肾血管平滑肌脂肪瘤临床特征及CT诊断价值

Clinical Features and CT Diagnostic Value of Renal Angiomyolipoma

目的:分析肾血管平滑肌脂肪瘤(RAML)临床特征及CT诊断价值.方法:选取天津市公安医院2019年7月至2021年12月收治的39例RAML患者作为研究对象,分析RAML的临床特征、CT诊断准确率及影像学表现.结果:术中共见49个瘤灶,其中肾上极10个,肾下极7个,肾上前段4个,肾后段12个,肾下前段5个,巨大弥漫8个,窦旁3个.肿瘤大小为0.1~20.0cm;31例包膜完整,边界清晰;8例包膜不完整,断面颜色均匀,多为淡黄或棕黄色,质地柔软,血管丰富,可见脂肪组织,部分区域出现血凝块.RAML由不同数量的血管、平滑肌和脂肪组织组成,其中等比例者8例,血管为主者14例,脂肪为主者17例.HMB45阳性34例,Vimen-tin均呈阳性,actin呈阳性30例,S-10032例,EMA均呈阴性反应.术前CT诊断准确35例,准确率为89.74%;误诊为脂肪瘤3例,误诊为肾癌1例.结论:CT检查是诊断RAML的主要方法,且CT薄层扫描、增强扫描是显示瘤灶内是否存在脂肪组织的主要手段,同时也是鉴别本病的有效手段.

Objective:To analyze clinical features and CT diagnostic value of renal angiomyolipoma(RAML).Methods:A total of 39 RAML patients who were admitted to Tianjin Public Security Hospital from July 2019 to December 2021 were selected,and the clinical features,CT diagnostic accuracy and imaging manifestations of RAML were analyzed.Results:A total of 49 tumor foci were found in the operation,including 10 in the upper renal pole,7 in the inferior renal pole,4 in the upper and anterior segment of the kidney,12 in the posterior segment of the kidney,5 in the anterior infrarenal segment,8 large and diffuse,and 3 in the parasinus.The tumor size was 0.1~20cm;31 cases had complete capsules with clear boundaries;8 cases had incomplete capsules,with uniform cross-section color,mostly pale yellow or brownish yellow,soft texture,abundant blood vessels,visible adipose tissue,and blood coagulation in some areas piece.RAML was composed of different numbers of blood vessels,smooth muscle and adipose tissue,among which 8 cases were equal proportion,14 cases were vascular predominant,and 17 cases were fat predominant.34 cases were HMB45 positive,all were Vimen-tin positive,30 cases were actin positive,and 32 cases were S-100.Preoperative CT diagnosis was accurate in 35 cases,with an accuracy rate of 89.74%;3 cases were misdiagnosed as lipoma,and 1 case was misdiagnosed as renal cancer.Conclusion:CT scan is the main method for the diagnosis of RAML,and its thin-section CT scan and enhanced scan are effectively means to show whether there is fat tissue in the tumor and to identify the disease.