不同病理类型肾肿瘤的影像学特点和病理学特点分析

Analysis of imaging and pathological features of renal neoplasms among different pathological types

目的比较不同病理类型肾肿瘤的临床流行病学、影像学及病理学特点。方法回顾性分析2010年1月至2019年1月收治的2 198例肾肿瘤患者的临床资料,男1 404例,女794例,男女比例1.77∶1。年龄(56.5±11.7)岁。对不同病理类型肾肿瘤的流行病学、超声和CT检查、病理学特点进行比较分析。结果 2 198例中,透明细胞癌1 891例(86.0%),乳头状肾细胞癌112例(5.1%),嫌色细胞癌76例(3.5%),低度恶性潜能的多房囊性肾肿瘤23例(1.0%),Xp11.2易位性癌13例(0.6%),集合管癌4例(0.2%),乏脂肪血管平滑肌脂肪瘤58例(2.6%),嗜酸性肾细胞瘤18例(0.8%),后肾腺瘤3例(0.1%)。不同病理类型肾肿瘤患者的年龄、性别总体差异有统计学意义(F=13.8,P<0.05;χ2=20.5,P<0.05),Xp11.2易位性癌的平均发病年龄最小[(44.9±17.1)岁],乏脂肪血管平滑肌脂肪瘤中女性患者比例较高[41例(70.69%)],透明细胞癌和乳头状肾细胞癌中男性患者比例较高[1 253例(66.3%)和77例(68.8%)]。不同病理类型肾肿瘤的左右侧分布无明显差异(χ2=16.27,P>0.05),临床表现均以偶发为主(χ2=19.63,P>0.05)。不同病理类型肾肿瘤的超声检查结果比较差异有统计学意义(χ2=67.1,P<0.05),透明细胞癌和嫌色细胞癌主要表现为低回声[858例(45.4%)和34例(44.7%)],乏脂肪血管平滑肌脂肪瘤主要表现为高回声[20例(34.5%)]和混合回声[16例(27.6%)],低度恶性潜能的多房囊性肾肿瘤主要表现为囊实性混合回声[14例(60.9%)]。不同病理类型肾肿瘤CT检查各期的CT值总体上差异均有统计学意义(P<0.05),透明细胞癌增强扫描动脉期CT值显著高于其他类型肿瘤(F=11.6,P<0.05),而实质期CT值下降明显,呈"快进快出"的强化特点。乳头状肾细胞癌增强扫描3期的CT值均低于透明细胞癌和嫌色细胞癌(P<0.05),呈"渐进性强化"特点。嫌色细胞癌强化效应介于二者之间。乏脂肪血管平滑肌脂肪瘤平扫CT值高于透明细胞癌,增强后持续强化,呈"快进慢出"的特点。透明细胞癌和乳头状肾细胞癌大体病理切面多为黄褐色[1 235例(72.6%)和51例(52.1%)],乏脂肪血管平滑肌脂肪瘤大体病理切面多为灰白色[21例(40.4%)]。结论不同病理类型肾肿瘤的流行病学、影像学及病理学均有一定特点,尤其是透明细胞癌、乳头状肾细胞癌、嫌色细胞癌、乏脂肪血管平滑肌脂肪瘤的增强CT扫描强化特点对鉴别诊断有一定价值。

Objective To compare the different pathological type of renal tumor, clinical epidemiology, imaging and pathological features, summarize its value in the diagnosis of renal tumor. Methods The clinical data of 2198 patients who underwent surgical treatment in our hospital due to renal tumors from January 2010 to January 2019 were retrospectively analyzed. There were 1 404 males and 794 females with an average age of (56.5±11.7) years old. The clinical epidemiology, image features and pathological features were compared. Results Among them, the pathological results concluded 1 891 cases of renal clear cell carcinoma (86.0%), 112 cases of papillary renal cell carcinoma (5.1%), 76 cases of chromophobe cell carcinoma (3.5%), 23 cases of multilocular cystic renal tumors with low malignant potential (1.0%), 13 cases of Xp11.2 translocation carcinoma (0.6%), 4 cases of collecting duct carcinoma (0.2%), 58 cases of anadipotic angiomyolipoma (2.6%), 18 cases of acidophiloma (0.8%), and 3 cases of metanephric adenoma (0.1%). The overall differences in age and gender among patients with renal tumors of different pathological types were statistically significant (F=13.8, P<0.05;χ2=20.5, P<0.05), Xp11.2-translocated carcinoma had the lowest mean age of onset, which was (44.9±17.1 years old). The percentage of women with anadipotic angiomyolipoma was higher (41, 70.7%), and the percentage of men with clear cell carcinoma and papillary renal cell carcinoma was higher (1 253, 66.3%)and(77, 68.8%). There was no statistically significant difference in side sex and clinical manifestations among patients with different pathological types of renal tumors (χ2=16.27, P>0.05). No significant difference in the distribution of left and right side, the clinical manifestations were mainly sporadic(χ2=19.63, P>0.05). The results of renal tumors ultrasound ith different pathological types showed statistically significant difference (χ2=67.1, P<0.05). Hyperechoic (20, 34.5%) and mixed echogenicity (16, 27.6%) were the main manifestations of lipoma. Multilocular cystic renal tumors with low malignant potential were mostly cystic and solid mixed echogenicity (14, 60.9%). CT values of renal tumors of different pathological types at all stages showed statistically significant differences (P<0.05). The CT values of clear cell carcinoma at the arterial phase of CT enhanced scan were significantly higher than those of other types of tumors (F=11.6, P<0.05), but decreased significantly in the parenchymal phase, showing the of enhanced scan were all lower than those of clear cell carcinoma and chromophobe cell carcinoma (P<0.05), showing a "progressive enhancement". The enhancement effect of chromophobe cell carcinoma is somewhere in between. The CT value on plain scan of anadipotic angiomyolipoma was higher than that of clear cell carcinoma, and the enhancement was followed by continuous enhancement, showing the characteristics of "fast in and slow out". The majority of clear cell carcinoma and papillary cell carcinoma were tan section (1 235, 72.55%;51, 52.13%). The grey-white section was the most common type of adipogenic angiomyolipoma (21, 40.4%). Conclusions The epidemiological characteristics, imaging and pathological features of renal tumors of different pathological types have certain characteristics, especially the enhanced CT features of renal clear cell carcinoma, papillary renal cell carcinoma, chromophobe cell carcinoma and anadipotic angiomyolipoma, which are of certain value for the differential diagnosis of renal tumors of different pathological types.