, 6例T2WI表现为不均匀高信号,增强后不均匀强化;1例T2WI为均匀稍高信号,增强后均匀强化。免疫组织化学：肿瘤均表达CD99阳性。 结论 青少年患者进行性发展的椎管内外软组织肿块伴脊柱溶骨性骨质破坏,提示脊柱ES可能。脊柱ES需结合病理学及免疫组化确诊。CT、MRI综合使用为脊柱ES诊断、治疗、疗效评价及预后提供帮助。     

CT和MRI术前评估颞骨段面神经鞘瘤

目的探讨CT及MR检查术前评估颞骨段面神经鞘瘤的应用价值。方法回顾性分析9例经手术病理证实的颞骨段面神经鞘瘤的患者临床资料,9例患者均接受MR平扫及增强扫描,其中3例同时接受CT平扫及增强扫描。结果 9例面神经鞘瘤患者6例位于左侧,3例位于右侧,病变单独累及迷路段2例,鼓室段1例,乳突段1例;累及迷路段+鼓室段3例,鼓室段+乳突段2例。1例肿瘤与面神经可见分界,余8例均未见明显分界,2例可见乳突及外耳道软组织肿块。CT主要表现为面神经走形区边缘规则或不规则的软组织肿块,伴不同程度不规则或虫蚀状骨质破坏及面神经管增粗,部分可见骨质硬化;MRI表现为T1WI呈等信号,T2WI呈等或稍高信号的肿块影,增强扫描呈明显均匀或不均匀强化。结论 CT及MRI相互结合可准确地显示颞骨段面神经鞘瘤的位置和形态及周围情况,可作为面神经鞘瘤术前评估的首要检查方法。     

骨盆软骨肉瘤的影像学表现

[目的]探讨骨盆软骨肉瘤的影像学特点,提高影像诊断的准确性.[方法]回顾分析17例经病理证实骨盆软骨肉瘤的影像学资料,其中15例行DR(digital radiography)拍片,14例行CT检查,12例患者行MRI(magnetic resonance imaging)检查.[结果]15例DR检查中13例DR片清晰显示不规则骨质破坏,11例DR片清晰显示病灶内有大小不一钙化.14例CT表现骨质呈溶骨性或膨胀性破坏,周围不均匀密度软组织肿块,可见不规则钙化或骨化.12例MRI表现为骨质破坏,周围软组织肿块,边界不清;T1WI呈低信号,T2WI呈高、低混杂信号,脂肪抑制序列T2WI呈混杂高信号,增强扫描呈周边强化或分隔样强化.[结论]软骨肉瘤影像学特征表现为骨质不规则破坏,伴软组织肿块内钙化.DR、CT、MRI三者相结合有助于骨盆软骨肉瘤的诊断.     

不典型肺硬化性血管瘤的CT表现

目的探讨不典型肺硬化性血管瘤(PSH)的CT特征。方法收集6例CT表现不典型、经病理证实的PSH患者影像学资料,分析其CT表现。结果 6例CT平扫表现如下:5例单发,其中3例表现为侧胸壁胸膜肿块、2例跨越斜裂胸膜生长,1例弥漫多发,贴近斜裂胸膜生长;4例形态不规则,2例呈类圆形或结节样;5例边缘见磨玻璃影;胸腔积液1例;囊变3例;粗点状钙化4例。5例接受CT增强扫描,动脉期3例轻度强化、1例中度强化、1例明显强化,静脉期3例强化程度稍增强、1例持续强化、1例CT值稍下降;均见贴近肿瘤边缘走行的血管影。结论不典型PSH CT多表现为不规则肿块,亦可呈多发结节状,可沿侧胸膜或跨越叶间胸膜生长,或伴胸腔积液。     

异位嗜铬细胞瘤的影像诊断

目的探讨异位嗜铬细胞瘤在CT、MR的影像表现及诊断价值。方法回顾性分析11例具有完整临床影像及病理资料的病例,其中MR检查9例次,CT检查6例次,同时行CT、MR检查4例。结果46例嗜铬细胞瘤中11例异位,发生率大于15％,良性占8例,恶变3例,CT、MR正确诊断为7／11。CT平扫表现为等或稍高密度肿块,强化明显呈均匀强化;MR扫描T1WI显示中等信号偏低的软组织肿块,T2WI则显示中高信号影;增强后肿瘤实体强化明显的影像学表现。结论CT、MR是异位嗜铬细胞瘤定性定位诊断中有效的影像检查方法。     

