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。     

多层螺旋CT在肾盂癌诊断中的价值

目的:探讨多层螺旋CT在肾孟癌的诊断和鉴别诊断中的应用价值.方法:经手术病理证实的20例患者,其中移行细胞癌16例,鳞状上皮癌4例,术前均行多层螺旋CT平扫和增强扫描,由两名主治医师以上职称共同阅片,将扫描图像进行平扫、动脉期、静脉期和分泌期及延迟期多期分析,与病理对照.结果:肾孟内肿决型15例,浸润肾实质型4例,肾孟壁增厚型1例.增强扫描动脉期18例肿瘤轻度不均匀强化,静脉期和分泌期11例病灶强化程度几乎没有改变,与相邻肾实质相比肿瘤呈低密度,15例延迟增强扫描见肾孟内充盈缺损.其中2例出现尿漏.1例肾孟内见型略高密度影,术前诊断凝血块,术后病理为乳头状移行细胞癌.结论:多屡螺旋CT平扫加增强扫描可提高肾孟癌的诊断正确率,平扫有利于和结石的鉴别,多平面重建更清晰显示病变位置及形态,增强扫描更有利于病变的定性诊断.     

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。     

肾癌不同病理亚型的MRI特点

目的探讨肾癌不同病理亚型的MRI表现。方法回顾性分析了2009年1月至2013年6月本中心收治的47例肾癌病例,所有病例均经MRI检查,术后病理确诊为肾细胞癌。以正常肾皮质信号强度为标准,采用目测法比较总结各病例的MRI特点。用SPSS 13.0统计软件,以P=0.05为标准进行卡方分析。结果肾透明细胞癌T1WI增强序列强化幅度明显高于其他两个亚型,且具有明显的"快进快出"的特点,有统计学意义(P0.05)。而肾乳头状细胞癌与肾嫌色细胞癌的T1WI增强序列图像无明显差异(P0.05)。肾透明细胞癌及肾乳头状细胞癌的化学位移图像中反相位图像部分区域较同相位图像有所降低,而肾嫌色细胞癌无此特点,有统计学意义(P0.05)。三种肿瘤均在DWI及ADC图像上呈略高信号,无明显差异(P0.05)。结论 MRI对鉴别肾透明细胞癌、乳头状肾细胞癌、肾嫌色细胞癌均有一定的参考价值,其中增强序列是鉴别肾透明细胞癌和乳头状肾细胞癌及肾嫌色细胞癌的重要参数。而通过化学位移成像能较好地鉴别肾嫌色细胞癌与肾透明细胞癌及肾乳头状细胞癌。     

乳头状肾细胞癌在双期增强CT扫描中的影像特征分析

目的探讨乳头状肾细胞癌(Papillary renal cell carcinoma,PRCC)在多层螺旋CT(MSCT)双期增强扫描中的影像特征,提高其诊断及鉴别诊断水平。方法回顾性分析经手术病理确诊的16例PRCC在常规双期MSCT增强扫描中的影像学特征,测量PRCC病灶及正常肾皮质在平扫、增强各期的CT值。t检验比较平扫、增强各期中肿瘤实性部分和正常肾皮质的CT值及其强化程度的比值。结果 CT平扫PRCC密度稍高于肾实质,但CT值对比无显著差异(P0.05);增强扫描,肿块强化程度显著低于正常肾皮质(P0.001),且呈持续性轻度强化特征;病灶及正常肾皮质在动、静脉期的强化程度分别与平扫期的CT值比较,其强化比值未见显著差异(P0.05)。结论 PRCC双期增强扫描强化值均显著低于肾皮质的强化且呈持续性轻度强化的模式有一定的特殊性,有助于本病的诊断及鉴别诊断。     

