肾脏交织状血管瘤的影像学表现：附2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及影像学表现,提高对该病的诊断及治疗水平。方法回顾性分析2例原发于肾脏的交织状血管瘤患者的临床资料,2例患者术前接受CT 或 MRI 检查均诊断为肾脏肿瘤性病变,均接受腹腔镜下根治性肾脏切除术。结果肿块在CT 上呈类圆形,边界尚清,凸向肾窦,增强呈不均匀性延迟强化特点；T2 WI 上呈不均匀的稍高信号,DWI 呈等或稍高信号,PWI 上强化方式与增强 CT 相似,呈向心性充填。术后病检肿块呈灰褐色,与周围组织境界清,无包膜；显微镜下,肿块具有松散的小叶结构,肿瘤细胞无异型性；免疫组化示 CD31(＋)、CD34(＋)。术后患者恢复良好,未出现明显复发或转移迹象。结论交织状血管瘤是肾脏的良性血管瘤性疾病,临床少见,影像学上有一定的特点,但术前诊断困难。此类病变应与肾脏恶性肿瘤,特别是血管肉瘤相鉴别。治疗上以手术治疗为主。

Imaging features of anastomosing hemangioma of the kidney:two cases report and review of the litera-ture

Objective The clinical characteristics and imaging manifestations of renal anasto-mosing hemangioma were analyzed and evaluated in order to improve its diagnostic accuracy. Meth-ods Clinical data and CT or MRI features of 2 cases of pathologic analysis-confirmed renal anasto-mosing hemangioma were analyzed retrospectively.All cases underwent CT or MR examination and were diagnosed as renal tumors before retroperitoneal laparoscopic nephrectomy. Results One case showed a renal sinus mass with a round,well circumscribed figures,with homogeneously per-sistent enhancement on contrast-enhanced CT,slightly high signal on DWI and inhomogeneous de-layed enhancement characteristics on PWI.The other one showed lightly high signal on T2 WI.Gross-ly,the resected specimen showed a well circumscribed but un-encapsulated round mass.On cut sur-face,the tumor was fleshy,brown with a spongy texture abutting but not invasion to the renal cap-sule.Immunohistochemical analysis revealed that the tumor cells exhibited positivity for CD31, CD34. Conclusions Anastomosing hemangioma was a benign hemangioma of the kidney,and has special imaging characteristics, but the preoperative diagnosis is difficult, and malignant renal tumors should be ruled out,especially angiosarcoma.