肾嫌色细胞癌CT表现与病理对照分析  

Chromophobe cell renal carcinoma:correlation between CT finding and pathology

作　　者：余霞玉 张岳 程建波 刘波 刘岘 吴政光[2] 秦鑫[3] 冯奕斌 

机构地区：[1]广州中医药大学第二附属医院(广东省中医院)放射科,广东广州510120 [2]广东省第二人民医院放射科,广东广州510317 [3]海南省人民医院放射科,海南海口570311 [4]广东省佛山市南海区桂城街道平洲社区卫生服务中心,广东佛山528251

出　　处：《医学影像学杂志》2015年第11期1976-1980,共5页Journal of Medical Imaging

摘　　要：目的探讨肾嫌色细胞癌(chromophobe cell renal carcinoma,CCRC)CT表现。方法回顾分析12例经病理证实的CCRC的临床和CT资料,并将CT双期增强表现特点与病理对照。结果 12例均单发,均为圆形/类圆形,边缘清晰,5例(41.7%)可见包膜,密度均较均匀,以等密度多见,2例呈稍高密度,5例(直径≥7.2cm)病灶内见小斑片状坏死、囊变,3例见钙化,其中,2例为中央瘢痕并钙化;双期增强扫描,2例呈"快进快出"强化,组织病理学检查,镜下所见:肿瘤细胞呈腺泡、巢状排列,间质内可见大量薄壁血管影;各2例、8例呈"轻度进行性"、"慢进慢出"强化,镜下所见:间质内分别见少许、中等量厚壁血管影。仅1例出现左侧腰大肌外侧淋巴结转移,均未见明确肾动、静脉癌栓形成,未见明确远处转移。结论 CRCC双期CT增强扫描后可呈多种强化方式,且以"慢进慢出"多见,可能主要与病灶内血管的数量以及血管壁的构成有关;中老年人(特别>50岁)肾脏占位、体积较大而密度相对较均匀,淋巴结及远处转移少见,CT双期增强后呈"慢进慢出"强化方式,特别是病灶内出现中央瘢痕并钙化,应考虑CRCC的诊断。Objective To explore the CT features of chromophobe cell renal carcinoma and the diagnostic value of two phases dynamic enhancement scanning for it.Methods The CT findings of 12 patients pathologically confirmed CCRC were retrospectively studied and compared with pathological features.Results Single tumor was found in all 12 patients,ranged in age from 21 years to 82 years.9patients were older than 50years（75%）.On unenhanced CT,the tumor mainly appeared as round like,smoothing border in all cases,and 5cases（41.7%）had complete packing membrane.The density of leisions were uniform relatively in 12 cases,calcification in 3cases,2cases of which showed the centre scar,and a little necrosis or cystic formation in 5（diameter≥7.2cm）.Among them,2cases revealed high density,and the others isodensity.On two-phase dynamic enhancement scan,2of them showed ＂fast-in and fast-out＂enhancement mode.The histologic examination showed that tumor cells were arranged in an alveolar or nesting pattern,with abundant thin-walled vessels in interstitial substance.2cases showed＂progressive delayed enhancement＂and 8cases showed＂slow-in and slowout＂enhanced mode.Histopathologically,tumor cells formed in organoid patterns,surrounded some light or moderate thicked-walled vessels.None had distant metastasis and tumor thrombus of renal arteries and veins,while lymph node metastasis beside the left psoas major occurred in one case.Conclusion On dynamic CT scan,the CCRC can manifest as multiple enhancement modes and the ＂slow-in and slow-out＂was the most common mode,which maybe mainly have a close relation with the number and composition of the stromal vascular.The disease should be considered for CCRC combined with a relatively large solid renal tumor,with a uniform density,rare lymph node and distant metastasis,in middleaged and elderly（specially,〉50years）,with a the＂slow-in and slow-out＂enhancement mode,and presence of centre scar and calcification in particular.

关 键 词：嫌色细胞癌 肾脏 体层摄影术 X线计算机 病理 

分 类 号：R737.5[医药卫生—肿瘤] R814.42[医药卫生—临床医学]