肾脏混合性上皮间质肿瘤家族的临床及MRI征象分析  

Mixed epithelial and stromal tumor family of the kidney:clinical and MRI features

作　　者：郭慧萍 郝雨薇 康欢欢 许伟 丁效蕙[3] 张晓晶[2] 赵建 白旭 叶慧义[2] 王海屹[2] Guo Huiping;Hao Yuwei;Kang Huanhuan;Xu Wei;Ding Xiaohui;Zhang Xiaojing;Zhao Jian;Bai Xu;Ye Huiyi;Wang Haiyi(Medical School of Chinese PLA,Beijing 100853,China;Department of Radiology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Pathology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心放射诊断科,北京100853 [3]解放军总医院第一医学中心病理科,北京100853

出　　处：《中华放射学杂志》2023年第6期661-667,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(81971580);北京市自然科学基金(7222167)。

摘　　要：目的探讨肾脏混合性上皮间质肿瘤家族(MESTF)的临床及MRI征象。方法回顾性分析2009年1月至2021年9月解放军总医院第一医学中心经病理确诊的42例MESTF患者的临床、MRI和病理资料。根据2019版Bosniak分类系统,分为囊性MESTF(36例)和囊实性MESTF(6例)。记录囊性和囊实性MESTF的R.E.N.A.L.肾肿瘤评分、病灶最大径、侧别、位置、边界、病变形状、生长方式、突向肾盂生长、出血、强化特点。分别应用2005版及2019版Bosniak分类标准对囊性MESTF进行分类,并分为低级别(Ⅰ、Ⅱ、ⅡF类)或高级别(Ⅲ、Ⅳ类)。采用独立样本t检验或Mann-Whitney U检验比较囊性和囊实性MESTF患者的年龄、R.E.N.A.L.肾肿瘤评分和病灶最大径,采用Pearsonχ^(2)检验、连续性校正χ^(2)检验或Fisher确切概率法比较临床特征、MRI征象及囊性MESTF在2005和2019版Bosniak分类系统中的分布差异。结果42例MESTF均为单发病灶,男25例、女17例,年龄(41±13)岁。相较于囊实性MESTF,囊性MESTF的生长方式更倾向于内生性生长(χ^(2)=17.77,P<0.001),其他临床和MRI征象差异均无统计学意义(P均>0.05)。在2005版Bosniak分类系统中低级别MESTF 7例、高级别MESTF 29例,2019版Bosniak分类系统中低级别24例、高级别12例,分布差异有统计学意义(χ^(2)=16.37,P<0.001)。结论MESTF好发于中年患者且无明显性别偏倚,囊性MESTF多为内生性生长且在2019版Bosniak分类系统中多为低级别。Objective To investigate the clinical and MRI features of the mixed epithelial and stromal tumor family(MESTF)of the kidney.Methods From January 2009 to September 2021,42 patients with pathologically-proven MESTF from the First Medical Center of Chinese PLA General Hospital were collected in this retrospective study.Clinical information,MRI features,and pathological results were documented.According to the Bosniak classification(BC)version 2019,all MESTFs were divided into cystic MESTFs(36 cases)and solid-cystic MESTFs(6 cases).The R.E.N.A.L.nephrometry score(RNS),lesion size,laterality,location,margin,shape,growth pattern,presence of protruding into renal sinus,hemorrhage,and enhancement pattern were evaluated and documented.Based on BC versions 2005 and 2019,all the cystic MESTFs were assessed and divided into low(Ⅰ,Ⅱ,ⅡF)and high(Ⅲ,Ⅳ)grades.The independent sample t test or Mann-Whitney U test were performed to compare age,RNS,and lesion size between cystic MESTFs and solid-cystic MESTFs.Pearsonχ^(2) test,continuity-adjustedχ^(2) test or Fisher exact probability test were utilized to evaluated the differences of clinical and MRI features and the distribution of low or high grades in two versions of BC.Results Forty-two MESTFs were unilateral and solitary masses,25 males and 17 females,with a mean age of(41±13)years old.Compared to solid-cystic MESTFs,cystic MESTFs were prone to demonstrate endophytic growth pattern(χ^(2)=17.77,P<0.001),and no significant differences in other clinical and MRI features were observed between cystic and solid-cystic MESTFs(all P>0.05).There were 7 low-grade and 29 high-grade tumors in the BC version 2005,respectively.Meanwhile,24 low-grade and 12 high-grade tumors in the BC version 2019,respectively.The distribution of low or high-grade tumors in the two versions of BC had a statistically significant difference(χ^(2)=16.37,P<0.001).Conclusion MESTFs demonstrated middle-age onset and no gender predilection.Cystic MESTFs are more likely to exhibit endophytic growth patt

关 键 词：癌 肾细胞 磁共振成像 混合性上皮间质肿瘤家族 Bosniak分类 

分 类 号：R737.11[医药卫生—肿瘤] R445.2[医药卫生—临床医学]