肾血管平滑肌脂肪瘤误诊为肾细胞癌12例临床分析

Clinical Characteristics and Misdiagnosis Analysis of 12 Patients with Renal Angiomyolipoma Misdiagnosed as Renal Cell Carcinoma

目的探讨肾血管平滑肌脂肪瘤(RAML)和肾细胞癌的临床特点、误诊原因及防范措施。方法回顾性分析2018年7月至2023年5月收治的术前诊断为RCC而术后病理证实为RAML 12例的临床资料。结果12例病变均位于单侧肾,左侧5例,右侧7例。2例因外伤后住院检查发现,10例因体检发现。术前均误诊为肾癌。误诊时间为5~8 d。入院后均行外科手术治疗,其中开放手术1例,腹腔镜手术11例;行肾部分切除术9例,肾根治性切除术3例。术后病理均为RAML。术后随访1年,均无复发。结论RAML极易误诊为肾细胞癌,特别是肿瘤较小且乏脂型RAML更容易误诊。对于术前性质难以确定的肾肿瘤,尤其是当肿瘤最大径<4 cm时,可以考虑采用肾部分切除术,以避免过度治疗。

Objective To investigate the clinical characteristics,causes of misdiagnosis,and preventive measures of renal angiomyolipoma(RAML)and renal cell carcinoma(RCC).Methods Retrospective analysis was performed on clinical data of 12 patients with preoperative diagnosis of RCC and postoperative pathological confirmation of RAML admitted to our hospital from July 2018 to May 2023.Results All 12 lesions were located in one kidney,including 5 patients on the left side and 7 patients on the right side.Two patients were detected during hospitalization after trauma,and 10 patients were detected during physical examination.They were misdiagnosed with renal cancer during preoperative imaging examinations.Misdiagnosis lasted 5-8 d.All patients underwent surgical treatment,including 1 patient undergoing open surgery and 11 patients undergoing laparoscopic surgery.Nine patients underwent partial nephrectomy and 3 patients underwent radical nephrectomy.The postoperative pathology confirmed RAML in all patients.At 1-year follow-up,there was no recurrence.Conclusion RAML is prone to misdiagnosis as RCC,especially for tumors with smaller diameter and less fat.For RCC whose preoperative nature is difficult to determine,especially when the maximum diameter of tumor is<4 cm,partial nephrectomy can be considered to avoid overtreatment.