肾嫌色细胞癌的螺旋CT表现与病理对照研究

Spiral CT signs of chromophobe cell renal carcinoma and pathogenic comparison

目的探讨肾嫌色细胞癌的螺旋CT表现及与病理分型和血管生成的关系。方法回顾性分析经手术病理证实的18例肾嫌色细胞癌的术前螺旋CT征像及病理结果。结果 18例CT平扫,等密度4例,低密度10例,高密度4例。6例有小囊变灶,2例有点状钙化。17例单发肿块,1例累及全肾。多期增强扫描:18例皮质期轻度强化,强化程度明显低于正常肾皮质。实质期及肾盂分泌期肿瘤密度均低于肾实质,10例髓质期较皮质期明显强化,11例实质期强化程度较髓质及皮质期明显。1例全肾不均匀强化,有小囊变,无钙化。实质期及分泌期10例显示假包膜。2例肾门淋巴结肿大,2例肾周脂肪囊侵犯。病理Robson分期:Ⅰ期13例,Ⅱ期3例,Ⅲ期2例,Ⅳ期0例。MVD平均14.86±2.04条/高倍视野;VEGF表达阳性4例(22.22%)。MVD、VEGF表达和肾癌分期与肿瘤CT强化程度有相关性(r_s=0.421,P<0.05)。结论肾嫌色细胞癌有较典型的CT特征及病理特点,有助于肾癌亚型的鉴别诊断。

Aim To analyze the relationship between spiral CT signs and pathology in CCRC.Methods There 18 cases with pathologically proved CCRC were retrospectively analyzed.All cases were examined with spiral CT in plain and multiphase enhancement scans before operation.CT features of CCRC were compared with surgical and pathological results. Results In 18 cases,the density of mass of 4 cases,10 caes with lower density and 4 cases with higher density by CT plain scan was the same as the normal renal density,6 cases wihth small necrosis and 2 cases with calcium.The NP features of CCRC were lower density than the normal renal density in all cases,so the EP features of CCRC.The enhancement degree of CCRC on the NP was obvious higher than the CMP in 10 cases,so was the enhancement degree of CCRC on the EP higher than the CMP and the NP in 11 cases.There pseudocapsule were observed in 10 cases at the NP and EP,enalargemenl of lymph node of renal door was in 2 cases.The positive expression rate of VEGF were 22.22%.There perinephric space abnormalities was not observed in 6 cases.The pathologic Robson phasing of CCRC was as the fllows：13 cases at phaseⅠ,3 cases at phaseⅡ,2 cases at phaseⅢ.The enhancement degree of CCRC on contrast CT and phasing was closely correlated with the MVD and VEGF of CCRC（P0.05）.Conclusion Spiral CT could distinctly show imaging characteristics of CCRC,which is helpful for differential diagnosis of the infection.