摘要
目的 总结儿童非典型肾母细胞瘤的CT影像特征和组织病理表现,探讨CT诊断非典型肾母细胞瘤的局限性。方法 回顾性分析8例非典型肾母细胞瘤患儿的CT影像表现和组织穿刺活检病理资料。结果 8例患儿CT检查均未明确肾母细胞瘤诊断。囊性部分分化型肾母细胞瘤1例,CT表现为多囊样肿块,肿块内为水样密度,仅囊壁和间隔可见强化,误诊为多房囊性肾脏肿瘤;组织病理提示囊肿型肾母细胞瘤。马蹄肾合并肾母细胞瘤2例,CT显示瘤体较小,实性部分轻度强化,囊变部分无强化,未明确诊断;组织病理提示为上皮型和胚芽型肾母细胞瘤各1例。肾盂肾母细胞瘤1例,CT平扫可见左肾盂内软组织样密度肿块,结合外伤病史诊断为肾盂积血;进一步行增强CT提示肾盂内肿块不均匀强化,且向输尿管内延伸,误诊为横纹肌肉瘤;组织病理提示为上皮型肾母细胞瘤。多发肾母细胞瘤3例,其中双侧2例、单侧1例,CT均表现为多个大小不等的瘤体,与肾脏非霍奇金淋巴瘤表现相似,未明确诊断;组织病理结果提示上皮型肾母细胞瘤2例、胚芽型肾母细胞瘤1例。含脂肪成分肾母细胞瘤1例,CT发现右肾巨大肿块内无强化的极低密度脂肪影,误诊为畸胎瘤型肾母细胞瘤;组织病理提示为胚芽型肾母细胞瘤。结论 非典型肾母细胞瘤组织病理表现多样,CT可分析其囊变、大小、发生部位、组织成分等,但不易作出明确诊断。
Objective To summarize the CT imaging features and histopathological findings of atypical nephroblastoma in children, and to investigate the limitation of CT on diagnosing atypical nephroblastoma. Methods The CT imaging and histopathological data of 8 children with atypical nephroblastoma were retrospectively analyzed. Results All 8 cases got no clear diagnosis of nephroblastoma by CT before operation, in which 1 case of cystic partially differentiated nephroblastoma was misdiagnosed as multi-compartmental cystic renal tumor by CT due to multi-cystic mass cystic nephroblastoma in the water density within the mass and visible enhancement only in the cyst wall and septum, and was histopathologically confirmed as cystic nephroblastoma;2 cases of horseshoe kidney combined with nephroblastoma were histopathologically confirmed as epithelial nephroblastoma in 1 case and germinal nephroblastoma in 1 case, which were not definitively diagnosed due to mild enhancement in the solid part and no enhancement in the cystic part because of too small size;1 case of renal pelvic nephroblastoma was found left renal pelvic mass in the soft tissue density and was diagnosed as renal pelvic hemorrhage by CT plain scan based on the history of trauma, while enhanced CT scan showed a heterogeneous enhancing mass in the renal pelvis extending into the ureter, which was misdiagnosed as rhabdomyosarcoma, and the histopathological result suggested epithelial nephroblastoma;3 cases of multiple nephroblastoma including 2 cases of bilateral nephroblastoma and 1 case of unilateral multiple nephroblastoma were not clearly diagnosed due to multiple tumors of different sizes on CT, similar to renal non-Hodgkin’s lymphoma, while the histopathological result suggested epithelial nephroblastoma in 2 cases and germinal nephroblastoma in 1 case, respectively;1 case of nephroblastoma with a fatty component was misdiagnosed as teratocystic nephroblastoma on CT due to a no-enhanced extreme low density fatty shadow within a large right renal mass, while t
作者
胡文
张雅
陈东
蒋昊翔
郝跃文
HU Wen;ZHANG Ya;CHEN Dong;JIANG Hao-xiang;HAO Yue-wen(Department of Imaging,Xi'an Children'sHospital,Xi'an,Shaanxi 710043,China;Departmentof General Surgery,Xi'an Children's Hospital,Xi'an,Shaanri 710043,China)
出处
《中华实用诊断与治疗杂志》
2022年第11期1171-1174,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
陕西省自然科学基础研究计划(2021JM-558)。
