肾癌与肾血管平滑肌脂肪瘤间的误诊分析

A study of the causes of misdiagnosis between renal cell carcinoma and renal angiomyolipoma

目的 探讨肾细胞癌 (RCC)和肾血管平滑肌脂肪瘤 (RAML)间的误诊原因。 方法 对 2 2 8例RCC ,6 2例RAML中 13例术前影像学检查或术中冰冻切片误诊的原因进行分析。 结果 RCC组中 4例术前影像学检查不能明确性质 ,术中冰冻病理结果为RAML ,行肿瘤剜出术或单纯肾切除 ,随访 1～ 4年 ,无复发。RAML组中 ,6例影像学检查诊断为RCC ;3例不能确定性质 ,术中冰冻病理结果 1例为恶性 ,2例仍不能区分良恶性 ,9例均行肾癌根治术。 结论 冰冻切片误诊与制片特点有关 ,富含血管组织的RCC易被误诊为RAML ,脂肪组织的确定是鉴别诊断的关键。

Objective To study the causes of misdiagnosis between renal cell carcinoma (RCC) and renal angiomyolipoma (RAML). Methods Since 1990, 228 cases of RCC and 62 RAML were surgically treated.13 of them,4 RCC and 9 RAML were incorrectly treated because the misdiagnosis on imaging examination or intraoperative frozen section study. The causes were analyzed. Results 4 RCC underwent enucleation or simple nephrectomy because of the frozen section diagnosis of RAML.None have developed recurrent RCC with 1～4 years of follow up.Of the 9 RAML cases,6 have been misdiagnosed as RCC on imaging procedures.The other 3 patients that failed to reach a proper diagnosis on imaging examination were submitted to intraoperative frozen section studies.1 was diagnosed as RCC and the other 2 remained uncertain. Radical nephrectomy have been performed for 9 patients. Conclusions Difficult interpretation due to poor quality of frozen sections is a potential cause of diagnosis error.RCC might be confused with RAML when the specimens contained highly vascular tissue. The content and distribution of fat is the main cause of imaging misdiagnosis.