肾细胞癌边缘部CT征象与病理对照研究

Comparison Study of CT and Pathologic Findings of the Margin of Renal Cell Carcinoma

目的：探讨肾细胞癌边缘部ＣＴ征象与病理基础。材料与方法：搜集３２例经手术病理证实的肾细胞癌，观察其术前边缘部的ＣＴ征象与术后病理改变对照。结果：（１）ＣＴ肿瘤边缘形态分３类：肿瘤边缘清楚无分叶（５０％）；边缘清楚伴分叶（２８％）；边缘不清（２２％）。（２）肿瘤边缘病理分３种类型：包膜完整（４８％）；包膜不完整或锯齿状（３３％）；无包膜（１９％）。（３）肿瘤平扫边缘不清者有７例，增强后病灶“缩小”或变清者占９４．４％。（４）肿瘤边缘形态与癌细胞分级关系：边缘清楚无分叶或伴分叶者，癌细胞分级Ⅰ～Ⅱ级占８１．８％，Ⅲ级占１８．２％；边缘不清者，以Ⅲ级为主，占７０％。结论：（１）ＣＴ肿瘤边缘３类形态恰与病理上肿瘤边缘３种类型相对应：即ＣＴ肿瘤边缘清楚无分叶者，病理上大多包膜完整；边缘清楚伴分叶者，病理上大多包膜不完整或锯齿状；边缘不清者，病理大多无包膜。因此，ＣＴ肿瘤边缘３类形态能较好地反映肿瘤包膜的完整程度以及肿瘤浸润情况。（２）ＣＴ平扫肿瘤边缘不清者，增强后肿瘤大多“缩小”或边缘变清，边缘不清是肿瘤周围正常肾实质内散在浸润的癌细胞所致，对于指导手术范围有一定帮助（手术应略扩大范围）。（３）ＣＴ平扫肿瘤边缘清楚无?

Objective: To study the CT features of renal cell carcinoma (RCC) and their pathologic basis. Materials and Methods: CT and pathologic findings were compared and analyzed in 32 patients with pathologically proved RCC. Results: (1) On CT scan, the tumor margin presented three patterns: clear margin and without lobulation (50%); clear margin and lobulated (28%); blur margin (22%). (2) Pathologically, the tumor margin could be classified into types: intact capsule (48%); incomplete capsule or serrated margin (33%); without capsule (19%). (3) On enhanced CT scan, the size of lesions with blur margin on plain scan was decreased in 7 cases. Conclusion: (1) CT can well demonstrate the tumor margin, and is well correlated with the pathologic findings. (2) CT pattern of RCC margin is very helpful in assessing the extent of tumor invasion and in grading the tumor cells.