本文選題：腎腫瘤　切入點(diǎn)：乳頭狀腎細(xì)胞癌　出處：《復(fù)旦學(xué)報(bào)(醫(yī)學(xué)版)》2017年03期

【摘要】：目的探討Ⅰ型和Ⅱ型乳頭狀腎細(xì)胞癌(papillary renal cell carcinoma,PRCC)的影像學(xué)表現(xiàn)及其差異。方法回顧性分析經(jīng)手術(shù)病理證實(shí)的47例PRCC患者資料,其中Ⅰ型21個(gè)病灶,Ⅱ型27個(gè)病灶(1例患者左腎含2個(gè)病灶)。所有患者術(shù)前均行腎臟CT或MRI平掃及動(dòng)態(tài)增強(qiáng)檢查。對(duì)PRCC的形態(tài)學(xué)特征、腫瘤外侵征象、增強(qiáng)CT表現(xiàn)進(jìn)行定性和定量分析。采用獨(dú)立樣本t檢驗(yàn)對(duì)病灶最大徑、三期CT值及皮髓交界期△CT、實(shí)質(zhì)期△CT進(jìn)行比較,采用Pearsonχ~2檢驗(yàn)或Fisher確切概率法對(duì)分類(lèi)變量進(jìn)行比較。結(jié)果一般形態(tài)學(xué)上,Ⅱ型PRCC平均最大徑大于Ⅰ型(t=-2.604,P=0.013),密度/信號(hào)更不均勻(χ~2=14.928,P=0.000),更易出現(xiàn)囊變或壞死(χ~2=5.598,P=0.018),且程度更明顯(χ~2=4.769,P=0.029);在CT圖像上,兩型之間出血和鈣化征象的差異均無(wú)統(tǒng)計(jì)學(xué)意義。分別有66.7%Ⅱ型PRCC和23.8%Ⅰ型PRCC出現(xiàn)乳頭結(jié)節(jié),兩型之間的差異有顯著統(tǒng)計(jì)學(xué)意義(χ~2=8.694,P=0.003)。在腫瘤外侵表現(xiàn)方面,除邊界征象外,Ⅱ型較Ⅰ型PRCC更易發(fā)生腎周脂肪侵犯、腎竇侵犯及轉(zhuǎn)移(P0.05)。在增強(qiáng)CT表現(xiàn)方面,兩型在皮髓交界期CT值、皮髓交界期△CT的差異均有統(tǒng)計(jì)學(xué)意義(t=-2.674,P=0.012;t=-3.109,P=0.005),而在平掃期CT值、實(shí)質(zhì)期CT值、實(shí)質(zhì)期△CT上的差異均無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論Ⅰ型和Ⅱ型PRCC在形態(tài)學(xué)特征、腫瘤外侵征象及強(qiáng)化程度上有一定差異,部分Ⅱ型腫瘤具有侵襲性生物學(xué)行為,預(yù)后更差。
[Abstract]:Objective to investigate the cell type of renal papillary carcinoma (papillary renal cell carcinoma, PRCC) and different imaging. Methods Retrospective analysis of the clinical data of 47 cases of PRCC confirmed by pathology, including type 21 lesions, type 27 lesions (1 patients with 2 lesions of Zuo Shen). All patients underwent renal CT or MRI plain and dynamic enhanced MRI. Morphological features of PRCC, tumor invasion signs, enhanced CT showed a qualitative and quantitative analysis. Using t test of independent samples the maximum diameter of the lesions, three CT values and the corticomedullary phase of delta CT, Delta CT parenchymal phase compared to compare categorical variables using the Pearson x ~2 test or Fisher exact test. Results the general morphology, type II PRCC average diameter more than 1 (t=-2.604, P=0.013), density / signal more uneven (x ~2=14.928, P=0.000), more prone to cystic degeneration or necrosis (x ~ 2=5.598, P=0.018), and a greater degree (x ~2=4.769, P=0.029); in the CT image, the two type between hemorrhage and calcification. There were no significant differences in type II were 66.7% PRCC and 23.8% type PRCC papillary nodules, there was significant difference between type two (x ~2=8.694, P=0.003). In tumor invasion performance, in addition to boundary signs, type II is the type I PRCC more susceptible to perirenal fat invasion, renal sinus invasion and metastasis (P0.05). In the aspect of enhancing CT performance, type two in the corticomedullary phase CT, corticomedullary phase differences were statistically CT the significance of (t=-2.674, P=0.012; t=-3.109, P=0.005), and scanning CT value on a flat, parenchymal CT, Delta CT on the difference in parenchymal phase was not statistically significant. Conclusion the type I and type II PRCC in morphology, tumor invasion signs and enhancement degree have certain difference, part of tumor aggressive biological The prognosis is worse by learning behavior.

【作者單位】： 復(fù)旦大學(xué)附屬中山醫(yī)院放射科;上海市影像醫(yī)學(xué)研究所;復(fù)旦大學(xué)上海醫(yī)學(xué)院影像醫(yī)學(xué)系;
【基金】：上海市自然科學(xué)基金(14ZR1438400)~~
【分類(lèi)號(hào)】：R445.2;R730.44;R737.11

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1 張小東,許克新,朱積川,王曉峰,王運(yùn)偉;乳頭狀腎細(xì)胞癌的病理及影像學(xué)特點(diǎn)(附二例報(bào)告)[J];中華泌尿外科雜志;1999年04期

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