肾嫌色细胞癌的CT表现及病理特点

Pathological and CT imaging manifestations of renal chromophobe cell carcinoma

目的:分析肾嫌色细胞癌的CT表现及病理特点,提高对该病的认识。方法:回顾性分析9例经病理证实的肾嫌色细胞癌患者的CT及病理资料,对病灶数目、部位、大小、形态、CT平扫和增强扫描及病理表现等方面进行综合性分析。结果:9例患者中,8例为单发病灶,1例为多发病灶,瘤体直径为2.7～10.6 cm,平均(6.0±1.9)cm。CT平扫7例呈稍高密度,2例呈等密度;1例内有小结节样钙化,1例中央见纤维瘢痕,1例见"劈裂征"。9例中除1例形态不规则与邻近肾实质及肾周筋膜分界不清晰外,其余8例均与邻近肾实质分界清晰,均呈圆形或类圆形外凸性生长方式,其中1例局部凸向肾盂,其余均凸出肾皮质外。增强扫描7例呈轻度-中度强化,2例呈明显强化。所有肿瘤均为实性或以实性为主,质地较硬,周围均可见完整假包膜,肿瘤细胞体积大,境界清楚、呈圆形或多角形,对Hale胶体铁染色均呈阳性。结论:肾嫌色细胞癌CT表现具有一定特征性,是发现病变、判断预后的可靠方法,对术前定性诊断具有重要价值。在病理上能与最常见的透明细胞癌和其他类型肾细胞癌相鉴别。

Objective To explore the CT appearance pathological characteristics of renal chromophobe cell carcinoma(RCCC)and improve the diagnostic accuracy of CT.Methods Totally 9 patients with RCCC confirmed by pathology were reviewed retrospectively on the pathological manifestations,lesion number,site,size,morphology as well as their data on CT noncontrast and contrast enhanced scan.Results Of the 9 cases,1 case had two lesions on one side of the kidney,the remaining 8 cases gained single lesions,CT plain scan showed round or round-like masses with clear boundary,and there were 7 cases of slightly high density and 2 cases of equal density.Among them,1 case had nodular calcification in the mass,1 case showed fibrous scar and 1 case gained'cleavage sign'in the center of the mass.The tumors diameter was from 2.7 to 10.6 cm,with an average(6.0±1.9)cm.In the 9 cases,there was 1 case gifted with irregular shape and unclear boundary between adjacent renal parenchyma and peritoneal fascia;the other 8 cases were clearly separated from the adjacent renal parenchyma and showed circular or round-like convex growth patterns,of which,one patient was locally convex to the renal pelvis,and the rest protruded out of the renal cortex.In contrast-enhanced scan,7 cases showed mild to moderate progressive enhancement,and 2 cases showed obvious enhancement.All the tumors were solid or mainly solid with hard texture,complete pseudo capsule around the mass,large cancer cells,clear and round or polygonal boundary as well as positive reaction to Hale colloidal iron staining.Conclusion RCCC has characteristic CT manifestations,which are of great value for finding lesions,prognosis determination and preoperative qualitative diagnosis.Pathological examination can be used for the differential diagnosis of RCCC,suprarenal epithelioma and etc.