肾周间隙原发性平滑肌肉瘤的CT分析与病理对照

CT Findings of Primary Leiomyosarcoma Located at Perirenal Space and Comparison with Pathological Results

目的探讨肾周间隙原发性平滑肌肉瘤的CT征象及病理表现,以提高对该病的诊断水平。方法对经病理证实的10例肾周间隙原发性平滑肌肉瘤的CT表现进行回顾性分析,结合文献分析肾周间隙原发性平滑肌肉瘤的CT表现特点,并与病理结果进行比较。结果肾周间隙原发性平滑肌肉瘤发病组织:5例位于肾脏,3例位于肾周组织,2例位于肾上腺。CT平扫,8例呈较大混杂密度软组织肿块影,较小者密度较均匀;9例行三期增强扫描,均表现为不均匀强化,其中8例出现不同程度的延迟性强化,另1例行皮质期及髓质期扫描者亦呈渐进性强化。1例出现同侧输尿管及膀胱的种植性转移。结论肾周间隙原发性平滑肌肉瘤的临床与CT表现均无特异性,延迟强化方式对CT诊断有一定帮助,确诊还有赖于病理组织学及免疫组织化学检查。

Objective To discuss the CT features and pathological findings of primary leiomyosarcoma located at perirenal space in order to improve the diagnostic accuracy. Methods CT manifestations and pathological findings of 10 patients with pathologically-proved primary leiomyosarcoma located at perirenal space were retrospectively analyzed. Combined with relevant literature, its CT characteristics were evaluated, and comparison between CT signs and pathological results was made. Results The origin sites of primary leiDmyosarcoma located at perirenal space included kidney （ n = 5）, perirenal tissue （n = 3） and adrenal gland （ n = 2）. Plain CT scanning showed that in 8 cases the lesion presented as a larger mixed-density soft tissue mass, and small lesions had homogeneous density. Tri-phase enhanced scanning was carried out in 9 cases, and the lesions displayed inhomogeneous enhancement ; among the 9 cases, 8 showed different degrees of delayed enhancement sign and the other one showed progressive enhancement pattern in cortical and medullary phase. Planting metastasis of ipsilateral ureter and bladder was observed in one case. Conclusion Primary leiomyosarcomas located at perirenal space have no characteristic clinical and CT manifestations. The confirmation of diagnosis depends on pathological and immunohistochemistry examination although delayed enhancement pattern is somewhat helpful in making the diagnosis.