下肢孤立性纤维性肿瘤影像学表现 (附2例报告及文献复习)

目的分析下肢孤立性纤维性肿瘤（SFT）的影像学表现。方法报告2例经病理证实的下肢SFT的影像学表现,并复习相关文献。2例患者均接受MR检查,1例接受X线检查。结果2例病变均主要位于大腿股二头肌内,MR多表现为边界清楚的椭圆形或类圆形肿块,T1WI呈等低或等信号,T2WI信号混杂,可表现为高、稍高和低信号;增强扫描多呈不均匀强化,肿瘤实质强化明显。X线平片1例未见骨质破坏。结论下肢SFT影像学表现有一定的特点,MR是其最佳检查方法。     

CT鉴别诊断脾原发血管性肿瘤的研究

目的评价CT检查对脾原发血管性肿瘤的临床诊断及鉴别诊断价值。 方法回顾性分析1989年12月至2018年11月经病理学证实的59例原发血管性肿瘤CT资料。 结果20例脾血管瘤增强扫描后可有3种强化方式;6例错构瘤表现与血管瘤类似;6例淋巴管瘤CT增强后无强化;17例血管淋巴管瘤依其淋巴管和血管构成比例不同而表现不一;8例窦岸细胞血管瘤表现为脾内多发低密度结节,呈渐进性强化或轻度强化;2例血管肉瘤表现为不均匀性强化,瘤内出现坏死和（或）异常肿瘤血管,常伴发转移。 结论脾原发血管性肿瘤影像学表现虽然各具特征,但部分征象相互重叠,CT检查有助于对其进行鉴别与诊断。     

64排螺旋CT动态增强扫描结合后处理对胃肠道外间质瘤的诊断价值

目的:探讨64排螺旋CT动态增强扫描结合后处理对胃肠道外间质瘤(extragastrointestinal stromal tumor,EGIST)的诊断价值。方法:回顾性分析8例经手术病理证实的EGIST CT表现及临床资料。所有病例均行64排螺旋CT动态增强扫描,包括平扫、动脉期、门静脉期和延迟期,扫描结束后在GE ADW4.4工作站行多平面重组(multiple planar reconstruction,MPR),观察肿块的大小、形态、边缘和强化程度,肿块周围和(或)内部有无血管影,肿块与邻近脏器的关系,分析肿块的来源与性质。结果:8例EGIST中,位于腹膜后3例,肠系膜3例,小网膜1例,肝脏1例。肿瘤最大径平均(11.0±2.4)(7.7~15.0)cm,圆形或卵圆形4例,分叶状3例,不规则形1例。平扫肿块内密度不均,见斑片状、瘢痕状及大片状坏死囊变区,囊变坏死部分CT值为25~28 HU,实性部分CT值为34~47 HU,增强后动脉期实性部分轻、中度强化3例,CT值较平扫增加15~22 HU;实性部分明显不均匀强化5例,CT值较平扫增加40~55 HU。门静脉期渐进性强化6例,CT值较动脉期增加10~25 HU。坏死区未见强化。增强后肿瘤周围和(或)内部可见线状扭曲血管影6例。结论:EGIST的影像学表现有一定特征性,多排螺旋CT动态增强结合MPR对于EGIST的定位与定性诊断有重要临床意义,建议为术前常规。     

