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目的探讨原发性肾滑膜肉瘤(primary renal synovial sarcoma,PRSS)及术后复发、转移的影像特征,以提高对该病的诊断和鉴别诊断的水平。资料与方法回顾性分析1例PRSS的临床、影像、病理、免疫组织化学以及术后随访资料,结合文献探讨PRSS及其术后复发、转移的影像学征象与临床和病理表现间的关系。结果 CT像上呈不均匀强化的囊实性肿物,大小约10.7 cm×12.3 cm×15.5 cm,肿块外缘可见出血;腰大肌受累;腹膜后未见淋巴结,双肺未发现转移病灶。超声探及右肾回声不均包块,边界略清,内中强回声和多发囊性回声区,多分隔,肿瘤内“星点”状血流信号。镜下瘤细胞呈“梭”形、束状排列,细胞异型,可见核分裂像;免疫组织化学染色:波形蛋白(Vimentin)、CD99、癌基因(Bcl-2)阳性,细胞角蛋白(CK)阴性。术后随访出现局部复发及肺转移,术8个月后死亡。结论 PRSS是一种罕见的恶性肿瘤,预后差,其影像学表现具有一定特征性,但确诊需依靠病理、免疫组织化学和SYT-SSX融合基因检测。CT在诊断肿瘤良恶性、肿瘤分期和随访方面有重要价值。
Objective To investigate the imaging features of primary renal synovial sarcoma (PRSS) and its recurrence and metastasis after surgery to improve the diagnosis and differential diagnosis of the disease. Materials and Methods The clinical, imaging, pathology, immunohistochemistry and postoperative follow-up data of one patient with PRSS were retrospectively analyzed. The relationship between PRSS and the recurrence and metastasis of PRSS and its postoperative recurrence and metastasis was analyzed with clinical and pathological findings. Results CT images showed uneven cystic solid tumors with a size of about 10.7 cm × 12.3 cm × 15.5 cm. Bleeding was visible on the outer edge of the mass. The psoas was affected. No retroperitoneal lymph nodes and no metastatic lung lesions were found. Ultrasound exploration and uneven mass of the right renal echo, the border a little clear, with strong echo and multiple cystic echogenicity, multi-separation, tumor “star point” blood flow signal. Microscopically, the tumor cells were in the shape of “shuttle”, arranged in the shape of a bundle, and the cells were atypical and showed mitotic figures. Immunohistochemical staining: Vimentin, CD99, Bcl-2 positive and cytokeratin )negative. Local recurrence and lung metastasis were observed after operation. The patients died after 8 months. Conclusions PRSS is a rare malignant tumor with poor prognosis. The imaging features of PRSS have certain characteristics. However, the diagnosis of PRSS depends on the pathology, immunohistochemistry and SYT-SSX fusion gene detection. CT in the diagnosis of benign and malignant tumor staging and follow-up has important value.