肾脏后肾腺瘤1例报告并文献复习

目的：探讨后肾腺瘤的临床病理学特征,提高对后肾腺瘤的认识.方法：分析1例29岁女性后肾腺瘤患者的临床病理资料,并结合相关文献进行讨论.结果：患者因腰部不适行B超检查发现右肾肿瘤,16层螺旋CT诊断为右肾肿瘤（良性可能大）,行肾肿瘤剜除术,术中见肿瘤被膜完整,切面色灰白,质地均匀,术中冷冻切片诊断为乳头状肾细胞癌,随即行肾癌根治术.镜下肿瘤细胞呈腺样或乳头状排列,并有砂粒体.免疫组化：NSE（＋）、Ki67、Vim为阳性.病理诊断：右肾后肾腺瘤.随访22个月,未见肿瘤复发.结论：后肾腺瘤术前难以依据影像学特征明确诊断,术前肿瘤穿刺活检结合免疫组化对明确诊断可能是一种可行的选择,更重要的是,了解其临床及病理特点有助于该肿瘤的准确诊断.后肾腺瘤的治疗多采取保留肾单位的手术,但由于其生物学行为及细胞起源的不确定性,术后长期随访观察是必需的.     

乳头状肾细胞癌的临床特征分析（附7例报告）

目的：观察乳头状肾细胞癌的临床特点,提高对其诊断要点、治疗及预后的认识。方法：回顾性分析7例乳头状肾细胞癌患者的临床资料,复习相关文献,并对患者进行随访。结果：7例患者均经病理证实为乳头状肾细胞癌,1例并发肾上腺腺瘤;首发症状主要以腰痛、血尿、消瘦、低热为主;CT影像均提示肿瘤密度在肾髓质期强化程度明显弱于肾皮质,且在肾髓质期和排泄期呈均匀强化;6例经腹行根治性肾切除,1例经腰行根治性肾切除,术后均辅以免疫治疗,未行放化疗;6例获随访,随访时间为3个月～2年,1例于术后6个月出现急性肾衰死亡,1例于12个月因肝及淋巴结转移死亡,其余4例在随访期间未出现复发和转移,无瘤生存至今。结论：乳头状肾细胞癌与其它肾细胞癌在临床表现上基本相同,但在影像学表现,病理形态及生物学行为上均与其他类型的肾细胞癌不同,诊断主要依靠CT影像,确诊有赖于病理和免疫组织化学检查,早期手术是首选治疗方式,其预后可能与分期及转移有关。     

104例肾嫌色细胞癌的临床分析

目的 探讨肾嫌色细胞癌的临床特点、治疗方式的选择及患者预后生存情况。方法回顾性分析陆军军医大学第二附属医院2012年1月至2022年1月收治的104例经术后病理诊断为肾嫌色细胞癌(chRCC)的患者临床资料。所有患者均行手术治疗,对患者的影像学资料、病理资料及术后生存情况进行分析和总结。结果 104例患者中有67例行CT检查,报告显示平扫期多数呈等密度或稍高密度软组织影,肿瘤内若存在坏死灶,则可能出现混杂密度影,部分肿瘤内有钙化,增强期大多呈现轻度或中度不均匀强化;4例行MRI检查,强化时均呈不均匀强化,静脉期强化均减退;病理结果示chRCC主要包括两种细胞类型,一种为体积较大的多角形半透明细胞,另一种为小圆形的嗜酸性细胞。8例患者失访,3例患者因非肾肿瘤性疾病死亡,2例因转移死亡,其余患者均长期生存,预后良好。结论 chRCC临床症状不典型,超声可作为首选体检筛查手段,CT和MRI检查在chRCC诊断上也具有一定优势。手术为早期chRCC首选治疗方案,多数患者预后良好,极少数患者术后出现转移或复发。晚期chRCC目前尚无统一治疗方案。     

Xp11.2易位性肾癌与肾嫌色细胞癌基于动态增强CT的鉴别诊断

目的比较Xp11.2易位性肾癌与肾嫌色细胞癌的动态增强CT特征。方法回顾性分析经手术及病理证实的27例成人Xp11.2易位性肾癌和28例成人肾嫌色细胞癌的动态增强CT特征与临床资料。结果Xp11.2易位性肾癌中,女性17(63.0%)例,平均发病年龄(31.9±10.6)岁,12(44.4%)例伴有肉眼血尿。肾嫌色细胞癌中,女性仅12(42.9%)例,平均发病年龄(51.6±11.6)岁,3(10.7%)例伴有肉眼血尿。CT平扫中与肾嫌色细胞癌相比,Xp11.2易位性肾癌比正常肾实质密度更高(P=0.049),形状更加不规则(P=0.028),包含更多坏死成分(P0.001)。在动态增强CT中两组肾癌都显示出中等程度的持续强化,CT值在肾实质期达到顶峰。肾嫌色细胞癌的CT图像特征中分别有5(17.9%)例轮辐式增强和2(7.1%)例节段性强化逆转,而Xp11.2易位性肾癌均无这两种特征。结论结合临床特点及动态增强CT特征,有助于术前鉴别Xp11.2易位性肾癌和肾嫌色细胞癌。     

