肾盂鳞状细胞癌的影像表现及病理特点  

Imaging and pathological features of squamous cell carcinoma of the renal pelvis

作　　者：田序伟[1] 马依迪丽·尼加提 孟令辉 邱娅[1] 戴国朝[1] TIAN Xuwei;Mayili·Nijiatii;MENG Linghui;QIU Ya;DAI Guochao(Department of Radiology,Kashgar First People's Hospital,Kashgar 844000,China)

机构地区：[1]喀什地区第一人民医院医学影像中心,新疆喀什844000

出　　处：《实用放射学杂志》2020年第10期1619-1621,1634,共4页Journal of Practical Radiology

基　　金：新疆维吾尔自治区天山青年计划项目(2018Q056)。

摘　　要：目的分析肾盂鳞状细胞癌(SCC)的CT、MRI表现与病理特点,提高对肾盂SCC的诊断能力.方法回顾性分析经手术病理证实的8例肾盂SCC患者的资料,对照分析其CT、MRI特征及临床病理特点.结果8例患者中,发生于右肾5例、左肾3例.形态不规则,与肾盂、肾实质无界限,呈弥漫性爬行生长,5例延伸至输尿管上端,范围广,最大径63~102 mm,平均(88.29±15.28)mm;7例伴有结石.CT表现:等密度,稍高于肾实质,平扫CT值39.6~47.1 HU,平均(43.68±2.80)HU,不均匀轻中度持续性强化,强化幅度低于肾实质,5例包绕同侧肾动脉.MRI表现:T1 WI呈等或稍高信号,T2 WI呈稍低信号,6例见片状坏死,病灶不均匀轻度强化;DWI均有明显扩散受限.病理结果:8例均侵犯肾实质、肾盂、突破肾包膜,7例侵犯神经束及血管,6例见脉管癌栓及淋巴结转移;免疫组化:CK5/6、P63、P40均为阳性,1例CK7阳性,1例GATA-3阳性.结论肾盂SCC不规则爬行生长的生物特性,CT等稍高密度,MRI等T1、低T2信号及乏血供肿瘤表现、同时累及肾实质、肾盂、输尿管、突破肾包膜的影像学特征能够反映其病理特点,对于术前诊断、术后评估具有重要价值.Objective To investigate the CT,MRI and pathological features of squamous cell carcinoma(SCC)of the renal pelvis,to improve the diagnosis ability of renal pelvis SCC.Methods Eight patients with SCC of the renal pelvis confirmed by pathology were reviewed.The CT,MRI and pathological features were analyzed.Results Of the 8 patients,5 cases in the right side and 3 in the left.The SCC was irregular in shape with a diffuse crawling growth,but without boundaries with the renal pelvis and renal parenchyma.5 cases grew along the ureter,and the average of the maximum diameter line was(88.29±15.28)mm(range 63-102 mm).7 cases had stone.The SCC of the renal pelvis was isodense in CT imaging,slightly higher than the renal parenchyma.The CT values was(43.68±2.80)HU(range 39.6-47.1 HU),with a mild to moderate inhomogeneous enhancement that the enhanced degree was lower than the renal parenchyma.5 lesions were surrounded the ipsilateral the renal artery.The SCC of the renal pelvis in MRI had iso-or slightly high signal on T1WI,and slightly low signal on T2WI.6 leisons had patchy necrosis with mild inhomogeneous enhancement.All of the cases had obviously limited diffusion on DWI.The pathology found that 8 lesions had renal parenchyma and renal pelvis invasion,and broken through the renal capsule.7 had nerve and blood vessel invasion,and 6 had vascular tumor emboli and lymph node metastasis.Imumunohistochemical results found the positive CK5/6,P63 and P40 in all case,CK7 in 1 case and GATA-3 in 1 case.Conclusion The biological characteristics of irregular crawling growth of SCC in the renal pelvis,slightly high density of CT,MRI and other T1 and low T2 signals,tumor manifestations of lack of blood supply,imaging features involving renal parenchyma,renal pelvis,ureter,and breakthrough of reanl capsule can reflect its pathological characteristics,which are of great value for preoperative diagnosis and postoperative assessment.

关 键 词：肾盂 鳞状细胞癌 计算机体层成像 磁共振成像 病理学 

分 类 号：R737.11[医药卫生—肿瘤]