黏液样小管状及梭形细胞肾癌的CT诊断

摘要

Objective:To discuss the CT manifestations of mucinous tubular and spindle cell renal carcinoma (MTSRCC)and to improve the understanding of this tumor.Methods:The CT features of 8 patients with surgery and pa-thology proven MTSRCC were retrospectively analyzed.Non-enhanced and triphasic enhanced CT scanning were performed in all of the 8 patients.The size,location,density in plain CT and the enhanced pattern and degree of the tumor,as well as the adjacent involvement,retroperitoneal lymph node and distant metastasis were analyzed.Results:All of the 8 patients with MTSRCC presented as single,well-defined,oval or round mass with the mean maximum diameter as 4.53cm (1.8 ~7.6cm).Iso-attenuation or slightly hyper-attenuation of the tumor was revealed on plain CT in 7 cases,and hypo-attenuation in 1 case.Association with nephrolithiasis in 1 case.No intra-tumoral hemorrhage or calcification was identified.Tumor showed as gradually mild enhancement after contrast administration,homogeneous enhancement was showed in 6 patients and heterogeneous enhancement in 2 patients.The enhancement degree was apparently less than that of normal renal cortex. The mean CT value of the tumor in these 8 patients increased at cortico-medullary phase and delayed phase was 26.2HU and 33.6HU respectively.The ratio of tumor and renal cortex in cortico-medullary phase and delayed phase was 21.54%and 33.28% respectively.Conclusion:MTSRCC is a rarely seen renal neoplasm with low degree malignancy,which predomi-nantly presents in adult women.The CT features include well-defined,mass,necrosis and calcification are seldom,could be associated with nephrolithiasis,iso-attenuated on plain CT and with progressively mild enhancement.%目的：探讨黏液样小管状及梭形细胞肾癌（MTSRCC）的 CT 表现，提高对该病的认识。方法：回顾性分析8例经手术病理证实的 MTSRCC 的 CT 表现，8例均行 MSCT 平扫及三期增强扫描。分析病灶大小、位置、形态、平扫密度、强化方式和程度、有无周边侵犯、淋巴结和远处转移等征象。结果：8例 MTSRCC 均为单发病灶，CT 上表现为边界清晰的类圆形或椭圆形肿块，最大直径平均为4．53 cm（1．8～7．6 cm），平扫7例呈等或稍高密度，1例呈低密度，1例伴同侧肾结石，均未见出血和钙化。增强扫描肿瘤呈渐进性轻度强化，6例呈均匀强化，2例呈不均匀强化，其强化程度明显低于正常肾脏皮质，8例皮髓质期和延迟期平均 CT 值分别增加26．2 HU 和33．6 HU，肿瘤与肾皮质的强化比值皮髓质期和延迟期分别为21．54％和33．28％。结论：MTSRCC 为好发于成年女性的较罕见低度恶性肿瘤，在 CT 上表现为边界清晰、出血坏死及钙化少见的规则肿块，可伴有同侧肾结石，具有平扫以等密度为主，渐进性轻度强化的特点。