不典型肾脏血管瘤影像表现(附三例病例报告)

Imaging Findings of Atypical Renal Hemangioma(with Three Case Reports)

目的探讨不典型肾脏血管瘤临床特点及影像学表现,以提高对本病的诊断。方法回顾性分析3例经手术病理证实肾脏血管瘤的临床资料,术前均接受检查,均诊断为肾脏肿瘤性病变,接受肾脏切除术。结果病灶在CT上呈圆形、类圆形或椭圆形等低密度灶,边界欠清,突向皮质外或肾窦,增强扫描实性成分早期边缘不均匀强化,静脉期不均匀延迟强化,中央或周围有不强化区域。MRI扫描在T_(1)WI上呈稍低信号,T_(2)WI呈不均匀高信号,正反相位图像区别不大,DWI呈等或稍高信号,增强扫描强化同CT相似。病理切片肿块呈灰褐色,细胞无异型性。免疫组化检查CD31(+)CD34(+),KI-64呈低增值,符合肾脏血管瘤。术后,患者均恢复良好,12月内无出现复发或转移。结论不典型肾脏血管瘤临床少见,具有一定的影像学特征,但较典型血管瘤相比,容易误诊为肾脏富血供良恶性肿瘤。最终确诊依赖病理学检查。治疗以手术切除或介入栓塞为主。

Objective To investigate the clinical features and imaging manifestations of atypical renal hemangioma in order to improve the diagnosis of this disease.Methods The clinical data of 3 cases of renal hemangioma confirmed by surgical pathology were retrospectively analyzed,and all of them were diagnosed with renal neoplastic lesions and underwent nephrectomy before surgery.Results The lesions were low-density lesions such as round,quasi-round or oval on CT,with unclear borders,protruding extracortical or renal sinuses,uneven enhancement of the early edges of the solid components of enhanced scanning,uneven delayed enhancement in the venous phase,and unreinforced areas in or around the center.MRI scans show slightly lower intensity on T_(1)WI,T_(2)WI shows uneven high intensity,there is little difference between positive and negative phase images,DWI shows equal or slightly higher intensity,and contrast scan enhancement is similar to CT.The mass of the pathological section is grayish-brown,and the cells are not atypical.Immunohistochemistry showed CD31(+)CD34(+),and KI-64 showed low proliferation,which was consistent with renal hemangioma.After the operation,the patients recovered well,and there was no recurrence or metastasis within 12 months.Conclusion Atypical renal hemangiomas are rare in clinical practice and have certain imaging features,but compared with typical hemangiomas,they are easily misdiagnosed as benign and malignant tumors with rich blood supply to the kidney.Definitive diagnosis relies on pathological examination.Treatment is mainly surgical excision or interventional embolization.