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肾嗜酸性细胞腺瘤的MSCT表现与病理对照研究

作者:陈兴发 陈晓丹 王运韬 任 旺 陈韵彬 陈 英 卢 涛

所属单位:福建省肿瘤医院(福建医科大学附属肿瘤医院)放诊科(福建 福州 350014)

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摘要

目的探讨肾嗜酸性细胞腺瘤的 MSCT表现,旨在提高对其诊断的准确性 及认识水平。方法 回顾性分析21例经手 术病理证实的肾嗜酸性细胞腺瘤CT、病 理及临床资料,分析比较其CT表现与病理 特征。结果 21例肾嗜酸性细胞腺瘤(1例 伴发同侧肾血管平滑肌脂肪瘤),9例位于 左肾,12例位于右肾。病灶呈圆形或椭 圆形,边界清楚,长径1.6-13.5cm,平 均6.7cm,其中<4cm者8例,≥4cm者 13 例。18例平扫呈等或稍高密度, 14例见 中央星状瘢痕组织,4例瘢痕内显示斑点 状钙化。动态增强扫描皮质期及髓质期肿 瘤实质均呈轮辐状明显强化,其中15例皮 质期实质部分强化高于髓质期,6例髓质 期实质部分强化高于皮质期,8例见粗大 迂曲血管影,12例表现为由肿瘤周边向 中心推进的渐进性强化,4例出现节段性 强化逆转,12例中央瘢痕延迟呈轻度强 化,13例有假包膜并见延迟强化。结论 肾嗜酸性细胞腺瘤是一种富血供肿瘤, MSCT表现具有一定特征性,结合中央星状 瘢痕,瘢痕内钙化、假包膜、肿瘤实质轮 辐状强化及瘢痕延迟强化等特点有助于肾 嗜酸性细胞腺瘤的诊断。

Objective To investigate the MSCT manifestations of renal oncocytoma in order to improve the level of diagnosis and recognition. Methods The MSCT imaging, pathological features and clinical data of renal oncocytoma in 21 patients which had been proved by pathology were retrospectively reviewed. Results CT scans were performed on 21 lesions of renal oncocytoma, one of which accompanied with ipsilateral renal angiomyolipoma. Nine lesions located in the left kidney and 12 in the right kidney. The shape of all lesions appeared round or oval with clear boundaries, The diameters of these lesions ranged from 1.6cm to 13.5cm,with a mean of 6.7cm,Eight lesions were less than 4.0cm and 13 lesions were greater than or equal to 4.0cm in diameter. On CT plain scan,8 lesions showed iso-density or slightly hyper-density. A stellate central scar was detected in 14 lesions and punctate calcifications were found in 4 lesions. Dynamic enhancement scan showed spoke-wheel-like enhancement in all lesions in the corticomedullary phase. Fifteen lesions in cortical phase showed higher enhancement than that in parenchymal phase, while 6 lesions in parenchymal phase showed higher enhancement, Eight lesions had thick and tortuous vessels, twelve lesions appeared progressive enhancement from periphery to center,4 lesions presented segmental enhancement inversion and 12 lesions with central stellate scar had light enhancement, enhanced pseuedocapsule was observed around the margin in 13 lesions in the excretory phase. Conclusion MSCT multiphase scanning provides valuable features for the diagnosis of renal oncocytoma.

【关键词】肾肿瘤;嗜酸性细胞腺瘤;计算机体层摄影术;病理学

【中图分类号】R737.11;R445.3

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.08.033

前言

肾嗜酸性细胞腺瘤(renal oncocytoma,RO),又名嗜酸细胞瘤, 是一种较为少见肾脏良性肿瘤,约占所有肾实性肿瘤的3%~7%[1]。国 内因缺乏术前准确诊断,多数患者接受根治性肾切除术治疗。近年 来,随着对此病的病理组织学特征认识水平的提高,能否准确定性诊 断对于指导治疗方案及预后有重要意义。本文回顾分析经手术病理证 实的21例RO的MSCT表现及临床资料并结合国内外文献报道,旨在提高 影像医师对该病的认识。