后肾始基腺瘤的CT与病理学特点分析

目的:探讨后肾始基腺瘤的CT特征及病理特点。方法:回顾性分析经手术病理证实的18例后肾始基腺瘤患者的临床资料,其中男10例,女8例,年龄33~75岁(平均50岁),均为单侧发病,左肾8例,右肾10例。患者均行CT平扫及增强扫描。分析18例患者CT和病理特点以及两者之间的关系。结果:18例患者CT平扫肿物呈等密度或稍低密度软组织肿块,最大径1.5~7.0cm,平均3.6cm;呈类圆形12例,不规则形6例;边界清晰6例,欠清晰7例,边界不清晰5例;密度均匀及不均匀各4例,密度欠均匀10例;CT值27~45HU,平均39HU。CT增强扫描示肿物未强化2例,轻到中度强化16例,呈软组织密度肿物影,低于肾实质强化水平,CT值50~77HU,平均63HU。11例延迟期扫描示肾盂肾盏有造影剂充盈并显示受压移位。患者术后病理学均证实为后肾始基腺瘤,光镜下肿瘤细胞体积较小,均匀分布,紧密排列,大小一致,形成长管样结构,部分可见乳头状或肾小球样结构。结论:后肾腺瘤的CT检查特征与病理特点有一定的相关性;正确认识其CT及病理学特点,有助于指导手术方案的制定,避免不必要的全肾切除术。     

Radiological features of renal pelvic hemangioma: a case series

BackgroundRenal pelvic hemangioma (RPH) is often misdiagnosed as renal pelvis cancer (RPC) due to its similarity in presentation, and there are few reports on the imaging findings of RPH. This study is aimed at improving the understanding of imaging findings specific for RPH by a retrospective analysis of the imaging findings of RPH.MethodsRPH cases confirmed by pathology and with high-quality images were collected in the analysis. Nine cases of RPH were enrolled, of which 6 cases underwent ultrasound (US); 7 cases underwent computed tomography (CT), including 6 cases with an enhanced scan; and 2 cases underwent magnetic resonance imaging (MRI), including 1 case with an enhanced scan. All images of cases were analyzed and sorted independently by two senior attending radiologist blinded to the pathological results, according to the imaging indicators, such as the density and intensity on CT and MRI respectively. When the opinions between radiologists were inconsistent, images were re-evaluated together until a consensus was reached.ResultsNine cases of RPH were collected from 5 males and 4 females, aged 16–70 years old, with a median age of 41 years. Five cases were located in the left kidney and 4 cases were located in the right kidney. The clinical symptoms mostly presented with hematuria. Nine cases demonstrated solitary masses, with 4 cases with blurred margins and 5 cases with well-defined margins. The size of the mass was about 1.5–8.0 cm, and the median size was 2.5 cm. The US showed mostly hypoechoic masses and color Doppler flow imaging (CDFI) showed minimal to no blood flow signal. Unenhanced CT scans showed mostly hypodensity and mostly mild continuous enhancement on an enhanced scan. The intensity of lesions was commonly heterogeneous on MRI due to hemorrhage and necrosis. One case showed mild continuous enhancement on an enhanced MRI scan.ConclusionsThe imaging findings of RPH commonly present as a focal lesion with blurred or well-defined margins, mild and continuous enhancement, and no cachexia of the clinical symptoms. RPH should be differentiated from malignant tumors of the renal pelvis for treatment.     

胸膜外孤立性纤维性肿瘤的影像学征象及临床、病理分析

目的探讨胸膜外孤立性纤维性肿瘤（SFT）的影像学表现及临床、病理特征。方法回顾性分析经病理证实的9例胸膜外SFT的影像学及临床、病理资料。结果9例SFT中,7例为良性,2例为低度恶性;病变位于颈部2例,盆腔2例,腹部2例,下肢1例,眼眶1例,臀部1例。7例接受CT扫描,肿块多呈类圆形,边界较清晰,大小31mm×27mm×23mm～311mm×l70mm×191mm;增强扫描后肿瘤明显强化,周围未见淋巴结转移。4例接受MR检查,小SFT的MRI较具特征性,T2WI呈等低信号,增强后均匀明显强化。病理：7例SFT有完整包膜,2例无明显包膜;镜下肿瘤细胞呈梭形、短梭形或卵圆形,胞浆红染,形成细胞密集区和疏松区;免疫组化：CD34和Vim均为阳性;bcl-2阳性6例,CD99阳性7例,S-100、SMA阴性7例,Des均为阴性。结论CT能够清楚、准确显示SFT的病变范围、强化方式;T2WI呈低信号及增强后较明显强化是SFT较具特征性的MRI表现。联合应用CT和MR能为该病的诊断、治疗提供更全面的信息,最后诊断有赖于组织病理学检查。     

