原发性肾肉瘤CT表现(附四种类型8例报告)

CT findings of primary renal sarcoma

目的:探讨肾脏原发性肉瘤的特征性CT表现。方法:回顾性分析经手术、病理证实的8例原发性肾肉瘤CT表现。临床症状中7例有腰、腹疼痛,消瘦5例,肉眼血尿5例,无症状体检发现1例。结果:8例中平滑肌肉瘤3例,肾恶性纤维组织细胞瘤2例,肾肉瘤样癌2例,肾癌肉瘤1例;肿块直经3.3～15.0cm,其中直经>9.0cm者4例;平扫密度均匀2例,不均匀6例;瘤内坏死囊变5例;肿块界限不清,边缘模糊6例;增强扫描皮质期肿瘤轻至中度强化,肾盂期和实质期强化减弱。结论:肾脏原发性肉瘤具有明显恶性肿瘤CT表现,但无组织学特异征象,与肾癌无法鉴别。

Objective:To study the CT characteristics of primary renal sarcoma.Methods:CT findings of 8 cases with surgery and pathology proved renal sarcoma were analyzed retrospectively.The clinical manifestations including abdominal pain (7 cases),lost of body weight (5 cases),naked eye hematuria (5 cases) and no symptoms on physical examination (1 case).Results:Of the pathology subtypes,there were leiomyosarcoma (n=3),malignant fibrohistiocytoma (n=2),sarcomatoid renal carcinoma (n=2) and carcinosarcoma (n=1).The diameter of the tumor masses were 3.3~15.0cm,4 cases had the diameter >9.0cm.Tumors were homogeneous in density (n=2) and heterogeneous (n=6),with intra-tumoral necrosis or cystic change (n=5).Tumor had ill-defined margin (n=6).After contrast administration,tumors were slightly/moderately enhanced on cortical phase,then the enhancement decreased on parachymal and pelvical phase.Conclusion:The CT findings of primary renal sarcoma showed significant malignant characteristics,yet were non-specific,and could not be differentiated from that of renal carcinoma.