肾嗜酸细胞腺瘤的诊断(附九例报告)

目的提高肾嗜酸细胞腺瘤的临床诊断及鉴别诊断水平。方法回顾９例肾嗜酸细胞腺瘤患者的临床及ＣＴ检查资料,对肿瘤标本行光镜和电镜观察,应用免疫组化ＬＳＡＢ法检测Ｃｙｔｏｋｅｒａｔｉｎ８（相对低分子质量角蛋白）和Ｖｉｍｅｎｔｉｎ（波型蛋白）,并与肾细胞癌相鉴别。结果ＣＴ增强扫描后肿瘤密度均匀一致,瘤体中央可见星状低密度区是该瘤的主要特征。病理组织学：肉眼观察肿瘤质均、无坏死、呈红棕色,部分肿瘤有中心瘢痕;光镜下胞浆强嗜酸性,粗颗粒,巢状或实片状排列,无坏死,无核分裂像或核分裂像罕见;Ｃｙｔｏｋｅｒａｔｉｎ８阳性,Ｖｉｍｅｎｔｉｎ阴性;电镜下有多量粗大线粒体。结论肾嗜酸细胞腺瘤是一种肾脏良性肿瘤,其ＣＴ影像特征有助于术前诊断。根据其组织学改变、免疫组化及电镜特点,可与胞浆嗜酸性肾癌鉴别。     

Multilocular cystic renal cell carcinoma: report of a case

We report a case of multilocular cystic renal cell carcinoma seen in a 54-year-old man. At the annual health check he was found to have numerous cysts of various sizes in the lower pole of the left kidney. Plain CT scan disclosed a mass in the lower pole of the left kidney. On enhanced CT scan septa were visible, suggesting a multilocular cyst. Left renal arteriography disclosed a hypervascular mass in the lower pole of the left kidney. Radical nephrectomy was performed. The gross appearance of the cut surface showed a feature of multilocular cyst. The histopathological diagnosis was clear cell carcinoma. We describe the clinical features of multilocular cystic renal cell carcinoma and discuss the differential diagnosis.     

Chromophobe renal cell carcinoma with osteosarcoma-like differentiation

Sarcomatoid differentiation in renal cell carcinoma is thought to be the result of the dedifferentiation of the parent tumor, and it can be found in the chromophobe renal cell carcinoma just as other subtypes. We report a case of chromophobe renal cell carcinoma, which showed osteosarcoma-like differentiation. This is the first known case ever to be clearly identified as such. The patient was a 74-year-old man, and the CT scan revealed a huge retroperitoneal mass, which protruded from the lower half of the kidney and directly invaded the colon. Intraabdominal dissemination and metastases to the liver and lungs were also found. The resected tumor histologically showed sarcoma-like spindle cell proliferation and partly produced massive osteoid, which simulated the osteosarcoma. In addition, a typical histology of chromophobe renal cell carcinoma was found in part of the tumor. Immunohistochemically, spindle cells were reactive for epithelial membrane antigen, cytokeratin, and vimentin. The cell nests that were labeled by epithelial membrane antigen and cytokeratin were also found in the osteosarcoma-like area. We think that these phenomena were the result of "dedifferentiation" and metaplasia of the chromophobe renal cell carcinoma.     

