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目的探讨肾嫌色细胞癌的螺旋CT表现及与病理分型和血管生成的关系。方法回顾性分析经手术病理证实的18例肾嫌色细胞癌的术前螺旋CT征像及病理结果。结果 18例CT平扫,等密度4例,低密度10例,高密度4例。6例有小囊变灶,2例有点状钙化。17例单发肿块,1例累及全肾。多期增强扫描:18例皮质期轻度强化,强化程度明显低于正常肾皮质。实质期及肾盂分泌期肿瘤密度均低于肾实质,10例髓质期较皮质期明显强化,11例实质期强化程度较髓质及皮质期明显。1例全肾不均匀强化,有小囊变,无钙化。实质期及分泌期10例显示假包膜。2例肾门淋巴结肿大,2例肾周脂肪囊侵犯。病理Robson分期:Ⅰ期13例,Ⅱ期3例,Ⅲ期2例,Ⅳ期0例。MVD平均14.86±2.04条/高倍视野;VEGF表达阳性4例(22.22%)。MVD、VEGF表达和肾癌分期与肿瘤CT强化程度有相关性(r_s=0.421,P<0.05)。结论肾嫌色细胞癌有较典型的CT特征及病理特点,有助于肾癌亚型的鉴别诊断。
Objective To investigate the spiral CT appearance of renal cell carcinoma and its relationship with pathological types and angiogenesis. Methods Retrospective analysis of 18 cases of renal cell carcinoma of the kidney confirmed by surgery and pathology before spiral CT signs and pathological findings. Results 18 cases of CT plain scan, 4 cases of equal density, low density in 10 cases, high density in 4 cases. 6 cases of small cystic lesions, 2 cases of calcification. 17 cases of single mass, 1 case involving the whole kidney. Multi-phase enhanced scan: 18 cases of mild cortical enhancement, significantly lower than the normal degree of strengthening the renal cortex. The parenchyma and renal pelvis during the secretory tumor density were lower than the renal parenchyma, 10 cases of medullary phase was significantly enhanced compared with the cortical phase, 11 cases of pubertal enhancement than the medulla and cortical phase was significantly. One case of uneven renal enhancement, small capsule change, no calcification. The parenchyma and secretory phase showed pseudocapsule in 10 cases. 2 cases of hilar lymph nodes, 2 cases of perirenal fat capsule infringement. Pathological Robson staging: stage Ⅰ 13 cases, stage Ⅱ 3 cases, stage Ⅲ 2 cases, stage Ⅳ 0 cases. MVD average 14.86 ± 2.04 / high power field; VEGF expression was positive in 4 cases (22.22%). MVD, VEGF expression and stage of renal cell carcinoma correlated with degree of tumor CT enhancement (r_s = 0.421, P <0.05). Conclusion Chromic renal cell carcinoma has more typical CT features and pathological features, which is helpful for the differential diagnosis of renal carcinoma subtypes.