肾黏液样小管状及梭形细胞癌和乳头状肾细胞癌的影像学表现及临床病理研究  

Imaging findings and clinicopathological study of myxoid tubular and spindle cell carcinoma of the kidney and papillary renal cell carcinoma

作　　者：施新 田浩[2] 黄娟 周国锋 刘益飞[4] SHI Xin;TIAN Hao;HUANG Juan;ZHOU Guo-feng;LIU Yi-fei(Department of Imaging,Chongming Campus,Shanghai Tenth People's Hospital,Shanghai 202157,China;Department of Imaging,Affiliated Hospital of Nantong University,Nantong 226001,China;Department of Imaging,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China;Department of Pathology,Affliated Hospital of Nantong University,Nantong 226001,China)

机构地区：[1]上海第十人民医院崇明分院影像科,上海202157 [2]江苏省南通大学附属医院影像科,南通226001 [3]上海复旦大学附属中山医院影像科,上海200032 [4]江苏省南通大学附属医院病理科,南通226001

出　　处：《中国肿瘤临床与康复》2022年第12期1418-1422,共5页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨肾黏液样小管状和梭形细胞癌(MTSCC)与肾乳头状细胞癌(PRCC)病理学、CT及MRI影像学表现及特征,探讨它们在肿瘤鉴别诊断中的意义。方法回顾性分析经手术病理证实的2012年1月至2022年6月间上海市第十人民医院崇明分院、复旦大学附属中山医院和南通大学附属医院的24例MTSCC及28例PRCC患者,观察分析两种肿瘤CT及MRI平扫+增强的影像学表现。结果24例MTSCC中16例镜下肿瘤组织由管状细胞及梭形细胞构成,伴有丰富的黏液样基质,8例患者缺乏黏液基质,以梭形细胞为主。28例PRCC中Ⅰ型9例,Ⅱ型19例,免疫组化:PRCC及MTSCC的PAX-8、CK7、CK18、EMA比较,差异无统计学意义(P>0.05),两者CD10表达比较,差异有统计学意义(P<0.05)。MTSCC患者CT图像病灶均起源于肾髓质,平扫一般密度均匀,较肾实质密度稍高,增强后93.8%(15/16)在排泄期强化程度最高;T2WI呈稍高、低信号,T1WI呈等、稍低信号,弥散受限程度较高,增强后延迟强化。PRCC平扫密度较肾实质相似,稍低或稍高于肾实质;7例出现钙化,11例突出肾轮廓向外生长,4例病灶中心位于肾外;增强后肿瘤强化峰值90%(18/20)位于髓质期;T1WI呈等或稍低信号,T2WI病灶呈低信号,部分混杂。结论MTSCC与PRCC病理免疫组化及影像学存在一定的重叠,MRI平扫及肿瘤的强化方式对两者鉴别诊断存在一定的临床价值。Objective To investigate the pathological,computed tomography(CT)and magnetic resonance imaging(MRI)findings of renal myxoid tubular and spindle cell carcinoma(MTSCC)of the kidney and renal papillary cell carcinoma(PRCC),and to explore the significance for differential diagnosis of kidney tumors.Methods The clinical data,gross pathology and immunohistochemistry of 24 patients with MTSCC and 28 patients with PRCC confirmed by surgery and pathology at Chongming Campus,Shanghai Tenth People’s Hospital,Zhongshan Hospital Affiliated to Fudan University and Affiliated Hospital of Nantong University were analyzed retrospectively between January 2012 and June 2022.Imaging manifestations of MTSCC and PRCC on CT and MRI were observed.Results Among 24 patients with MTSCC,16 patients had tubular and spindle cells accompanied by abundant mucinous matrix and 8 patients lacked mucinous matrix,which were mainly spindle cells.Among the 28 patients with PRCC,9 patients had type I cancer and 19 had type II cancer.In terms of immunohistochemistry,there was no significant difference in Pax-8,CK7,CK18 and EMA between PRCC and MTSCC(P>0.05).However,there was significant difference in the expression of CD10 between the two groups(P<0.05).The lesions in MTSCC on CT images originated from renal medulla.The density of plain scan was generally uniform and slightly higher than that of renal parenchyma.After enhancement,93.8%(15/16)had the highest enhancement degree in excretion phase.T2WI showed slightly high and low signal.T1WI showed equal and slightly low signal.The degree of diffusion limitation was high,and the enhancement was delayed after enhancement.The plain scan density of PRCC was similar to that of renal parenchyma,slightly lower or higher than that of renal parenchyma.Calcification occurred in 7 patients,11 patients protruded the outline of the kidney and grew outward,and the focus center was located outside the kidney in 4 patients.After enhancement,the peak value of tumor enhancement was 90%(18/20)in medullary phase.T1WI sho

关 键 词：肾黏液样小管状和梭形细胞肿瘤 肾乳头状细胞肿瘤 免疫组织化学 计算机体层成像 磁共振成像 

分 类 号：R737.11[医药卫生—肿瘤]