Chromophobe cell renal carcinoma: report of two cases

We report two cases of chromophobe cell renal carcinoma. Case 1 was in a 62-year-old man with the chief complaint of hematospermia. Ultrasound incidentally detected a left renal mass. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a relatively homogeneous, hypovascular tumor of the left kidney. We performed radical nephrectomy after making a clinical diagnosis of possible renal carcinoma. Case 2 was in a 66-year-old woman who was admitted to our hospital after a left renal mass was incidentally found by ultrasonography during a health check. We performed laparoscopic radical nephrectomy after making a diagnosis of renal cell carcinoma by CT and MRI. Both of the tumors were shown to be chromophobe cell carcinoma by microscopic examination after H & E staining and immunohistochemistry using Hale's colloidal iron stain. Chromophobe cell carcinoma is an uncommon type of renal cell carcinoma and the number of reported cases is limited in Japan. The clinical features and management of this rare tumor are discussed.     

Simultaneous occurrence of renal cell and transitional cell carcinoma in the same kidney and ureter. A case report

An unusual case of 2 concurrent primary renal tumors within the same kidney is reported. A 70-year-old woman presented with gross hematuria when she was in the hospital for cerebral infarction. Excretory urography revealed a marked expansion of the right kidney with no renal function. CT scan showed a mass arising from the right kidney, the hydronephrotic right renal pelvis, and a mass in the lower right ureter. Selective renal angiogram showed marked neovascularity of the mass. There was an encasement of the intrarenal artery to the lower pole. Angiographic findings were highly suggestive of a renal cell carcinoma with a second neoplasm in the renal pelvis. Subsequently, the patient underwent right radical nephroureterectomy and partial cystectomy. Section of the removed specimen revealed a 4.0 X 3.8 cm solid tumor confined to the kidney in the upper pole and a transitional cell carcinoma arising from the renal pelvis. In addition, transitional cell carcinoma was present in the distal ureter.     

多房性囊性肾癌一例报告及文献复习

目的 提高多房性囊性肾癌的诊治水平.方法多房性囊性肾癌患者1例,男,49岁.体检B超偶然发现右肾下极多囊性肿物1个月.囊内无回声区,其间混杂低回声区;CT检查右肾下极见多囊性低密度病变,边界清楚、光整,内见薄壁分隔,增强扫描分隔可见强化;MRI检查示右肾下极多囊性病变,增强扫描囊壁可见强化.行右肾部分切除术,完整切除肿瘤.结果 病理报告:肾被膜下见多房状肿物,大小约3.0 cm×2.0 cm×2.0 cm,囊壁光滑,腔内含清亮的浆液性及血性液体,囊壁厚约0.1～0.2 cm,与肾周脂肪粘连.镜下多数囊腔内衬单层或复层立方状透明细胞,细胞核小而圆,位于细胞中央,无明显核仁;有的囊腔内衬扁平上皮细胞或无内衬上皮,偶见由透明细胞覆盖的小乳头;囊腔间隔由胶原纤维组成,部分间隔内可见灶状透明细胞,但未形成肉眼可见的结节.病理诊断:多房性囊性肾癌.术后随访20个月未见复发和转移.结论 多房性囊性肾癌是肾癌的一种罕见亚型,发病率低,是一种完全由囊腔构成的肿瘤;影像学检查可提供直接依据,确诊需依靠病理学检查;外科手术治疗预后良好.     

Bilateral renal cell carcinoma in a patient receiving long-term dialysis

Bilateral renal cell carcinoma developing in a 55-year-old male receiving long-term dialysis is reported. The patient, who had undergone maintenance hemodialysis for 12 years, was admitted in July, 1986 for the purpose of extensive examination of a right renal mass. CT scan and ultrasonography demonstrated an enlarged bilateral kidney associated with multiple cysts, containing a solid mass in the right upper pole. The patients underwent right nephrectomy under the diagnosis of right renal tumor. The solid tumor 4 x 3 cm in size revealed a grade 1 to 2 renal cell carcinoma pathologically. Two small tumors were recognized in other portions of the kidney. Multiple cysts of varying sizes, the largest 2 cm in diameter, replaced the renal parenchyma. The cyst walls frequently contained hyperplastic changes. The patient has been subsequently followed up for 2 years and 9 months and underwent left nephrectomy for suspected left renal tumor. The surface of the left kidney was covered by numerous cysts. The result of pathological examination was renal cell carcinoma, which was recognized in a total of 7 regions of the left kidney. The patient remains well on hemodialysis, with no evidence of recurrence or metastasis.     

