良性占位性病变误诊为肾癌的原因分析

目的　提高肾脏良恶性占位的诊断水平 ,降低误诊率。　方法　肾占位性病变患者 12例 ,年龄 35～ 6 9岁 ,平均 5 2岁。腰部胀痛不适 9例 ,其中 2例伴全程血尿 ;体检超声偶然发现肾脏占位 3例。术前均行超声、CT等影像学检查诊断为肾癌。　结果　 12例患者均手术治疗。术中行冰冻病理检查 7例 ,提示为肾脏良性占位 ,行肿块剜除或单纯肾切除术 ;按肾癌行根治术 5例 ,术后病理均为肾脏良性病变。随访 1～ 3年 ,无复发。　结论　临床医师不应过高评价CT及超声等影像检查的诊断学意义 ,对无法确诊病例可行手术探查 ,术中行冰冻病理检查提高确诊率。多数误诊的良性肾占位与肾癌的影像学表现不同。

Clinical analysis of differential diagnosis between renal cell carcinoma and benign space-occupying mass

Objective To improve the differential diagnosis between benign renal mass and renal cell carcinoma(RCC) so as to lower the misdiagnosis rate. Methods This study included 12 cases of renal mass,whose age ranged from 35 to 69 years with a mean of 52 years.Among the 12 cases,flank pain occurned in 9,2 of whom had gross hematuria.Three clinically asymptomatic cases were detected incidentally by ultrasound in physical examination.All the 12 cases underwent imaging examinations such as B-ultrasound and CT scan,and all of them were preoperatively diagnosed as RCC. Results All the cases were surgically treated.Seven underwent enucleation or simple nephrectomy because of the diagnosis of benign renal mass by intraoperative frozen section.Five underwent radical nephrectomy.None developed recurrence during follow-up of 1 to 3 years. Conclusions Clinicians should not overestimate the diagnostic significance of imaging examinations such as CT and ultrasonography.For cases who have no definite diagnosis,surgical exploration can be performed.Intraoperative frozen section by pathologic study can increase correct diagnostic rate. Most of the misdiagnosed benign renal masses have different imaging features from those of RCC.