儿童肾透明细胞肉瘤超声及CT表现  

Imaging findings of clear cell sarcoma of the kidney in children

作　　者：张鸽[1] 时胜利 宋鹏鹏 Zhang Ge;Shi Shengli;Song Pengpeng(Department of Radiology,Affiliated Hospital of Youjiang Medical University for Nationalities,Baise,Guangxi 533000)

机构地区：[1]河南大学附属肿瘤医院(郑州市第三人民医院)超声影像科,450000 [2]郑州大学附属儿童医院放射科

出　　处：《实用医学影像杂志》2022年第6期604-606,共3页Journal of Practical Medical Imaging

摘　　要：目的探讨儿童肾透明细胞肉瘤(CCSK)的超声及CT表现,提高诊断能力。方法病例资料为我院2012年1月至2021年12月收治的6例经手术及病理确诊的CCSK患儿,6例均行超声及CT检查,回顾性分析其影像学特点。结果本组均为男性,中位发病年龄45个月,临床分期Ⅱ~Ⅳ期。6例肿瘤均为单发,其中位于左肾4例,右肾2例,肿瘤长径74~181 mm;超声呈中等回声3例,等低回声2例,等高回声1例,其中5例伴大小不等无回声区,4例血流信号丰富;CT平扫肿瘤密度不均匀,主要位于肾髓质并压迫皮质,所有肿瘤伴不规则状液化坏死灶,其中2例呈虎斑状条纹,4例伴钙化灶。增强扫描肿瘤呈中-重度强化,瘤体内见细小供血血管,3例伴肺部、淋巴结及骨骼转移。结论CCSK发生于肾髓质,发现时瘤体多较大,单中心膨胀性生长,恶性程度高,早期即可发生多系统转移,预后不良,虎斑状条纹具有一定影像学诊断价值。肿瘤血供丰富,虎斑状条纹在超声及CT表现中具有一定特点,但确诊仍需依赖于病理活检。Objective To investigate the ultrasonographic and CT manifestations of clear cell sarcoma of kidney(CCSK) in children. Methods Six cases of CCSK were diagnosed by surgery and pathology in our hospital.All 6 cases were examined by ultrasound and CT,and their imaging characteristics were retrospectively analyzed. Results All patients were male with a median age of 45 months and clinical stages Ⅱ~Ⅳ.All the 6 cases were single tumors,including 4 cases in the left kidney and 2 cases in the right kidney. The tumor length ranged from 74 mm to 181 mm.Ultrasonography showed moderate echo in 3 cases, iso-hypoecho in 2 cases,iso-hyperecho in 1 case, 5 cases were accompanied by anechoic area of unequal size, and rich blood flow signal in 4 cases. On contrast enhancement CT scan, the tumor density was not uniform, mainly located in the renal medulla and pressing on the cortex. All tumors were accompanied by irregular liquefaction necrotic foci, including 2 cases with tiger-like stripes and 4 cases with calcification foci. On enhanced scan,the tumor showed moderate to severe enhancement, and small blood vessels were observed in the tumor. Three cases were accompanied by pulmonary, lymph node and bone metastasis. Conclusion CCSK occurs in the renal medulla. How large the tumors was with single center expansion growth and high degree of malignancy. Multi-system metastasis can occur at early stage, and the prognosis is poor. The tumor has abundant blood supply and tiger stripes have certain characteristics in ultrasound and CT findings, but the diagnosis still depends on pathological biopsy.

关 键 词：儿童 肾疾病 肉瘤 透明细胞 超声检查 体层摄影术 X线计算机 

分 类 号：R730.44[医药卫生—肿瘤] R737.11[医药卫生—临床医学] R445.1