Purpose To analyze the CT features of rare primary renal malignant tumors in children, and to improve the understanding and diagnosis of this disease. Materials and Methods The clinical and imaging data of 18 children with rare primary renal malignant tumors confirmed by pathology were retrospectively analyzed. Plain CT scan and enhanced CT scan were performed in all 18 cases, and their CT features were analyzed. Results For 18 patients, 7 cases were clear cell sarcoma of kidney, the mean diameter of tumor was (10.5±3.6) cm. The plain CT scan showed inhomogeneous low density. Most of the tumors were prominent outside the kidney, with 2 cases of small, patchy calcifications. Enhanced CT scan showed mild, moderate and inhomogeneous enhancement in the cortical stage, with varying degrees of necrosis. It could be seen as fish-like. There was stripe-like enhancement and vascular shadow passing through the lesion, which was further enhanced in the parenchymal phase. In 6 cases of renal cell carcinoma, the average diameter of the tumor was (5.5±1.5) cm. The plain CT scan showed the boundary of the renal tissue was clear and the false capsule, with 4 cases of coarse nodular calcification, and there was a low density cystic necrosis area and a slightly higher density bleeding shadow in the tumor. The enhanced CT scan showed mild and moderate inhomogeneous enhancement in the cortical phase of the lesion, and in the parenchymal phase, it could be slightly lower or slightly higher than that in the cortical phase. In the 5 cases of renal neuroblastoma, the average diameter was (13.9±7.7) cm, plain CT scan showed mixed density, with 2 cases of irregular calcification. Enhanced CT scan showed mild enhancement of the cortical phase of the tumor, and small blood vessels around the mass of the tumor. Some were tortuous and thicken, and the degree of enhancement was increased in parenchymal terms. Conclusion Primary renal malignant tumors in children that our team analyzed are relatively rare. In clinic, we should consider the possibility of these kinds of tumors in children with malignant kidney occupying, so as to reduce missed diagnosis and misdiagnosis.%目的 分析儿童少见肾脏原发恶性肿瘤的 CT 表现特点,提高对该类疾病的认识及诊断水平.资料与方法 回顾性分析18例经病理证实的儿童少见肾脏原发恶性肿瘤的临床及影像资料,18例均行CT平扫及增强扫描,总结其CT表现特点.结果 18例患儿中,肾透明细胞肉瘤7例,肿块平均最大径(10.5±3.6)cm,平扫呈不均匀等低密度,瘤体大部突出于肾外,2例有点状、小斑片状钙化,增强扫描皮质期呈轻中度不均匀强化,肿瘤均有不同程度的坏死,可呈鱼肉样,病灶内部可见线条状强化血管影穿行,实质期进一步强化;肾细胞癌6例,肿块平均最大径(5.5±1.5)cm,CT平扫肿瘤与肾周边组织分界较清,可见假包膜,4例有粗大结节状钙化,瘤内可见低密度囊变坏死区及斑片状稍高密度出血影,增强扫描病灶皮质期呈轻中度不均匀强化,实质期强化程度可略低或略高于皮质期;肾神经母细胞瘤5例,肿块平均最大径(13.9±7.7)cm,CT 平扫呈混杂密度,2例钙化为不规则形,增强扫描肿瘤皮质期呈轻度强化,肿块周边可见小血管影,部分明显纡曲增粗,实质期强化程度增加.结论 本组儿童原发肾脏恶性肿瘤均较少见,临床工作中对儿童肾脏恶性占位病变应考虑上述几种肿瘤的可能性,以减少漏诊、误诊.
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