摘要
目的探讨肾脏混合性上皮间质肿瘤(MESTK)的CT、MRI特点以及病理特征,提高对本病的认识,降低术前影像误诊率。方法回顾性分析7例经本院术后病理确诊的MESTK患者的CT与MRI资料。结果 CT与MRI示均为单侧、单发病灶,病灶呈囊实性表现,实性成分占比不一。增强后病灶内囊性成分不强化,实性成分及分隔明显延迟强化。5例病灶可见尖角状凸起向肾盂内延伸,肾盂局部受累。5例患者行全肾切除术,术后随访均未见肿瘤复发征象;2例患者行保留肾单位手术,其中1例术后5个月常规复查CT发现肿瘤术后复发,且复发病灶影像学表现与原发肿瘤类似。病理特点:MESTK由上皮和间质成分共同构成,间质成分主要为梭形细胞,并可见特征性束状分布的平滑肌组织和厚壁血管,典型的上皮细胞呈立方形、柱状或鞋钉样;免疫组织化学:上皮成分细胞角蛋白(CK)、上皮细胞膜抗原(EMA)阳性,间质成分平滑肌及肌动蛋白(SMA)、波形蛋白(Vim)、ER和PR阳性。结论肾脏混合性上皮间质肿瘤好发于中年女性,尤其是围绝经期。影像表现为肾脏单发囊实性肿块,实性成分占比不一,增强后实性成分及分隔渐进性强化,局部向肾盂内突入为与其他肾脏肿瘤的鉴别关键点。
Objective To explore the CT and MRI features and pathological analysis of mixed epithelial and stromal tumors in the kidney,so as to improve the understanding of the disease and to reduce the misdiagnosis rate of preoperative imaging diagnosis. Methods The CT and MRI data of 7 patients with mixed renal epithelial and stromal tumors confirmed by postoperative pathology were retrospectively analyzed. Results The average age of patients was 47 years old,6 cases were female,and 1 case was male. The first clinical symptoms were mainly lumbar pain without obvious cause,with or without gross hematuria. CT and MRI showed unilateral and single lesions,and the lesions showed cystic solid mass appearance. The solid components accounted for different proportions. After the enhancement,the cystic components in the lesions were not enhanced,and the enhancement of the solid components and margins were significantly delayed. In 5 cases,sharp horns were found to extend into the renal pelvis,and the renal pelvis was partially affected. Five patients underwent total nephrectomy. No signs of tumor recurrence were found in the follow-up patients. Two patients underwent nephron sparing surgery. One patient underwent routine reexamination of CT in 5 months after surgery and found recurrence of tumor recurrence. Academic performance is similar to primary tumor. Pathological features:MESTK consists of epithelial and mesenchymal components. The interstitial components are mainly fusiform cells,and there are characteristic bundles of smooth muscle tissue and thick-walled blood vessels. Typical epithelial cells are cuboidal,columnar or stud-like. Immunohistochemistry:epithelial component cytokeratin(CK),epithelial membrane antigen(EMA) positive,interstitial smooth muscle and actin(SMA),vimentin(Vim),ER and PR positive. Conclusion Mixed epithelial and interstitial tumors of the kidney occur in middle-aged women,especially in the perimenopausal period.In masses with solid-cystic components of the kidney,the proportion of the ingredients is di
作者
潘红利
侯唯姝
李小虎
徐曼
余永强
PAN Hongli;HOU Weishu;LI Xiaohu(Department of Radiology,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui Province)
出处
《临床放射学杂志》
CSCD
北大核心
2019年第11期2133-2137,共5页
Journal of Clinical Radiology
