肾脏嗜酸细胞腺瘤影像学误诊分析  

Analysis of Imaging Misdiagnosis of Renal Oncocytoma

作　　者：张玉霖 陈宜春 罗雪 杜雪梅 朱丽[2] 何莲 彭利 敖平[2] ZHANG Yulin;CHEN Yichun;LUO Xue;DU Xuemei;ZHU Li;HE Lian;PENG Li;AO Ping(Department of Ultrasound,Longquan Hospital,West China Hos-pital of Sichuan University,Chengdu 610100,China;Department of Radiology,Longquan Hospital,West China Hos-pital of Sichuan University,Chengdu 610100,China;Department of Pathology,Longquan Hospital,West China Hos-pital of Sichuan University,Chengdu 610100,China)

机构地区：[1]四川大学华西医院龙泉医院超声科,成都610100 [2]四川大学华西医院龙泉医院放射科,成都610100 [3]四川大学华西医院龙泉医院病理科,成都610100

出　　处：《临床误诊误治》2024年第14期23-28,共6页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨肾脏嗜酸细胞腺瘤(RO)的临床特点、影像学表现,总结其误诊原因及防范措施。方法回顾性分析2例术前曾误诊的RO临床及影像学资料。结果2例均为女性,年龄分别为45岁、67岁,皆因体检发现肾脏占位性病变,术前均行肾脏超声及增强CT检查,病灶位于左、右肾各1例,呈类圆形,边界清晰,凸向肾外,超声检查1例呈稍高回声,1例呈囊实性混合回声,2例彩色多普勒血流成像均于肿瘤内及周边见血流信号;CT平扫2例均为稍低密度,增强扫描1例明显强化,1例轻度强化,强化呈“快进慢出”方式,2例均无静脉瘤栓,肾门旁及腹膜后无增大淋巴结。术前误诊为肾嫌色细胞癌、肾透明细胞癌各1例。误诊时间2~5 d。1例行根治性右肾切除术,1例行左肾部分切除术,术后病理检查确诊为RO,2例随访至今均未见复发或转移。结论RO较少见,临床表现缺乏特异性,影像学表现与肾癌存在较多重叠,术前易误诊。遇到边界清楚的圆形或类圆形肾脏孤立性肿物患者,当肿物呈“快进慢出”强化方式,尤其当肿瘤出现延迟强化的星芒状中央瘢痕及“节段增强反转”等特征时应高度怀疑本病可能。Objective To investigate the clinical features and imaging manifestations of renal oncocytoma(RO),and to summarize the causes of misdiagnosis and preventive measures.Methods The clinical and imaging data of 2 patients with RO misdiagnosed before operation were analyzed retrospectively.Results Both patients were females,aged 45 years and 67 years respectively,and presented with space-occupying lesions of kidney detected in physical examination.Preoperative renal ultrasonography and enhanced CT examination were performed in both patients,with one lesion located in the left and right kidneys respectively in the two patients,showing a quasi-circular shape with clear boundary and protrusion outward to the kid-ney.Ultrasound examination showed slightly high echo in one patient,and cystic-solid mixed echo in the other patient.Color Doppler flow imaging showed blood flow signals in and around the tumor in 2 patients.CT plain scan showed slightly low den-sity in 2 patients,enhanced scan showed obvious enhancement in 1 patient and mild enhancement in 1 patient,and the en-hancement showed a"fast in and slow out"mode.No venous tumor thrombin was found in 2 patients,and no enlarged lymph nodes were found near renal portal and retroperitoneum.They were misdiagnosed as chromophobe renal cell carcinoma and clear cell renal cell carcinoma respectively before operation.The misdiagnosis lasted 2-5 d.One patient underwent radical right nephrectomy and the other underwent partial left nephrectomy.RO was confirmed by pathological examination after opera-tion.No recurrence or metastasis was observed in the 2 patients.Conclusion RO is rare,with no specific clinical manifesta-tions,and imaging findings overlap with renal carcinoma,which often lead to misdiagnosis before surgery.For patients with round or quasi-circular isolated renal masses with clear boundaries,when the masses show a"fast in and slow out"enhance-ment mode,especially when the tumor has delayed enhancement of star-shaped central scars and"segmental enhancement in-version"

关 键 词：嗜酸细胞腺瘤 肾脏肿瘤 误诊 肾嫌色细胞癌 肾透明细胞癌 超声 多层螺旋CT 鉴别诊断 

分 类 号：R737.11[医药卫生—肿瘤]