肾脏原发性未分化多形性肉瘤MSCT诊断及病理对照研究

MSCT diagnosis and pathological study of renal primary undifferentiated pleomorphic sarcoma

目的:探讨肾脏原发性未分化多形性肉瘤的临床、病理特征及多层螺旋CT表现。方法:回顾性分析8例经病理证实的肾脏原发性未分化多形性肉瘤的临床病理资料及CT影像特征。结果:8例均为单发,左肾6例,右肾2例,5例病灶主体位于肾上极,3例位于肾下极。5例病灶主体位于肾实质,2例侵犯肾窦,1例主体位于肾窦。5例伴有同侧不同程度肾积水,2例伴有明显肾周侵犯,1例肾静脉癌栓形成。7例形态不规则、边界不清,1例类圆形、边界清晰。CT平扫均表现为不均匀等/低混杂密度,1例病灶内可见斑点状、结节状钙化;增强扫描8例皮质期均表现为不均匀轻至中度强化,强化程度低于肾皮质;6例实质期、肾盂期持续强化,2例强化程度下降。结论:肾脏原发性未分化多形性肉瘤易误诊,CT增强扫描有一定的特征性,主要依靠病理和免疫组化确诊。

Objective ： To investigate the clinicaL/pathological features and muhi - slice spiral CT findings of renal primary undifferentiated pleomorphic sarcoma. Methods：The clinical and pathological data of＇ 8 patients with renal primary undifferentiated pleomorphic sarcoma by proved pathologically were retrospectively analyzed. Results：8 cases were single,left kidney in 6 cases,right kidney in 2 cases,5 cases of were located in the upper pole of the kidney,3 cases in the lower pole of the kidney. 5 cases of the main lesion wete in the renal parenchyma, of which the renal sinus was invaded in 2 cases, and 1 case of the main lesion in the renal sinus 5 cases were accompanied with different degrees of hydronephrosis. 2 eases were accompanied with obvious perirenal invasion, and the renal vein thrombosis was found in 1 case. 7 cases of irregular shape, the boundary was not clear, 1 case of circular, clear boundaries. CT scan showed nonuniformity iso/lowdensity, 1 cases of lesions seen in spots, nodular calcification. In the 8 cases of en- hanced scan,all of the patients showed mild to moderate enhancement in cortical phase, and the degree of enhance- ment was lower than that of renal cortex. In these cases, the parenchymal phase and the renal pelvis were continuously strengthened in the 6 eases, and the degree of enhancement was decreased in the 2 cases. Conclusion ： Renal primary undifferentiated pleomorphic sarcoma is easy to misdiagnosed. CT enhanced scan has a certain characteristics, mainly rely on pathological and immunohistochemical diagnosis.