儿童肾脏和腹膜后常见肿瘤的CT诊断及鉴别诊断

CT diagnosis and differential diagnosis of renal and retroperitoneal tumors in children

目的探讨儿童肾脏和腹膜后肿瘤的CT诊断及鉴别诊断。方法回顾性分析189例儿童肾脏和腹膜后肿瘤的CT表现。所有病例均经手术病理证实,其中肾母细胞瘤71例(73个肿瘤),神经源性肿瘤89例(成神经细胞瘤70例,神经节成神经细胞瘤2例,神经节细胞瘤17例),畸胎瘤18例,淋巴瘤11例。结果肾母细胞瘤CT表现为圆形或类圆形的有包膜肿块,常引起肾脏破坏,残肾呈新月形包绕肿块,易形成肾静脉、下腔静脉瘤栓及肺内转移。成神经细胞瘤与神经节成神经细胞瘤表现类似,多有钙化及血管包埋等征象,可侵犯肾脏,以淋巴结、颅脑、骨骼及肝脏转移常见;神经节细胞瘤表现为肾上腺区或脊柱旁体积较小的卵圆形低密度肿块,增强早期无强化或轻微强化。淋巴瘤发生于中线附近,呈分叶状多中心融合病灶,血管包埋较松散,侵犯肾脏多为双侧。畸胎瘤发生于一侧腹膜后,钙化或骨化以及脂肪密度是其特征。结论CT对儿童肾脏和腹膜后肿瘤具有较高的诊断和鉴别诊断价值。

Objective To investigate the diagnosis and differential diagnosis of renal and retroperitoneal tumors in children with CT. Methods CT findings in 189 cases of pathologically confirmed renal and retroperitoneal tumors, including nephroblastoma in 71 cases, neurogenic tumor in 89 cases （neuroblastoma in 70 cases, ganglioneuroblastoma in 2 cases and ganglioneuroma in 17 cases）, teratoma in 18 cases and lymphoma in 11 cases, were retrospectively analyzed. Results CT showed that nephroblastoma was a round or oval encapsuled mass usually resulting in renal destruction, the residual kidney was a crescent-shaped encapsuled mass which is easy to lead to thrombosis of renal vein and inferior vena cava due to tumor. The manifestations of neuroblastoma were similar to those of ganglioneuroblastoma, usually with calcification and embed vessels, and could invade the kidneys and often metastasize to lymph nodes, cranium and brain, bones and liver. The ganglioneuroma was manifested as a small oval-shaped low dense mass in adrenal gland area or in paravertebral, with no exacerbation or slight exacerbation in its early stage. Lymphoma was located around the median line and presented as an irregular mass fused by multiple lymph nodes embedding the vessels loosely. Teratoma, usually occurred on one side of the retroperitonium, was characterized by calcification/ossification and fat tissue. Conclusion CT is of a higher value for the diagnosis and differential diagnosis of renal and retroperitoneal tumors in children.