摘要
目的分析肾癌亚型的CT特征,探讨其CT诊断及鉴别诊断与临床应用。方法回顾性分析58例经手术病理证实为肾癌亚型的CT特点,其中透明细胞癌39例,嫌色细胞癌9例,乳头状细胞癌5例,集合管癌5例。结果透明细胞癌,多位于肾皮质,以膨胀性生长多见,血供丰富,明显坏死、囊变,强化明显,密度明显不均匀,强化峰值在皮髓质期,呈快进快出型式,肾静脉瘤栓1例,腹主动脉旁淋巴结肿大2例,均全肾手术切除,随访15例,其中4例复发;嫌色细胞癌,多位于肾实质,多为膨胀性生长,肿块呈实性,密度最均匀,血供不丰富,多为轻中度强化,强化峰值在实质期,手术全肾切除6例,保肾手术3例,随访5例均无复发;乳头状细胞癌多位于肾皮质,呈膨胀性生长,密度较不均匀,以多灶性坏死多见,血供不丰富,轻中度强化,强化峰值在实质期,手术全肾切除3例,保肾手术2例,随访2例无复发;集合管癌,位于肾实质,呈浸润性生长,边界不清,密度不均匀,有明显坏死,血供不丰富,为轻中度强化,强化峰值在实质期,均有肾门、腹主动脉旁多发淋巴结肿大,其中肾静脉、下腔静脉瘤栓1例,骨转移1例,手术全肾切除5例,术后随访3例均复发。结论肾癌亚型的CT表现有一定差异,仔细分析其CT特征可提高术前诊断的准确性有助于指导治疗,具有重要的临床应用价值。
Objective To analyze the CT features of Subtype of Renal Cell Carcinoma, and discuss the clinical application and the value of CT in diagnosis and differential diagnosis. Methods The CT findings of 58 cases with subtype of renal cell carcinoma comfirmed by pathology,in which 39 cases were clear cell carcinoma,9 cases were chromophobe cell carcinoma,5 cases were papillary cell carcinoma,Scases were collecting duct carcinoma,were reriewed. Results Most clear cell carcinoma,were located in the renal cortex, more common in expansive growth, abundant blood supply, obvious necrosis and cystic degeneration, enhanced obviously, with uneven density, the peak attenuation at corticomedullary phase,were fast in fast out, 1 case had renal vein tumor thrombus,2 cases with paraortie hyperlymphonodus, both holonephros surgical resection, the follow - up data of 15 cases,in which 4 cases were relapsed. Chromophobe cell carcinoma, most were located in the renal parenchyma, demonstrated expansive growth,were solid mass, the density were uniform, with poor blood vessel,most showed mild to moderate enhancement, the peak attenuation at parenchymal phase,6 cases had been performed nephrectomy, 3 cases were treated by nephron sparing surgery, followed up for 5 patients had no recurrence; Papillary cell carcinoma, most were located in the renal renal cortex, demonstrated expansive growth, the density were uneven,showed common multi - focal necrosis, with poor blood vessel, showed mild to moderate enhancement, the peak attenuation at parenchymal phase,3 cases had been performed nephrectomy, 2 cases were treated by nephron sparing surgery, followed up for 2 patients had no recurrence ; Collecting duct carcinoma, most were located in the renal parenehyma, showed infiltrative growth, the edge of the boundary is unclear, the density were uneven, with obvious necrosis, with poor blood vessel, showed mild to moderate enhancement, he peak attenuation at parenchymal phase, both had the renal hilum, paraaortic multiple hyperlymphonodus,in which 1 case had renal vein, inferior vena cava tumor thrombus, 1 case had bone metastases,5 cases had been performed nephrectomy, followed up for 3 patients had recurrence. Conclusion CT manifestations of renal cell carcinoma subtypes had some differences, Careful analysis of the CT features could improved the accuracy of preoperative diagnosis, it was helpful for the treatment, with high value of clinical applications.
出处
《医学研究杂志》
2013年第5期179-183,共5页
Journal of Medical Research
