肾母细胞瘤的CT诊断分析
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摘要
目的:探讨CT在儿童肾母细胞瘤诊断及鉴别诊断中的作用,提高肾母细胞瘤的诊断符合率。方法:回顾性分析经临床、手术及病理证实的肾母细胞瘤患儿67例,所有患者均行术前CT检查。结果:67例儿童肾母细胞瘤中,男女之比为1.23:1,发病年龄多小于5岁(86.6%),临床症状多表现为腹部肿块(37.3%)、血尿(25.4%)及腹痛(19.4%)。67例患儿均为单侧发病,肿瘤直径多大于5cm(95.5%)。病灶以实性为主者58例,以囊性为主9例,其中4例诊断为部分分化型肾母细胞瘤。CT增强扫描病灶呈不均匀强化,常伴坏死、出血,肿块内部可见钙化。瘤肾一般呈抱球征表现,肿块一般较大,可见包膜,可跨中线生长,但不包绕大血管。肿瘤可侵犯肾外大血管,并且出现癌栓(11.9%)。肾母细胞瘤淋巴结转移和远处转移均少见(出现概率分别为7.5%为24.0%),常见转移部位有肺、肝脏等。所有病例骨质未见明显破坏。结论:CT对诊断肾母细胞瘤具有重要价值,可评估血管及淋巴结侵犯,并且对其临床分期具有一定价值。
Objective:To investigate the value of CT in the diagnosis of nephroblastoma(Wilms tumor)and to improve the diagnostic accuracy of Wilms tumor.Methods:This study retrospectively reviewed 67 cases of nephroblastoma.Diagnoses were confirmed by clinical,surgical and pathological evidence.Preoperative CT scan was performed in all of the cases.Results:Among 67 cases of Wilms tumor,the male to female ratio was 1.23:1.The age of onset was mostly younger than 5 years old(86.6%).Common clinically presentations were abdominal mass(37.3%),hematuria(25.4%),and abdominal pain(19.4%).All of the 67 cases were unilateral.Most of the tumors were larger than 5 cm in diameter(95.5%).58 cases were mainly composed of solid tissue.The other 9 cases mainly had cystic components,4 of which were diagnosed as partially differentiated nephroblastoma.On the enhanced CT scan,the lesions showed uneven enhancement.Necrosis and hemorrhage were frequently seen.Calcification within the mass was also observed.Diseased kidney frequently demonstrated ballholding sign.The size of the mass was mostly large.The capsule was visible.The mass may cross the midline but mostly didn't surround large vessels.Tumors may invade extrarenal large blood vessels and form tumor thrombus(11.9%).Metastasis to lymph nodes and remote metastasis were not common in the reviewed cases(7.5%and 24%).Lung and liver were two of the common sites of metastasis.There was no significant bone destruction in all of the cases.Conclusion:CT imaging has significant value in the diagnosis of Wilms tumor.Preliminary determination of pathological changes of abdominal vessels and lymph nodes could be made using CT scan.It also plays an important role in tumor staging.
Objective:To investigate the value of CT in the diagnosis of nephroblastoma(Wilms tumor)and to improve the diagnostic accuracy of Wilms tumor.Methods:This study retrospectively reviewed 67 cases of nephroblastoma.Diagnoses were confirmed by clinical,surgical and pathological evidence.Preoperative CT scan was performed in all of the cases.Results:Among 67 cases of Wilms tumor,the male to female ratio was 1.23:1.The age of onset was mostly younger than 5 years old(86.6%).Common clinically presentations were abdominal mass(37.3%),hematuria(25.4%),and abdominal pain(19.4%).All of the 67 cases were unilateral.Most of the tumors were larger than 5 cm in diameter(95.5%).58 cases were mainly composed of solid tissue.The other 9 cases mainly had cystic components,4 of which were diagnosed as partially differentiated nephroblastoma.On the enhanced CT scan,the lesions showed uneven enhancement.Necrosis and hemorrhage were frequently seen.Calcification within the mass was also observed.Diseased kidney frequently demonstrated ballholding sign.The size of the mass was mostly large.The capsule was visible.The mass may cross the midline but mostly didn't surround large vessels.Tumors may invade extrarenal large blood vessels and form tumor thrombus(11.9%).Metastasis to lymph nodes and remote metastasis were not common in the reviewed cases(7.5%and 24%).Lung and liver were two of the common sites of metastasis.There was no significant bone destruction in all of the cases.Conclusion:CT imaging has significant value in the diagnosis of Wilms tumor.Preliminary determination of pathological changes of abdominal vessels and lymph nodes could be made using CT scan.It also plays an important role in tumor staging.
引文
[1]汪洪,邬颖华,刘海连.多排螺旋CT诊断儿童肾母细胞瘤18例分析[J].临床合理用药杂志,2011,4(1):21-23.
[2]Olukayode AA,Richard IO,Rachael AA,et al.Pattern of computed tomography scan findings in children with Wilms'tumor in a tertiary hospital in Lagos,Nigeria[J].Indian J Med Paediatr Oncol,2014,35(1):31-35.
[3]Weirich A,Leuschner I,Harms D,et al.Clinical impact of histologic subtypes in localized non-anaplastic nephroblastoma treated according to the trial and study SIOP-9/GPOH[J].Ann Oncol,2001,12(3):311-319.
