低度恶性潜能的多房囊性肾肿瘤与囊性肾瘤的CT影像特征及临床病理分析

目的:分析低度恶性潜能的多房囊性肾肿瘤(multilocular cystic renal neoplasm of low malignant potential,MCRNLMP)与囊性肾瘤(cystic nephroma,CN)的临床病理特征及CT影像特征,并探讨其诊断价值。方法:回顾性分析2000年1月至2019年3月经武汉大学人民医院及荆州市中心医院病理证实的20例MCRNLMP与12例CN患者的临床资料,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析肿瘤的增强CT影像特征,免疫组织化学法检测其免疫表型。结果:MCRNLMP与CN在囊壁及间隔厚度、强化的高密度病灶数量、强化的达峰强度、Bosniak分级上差异具有统计学意义(P<0.05)。当囊壁及分隔厚度>2.25 mm、强化的高密度病灶数量>1个、强化的达峰强度在中度水平以上时,诊断MCRNLMP的ROC曲线下面积分别为0.879、0.800、0.838,可作为MCRNLMP的最佳诊断界值。免疫组织化学法检测MCRNLMP与CN分别特征性表达肾细胞癌(renal cell rarcinoma,RCC)标记物与雌激素受体(estrogen receptor,ER)和孕激素受体(progesterone receptor,PR)。结论:囊壁及间隔厚度、强化的高密度病灶数量以及强化的达峰强度在鉴别MCRNLMP与CN中具有较高的诊断价值,确诊依赖于组织病理学和免疫组织化学法检测。

Features of CT imaging and clinicopathological characteristics in multilocular cystic renal neoplasm of low malignant potential and cystic nephroma

  Objective  To explore the clinicopathological features and the diagnostic value of the CT scan in multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) and cystic nephroma (CN).  Methods  The clinical data of 12 patients with CN and 20 patients with MCRNLMP, confirmed by pathology at the Renmin Hospital of Wuhan University and Jingzhou Central Hospital from January 2000 to March 2019, were retrospectively analyzed. The receiver operating characteristic (ROC) curves were used to analyze the feature of contrast-enhanced CT images of the tumors, and the immunophenotypes of the tumors were observed by immunohistochemistry.  Results  There were statistically significant differences between MCRNLMP and CN in terms of thickness of the cyst wall and partition, number of soft-tissue enhancing masses, peak intensity of enhancement, and the Bosniak classification (P < 0.05). Based on ROC curve analyses, when the thickness of the capsule wall and partition was greater than 2.25mm, the number of enhanced highdensity lesions was greater than 1, and the peaking intensity of fortification was above the moderate level in the diagnosis of CRNLMP. The areas under the curve of the three indexes were 0.879, 0.800 and 0.838, which can be used as the best diagnostic criterion for MCRNLMP. Immunophenotyping revealed that MCRNLMP characteristically expressed the renal cell carcinoma (RCC) marker, and CN characteristically expressed the estrogen receptor(ER) and progesterone receptor(PR).  Conclusions  The cyst wall and septal thickness, number of soft-tissue enhancing masses, and peak intensity of enhancement show a higher diagnostic value in differentiating MCRNLMP and CN. The precise diagnosis relies on the pathological and immunohistochemical examination.