Chromophobe cell renal carcinoma: a case report

We report a case of chromophobe cell renal carcinoma. A 45-year-old woman with a chief complaint of macrohematuria and left backache was introduced to our hospital in October 1998. Abdominal computed tomographic scan (CT) revealed a solitary, solid mass (16 x 14 x 12 cm) at the upper pole of the left kidney. Angiography showed a hypervascular character but irregular neovasculizations were found. We performed a radical nephrectomy with a preoperative diagnosis of malignant renal tumor. The cut surface appearance of the tumor was homogeneous, grey-beige and solid. Light microscopic findings revealed voluminous cells with light, but not clear cytoplasm displaying a fine reticular pattern. Histochemical staining with Hale's colloidal iron stain demonstrated a distinctly positive cytoplasmic reaction. Since the ultrastructural study revealed numerous intracytoplasmic microvesicles, we finally reached the diagnosis of chromophobe cell renal carcinoma. We report our case here with reference to the relevant literature.     

Bilateral Chromophobe Cell Renal Carcinoma in Tuberous Sclerosis Comple

We report on a patient with tuberous sclerosis complex and polycystic kidney disease who developed bilateral chromophobe cell renal carcinoma. We discuss the tuberous sclerosis complex, associated bilateral renal cell carcinoma, polycystic kidney disease and chromophobe cell renal carcinoma; a recently established subtype with a rather favorable prognosis.
In a patient with tuberous sclerosis complex and multiple space-occupying lesions, a diagnosis of angiomyolipoma should be considered first but bilateral and/or multifocal renal cell carcinoma is a likely diagnosis.     

肾脏原发性淋巴瘤一例报告并文献复习

目的 提高肾脏原发性淋巴瘤的诊治水平.方法 回顾性分析1例肾脏原发性淋巴瘤患者的临床病理资料,结合文献复习讨论.患者,女,61岁.因左侧腰痛2周入院.查体:左上腹压痛,左肾区叩击痛.B超检查见左肾正常结构未显示,集合系统分离,最宽处约1.0 cm,左肾区可探及一巨大低回声肿物,大小9.7cm×5.3cm,边界模糊.CT检查见左肾中下极肿物,大小9.8 cm×8.9 cm ×8.8 cm,边界不清,平扫CT值为39 HU,增强后为61 HU,强化不明显.术前诊断:左肾恶性肿瘤.结果 患者行根治性左肾切除术.病理报告:左肾大部分被肿瘤组织占据,中下极见10.0cm×9.5 cm ×8.5 cm类圆形肿物,质硬,肿物切面呈灰白色,质地细腻.镜下瘤细胞呈弥漫性浸润,卵圆形或多边形,略大于正常淋巴细胞,核大深染呈不规则形.病理诊断:肾弥漫性大B细胞性淋巴瘤.骨髓穿刺检查未见异常.行环磷酰胺+吡喃阿霉素+长春新碱+泼尼松+利妥昔单抗方案化疗6周期.术后每3个月复查胸部X线片、腹部B超及CT等.随访20个月,未见肿瘤复发.结论 肾脏原发性淋巴瘤临床罕见,症状与肾癌相似,影像学检查无特征性改变,确诊需依靠病理学检查.本病预后不良,手术切除患肾联合规范的全身化疗,可延长患者的生存期.     

A case report of chromophobe cell renal carcinoma arising from atrophic kidney during long-term haemodialysis

A 60-year-old woman with chromophobe cell renal carcinoma arising from the atophic right kidney during long-term haemodialysis was reported. The right renal tumour was detected incidentally by abdominal ultrasound examination. She received right nephrectomy through flank incision, and the pathological diagnosis was an eosinophilic variant of chromophobe cell renal carcinoma. Chromophobe cell renal carcinoma is a relatively rare subtype of renal cell carcinoma (5%), and the rate of this subtype on a long-term haemodialysis was quite low (0.6-0.7%), and almost all these patients had acquired cystic disease accompanied with haemodialysis. By contrast, our case occurred in the atrophic kidney (non-cystic kidney), and this might be the first case report of chromophobe cell renal carcinoma arising from an atrophic kidney in a patient on long-term haemodialysis.