Coexistence of cyst and tumor in the same kidney: a case report

A case of renal cyst associated with renal tumor is presented herein. A 40-year-old male patient visited our outpatient clinic for left renal cyst which had been found by ultrasonography on routine clinical examination. CT scan demonstrated an irregular area in the cyst wall measuring about 2 cm in thickness which showed enhancement of density with contrast medium. Magnetic resonance imaging (MRI) also demonstrated a round mass with abnormal signal on the cyst wall, protruding into the cyst cavity. Transabdominal radical nephrectomy was performed on 13 July 1987, and to the resected kidney was attached a cyst measuring 7 cm in diameter in the lower pole. Grossly, the cyst contained amorphous red-brown material which turned out to be old blood clots and the wall harbored a tumor (3.0 x 2.5 cm). Histologically, the tumor was renal cell carcinoma, the surface of which was covered with necrotic tissue. The coexistence of renal cyst and tumor is rare and 62 cases were collected from the Japanese literature including our case, and discussion was made in relation to the etiological factors.     

腹膜后肾上腺外副神经节瘤的CT表现

目的分析腹膜后肾上腺外副神经节瘤的CT表现,了解其影像学特点。方法回顾性分析12例经病理证实的腹膜后肾上腺外副神经节瘤的CT表现,并复习相关文献。术前对所有患者行CT平扫,对其中10例行增强扫描。结果12例肿瘤均为单发;3例为功能性,9例为非功能性;11例良性,1例恶性。8例肿瘤呈椭圆形或长椭圆形,4例为类圆形;7例肿瘤边界清楚,5例边界不清。平扫肿瘤呈稍低于肌肉的中等软组织密度,11例密度不均匀,瘤内见囊变、坏死或钙化;1例较小肿瘤密度均匀。增强扫描9例呈明显不均匀强化,1例强化较均匀。动态增强扫描显示肿瘤延迟强化,实性部分动脉期呈轻一中度强化,门脉期及实质期强化更加显著。结论腹膜后肾上腺外副神经节瘤的CT表现有一定特点,能为术前诊断和制定手术方案提供帮助。     

Adult Capillary Hemangioma of the Liver: Report of a Case

We report a rare case of capillary hemangioma of the liver in an adult. The patient was a 55-year-old man, admitted for investigation of a hepatic tumor. The tumor was seen as a hypoechoic mass with a peripheral hypoechoic ring on ultrasonography. Computed tomography (CT) showed an enhancement pattern different from that of hepatocellular carcinoma (HCC) or cavernous hemangioma. Ultrasonography-guided biopsy was technically very difficult because the tumor was located just below the diaphragm. We could not establish whether the tumor was HCC or cavernous hemangioma by the imaging findings, so we performed a hepatic resection. Histopathological examination confirmed a diagnosis of capillary hemangioma. Ultrasonography, CT, and magnetic resonance imaging showed an intermediate pattern between cavernous hemangioma and HCC. Thus, we must be aware of the possibility of capillary hemangioma when finding an atypical liver tumor inconsistent with HCC or cavernous hemangioma.     

原发性肾脏类癌2例报告并文献复习

目的：探讨原发性肾脏类癌的临床特征及诊治方法。方法：总结2例原发性肾脏类癌患者的临床资料结合文献复习讨论。例1,女,48岁。因右腰酸痛1个月入院。B超示右肾中上极中等回声占位,边界清楚,内有血流信号。CT示右肾中上极10．0cm×7．5cm实性占位,增强后病灶均匀轻度强化。例2,男,44岁。体检发现左肾占岱40天入院。B超示左肾门处中等回声占位,边界清楚,内有血流信号。CT示左肾中极肾门处3．7cm×3．5cm实性占位,增强后病灶均匀轻度强化;其内伴-钙化点。结果：2例均行根治性肾切除术。病理检查镜下肿瘤细胞形态为多边形,嗜酸性颗粒状细胞质,边界不清,呈柱状或缎带状排列混合有实性巢状排列;细胞核呈园形大小一致,核分裂像难见。免疫组化：突触素、波形蛋白均为阳性。病理诊断为肾脏类癌伴淋巴结转移。例1术后30个月死于肝骨转移;例2术后随访26个月,未见肿瘤复发转移。结论：原发性肾脏类癌临床罕见,易发生淋巴结转移,确诊依靠病理学检查,根治性肾切除应为治疗原发性肾类癌的首选方法。