肾癌CT表现及其病理新分型21例分析.docVIP

肾癌CT表现及其病理新分型21例分析 　【摘要】 ［目的］ 提高基于新病理分型的肾细胞癌的CT诊断认识。［方法］ 回顾性分析经病理证实的21例肾细胞癌CT表现和病理结果。［结果］ 11例透明细胞癌，1例颗粒细胞癌，4例混合细胞癌，1例多房囊性肾细胞癌，1例乳头状癌，2例嫌色细胞癌，1例集合管癌。新分型中颗粒细胞癌和多房囊性肾细胞癌均归于透明细胞癌，此型血供丰富，增强扫描后强化明显，不复杂性囊变为其特征；而乳头状癌和嫌色细胞癌相对少血供，易于坏死囊性变，强化程度低于透明细胞癌；集合管癌较少见，CT表现缺乏特异性。［结论］ 各型肾细胞癌CT表现特异性不强，组织学类型确诊仍依靠病理。了解其CT表现与病理之间的关系有助于CT诊断与鉴别诊断。 【关键词】 肾细胞肿瘤 An Analysis of CT Features and New Pathological Typing in 21 Cases with Renal Cell Carcinoma Abstract: ［Purpose］ To improve the knowledge of CT diagnosis for renal cell carcinoma based on the new pathological typing. ［Method］ The CT features and pathology of 21cases with renal cell carcinoma pathologically proved were retrospectively analyzed. ［Results］ There were 11 cases with clear cell carcinoma; 1 case, granular cell carcinoma; 4 cases, mixed cell carcinoma; 1 case, multilocular cell carcinoma; 1 case, papillary renal carcinoma; 2 cases, chromophobe cell carcinoma and 1 case, collecting duct carcinoma. Granular cell carcinoma and multilocular cell carcinoma were both classified as clear cell carcinoma in new pathological typing. With rich blood vessel, this subtype showed dramatic enhancement on CT image and simple cystic degeneration was the characteristic. While granular cell carcinoma and chromophobe cell carcinoma was relatively with poor blood vessel and the degree of enhancement was lower than clear cell carcinoma. Necrosis and cystic degeneration were found in them. Collecting duct carcinoma was rare and its CT feature was lack of specificity. ［Conclusion］ The CT features in every subtype of renal cell carcinoma show no obvious specificity and the pathology is still the base of confirmed diagnosis understanding the relationship between them will help for CT diagnosis and differential diagnosis. Key words: renal cell carcinoma; CT features; pathology subtype 肾癌又称肾细胞癌，多发生于40岁以后，占成人肾脏恶性肿瘤的80％～83％，男性为女性的3倍[1]。最常见的临床症状为无痛性肉眼血尿、腰痛和包块。现已明确该肿瘤起源于肾小管上皮细胞，属于肾腺癌。2004年WHO对成人肾脏肿瘤重新分类，为提高对肾细胞癌的CT诊断及其病理新分类的认识，现搜集我院21例经手术病理证实的肾细胞癌病例，以分析其CT