[4]宋新兰,付娟娟,胡小萍.新疆儿童肾母细胞瘤的临床病理研究[J].实用癌症杂志,2016,31(4):670-673.
[5]Kim S,Chung DH.Pediatric solid malignancies:neuroblastoma and Wilms'tumor[J].Surg Clin North Am,2006,86(2):469-487.
[6]Fukuzawa H,Shiima Y,Mishima Y,et al.Predictive factor for intraoperative tumor rupture of Wilms tumor[J].Pediatr Surg Int,2016,33(1):1-5.
[7]郭飞,张俊杰,孙俊锋,等.肾母细胞瘤瘤体中差异性炎症因子的鉴定及其临床意义[J].中华泌尿外科杂志,2016,37(3):214-218.
[8]Riccabona M.Imaging of renal tumours in infancy and childhood[J].Eur Radiol,2003,13(6):L116-L129.
[9]Lee JS,Padilla B,Dubois SG,et al.Second malignant neoplasms among children,adolescents and young adults with Wilms tumor[J].Pediatr Blood Cancer,2015,62(7):1259-1264.
[10]Osuoji RI,Williams OM,Ajai OT,et al.Wilms'tumour:experience in a developing tertiary centre in nigeria[J].East Central African J Surg,2012,16(3):51-57.
[11]Cushing B,Slovis TL.Imaging of Wilms'tumor:what is important![J].Urol Radiol,1992,14(1):241-251.
[12]Smets AM,De KJ.Malignant tumours of the kidney:imaging strategy[J].Pediatr Radiol,2010,40(6):1010-1018.
[13]Kanoh S.With advances in medical imaging can the radiologist reliably diagnose Wilms'tumours?[J].Clin Radiol,1999,55(4):321-327.
[14]Quartuccio N.Wilms'tumor[J].Ca A Cancer J Clin,2014,46(1):46-63.
[15]张新荣,高修成,唐文伟,等.儿童肾母细胞瘤的影像诊断[J].放射学实践,2011,26(4):394-397.
[16]曹淑丽.小儿肾母细胞瘤的CT表现特征临床分析[J].现代中西医结合杂志,2015,24(9):997-999.
[17]Barber TD,Derinkuyu BE,Wickiser J,et al.Wilms tumor:preoperative risk factors identified for intraoperative tumor spill[J].JUrol,2011,185(4):1414-1418.
[18]Oue T,Fukuzawa M,Okita H,et al.Outcome of pediatric renal tumor treated using the Japan Wilms tumor study-1(JWiTS-1)protocol:a report from the JWiTS group[J].Pediatr Surg Int,2009,25(11):923-929.
[19]Geller E,Smergel EM,Lowry PA.Renal neoplasms of childhood[J].Radiol Clin North Am,1997,35(6):1391-1413.
[20]D'Angio GJ,Evans AE,Breslow N,et al.The treatment of Wilms'tumor:results of the national Wilms'tumor study[J].Cancer,1989,64(2):633-646.
[21]Oue T,Yoneda A,Usui N,et al.Image-based surgical risk factors for Wilms tumor[J].Pediatr Surg Int,2017,34(2):1-6.
[22]陈力,刘敏,何小庆,等.29例艾滋病相关淋巴瘤临床特点及预后因素分析[J].新发传染病电子杂志,2018,3(3):153-155.
[23]Irtan S,Jitlal M,Bate J,et al.Risk factors for local recurrence in Wilms tumour and the potential influence of biopsy-the United Kingdom experience[J].Eur J Cancer,2015,51(2):225-232.
[24]Diab AA,Hirmas N,Almousa A,et al.Inferior vena cava involvement in children with Wilms tumor[J].Pediatr Surg Int,2017,33(5):1-5.
[25]李红,潘海鹏,李美蓉,等.婴儿先天性中胚层肾瘤的CT表现[J].浙江临床医学,2015,17(6):1007-1008.
[26]朱明水,唐文伟,李小会,等.儿童肾透明细胞肉瘤的CT表现[J].实用放射学杂志,2016,32(9):1418-1421.
[2]Olukayode AA,Richard IO,Rachael AA,et al.Pattern of computed tomography scan findings in children with Wilms'tumor in a tertiary hospital in Lagos,Nigeria[J].Indian J Med Paediatr Oncol,2014,35(1):31-35.
[3]Weirich A,Leuschner I,Harms D,et al.Clinical impact of histologic subtypes in localized non-anaplastic nephroblastoma treated according to the trial and study SIOP-9/GPOH[J].Ann Oncol,2001,12(3):311-319.
[4]宋新兰,付娟娟,胡小萍.新疆儿童肾母细胞瘤的临床病理研究[J].实用癌症杂志,2016,31(4):670-673.
[5]Kim S,Chung DH.Pediatric solid malignancies:neuroblastoma and Wilms'tumor[J].Surg Clin North Am,2006,86(2):469-487.
[6]Fukuzawa H,Shiima Y,Mishima Y,et al.Predictive factor for intraoperative tumor rupture of Wilms tumor[J].Pediatr Surg Int,2016,33(1):1-5.
[7]郭飞,张俊杰,孙俊锋,等.肾母细胞瘤瘤体中差异性炎症因子的鉴定及其临床意义[J].中华泌尿外科杂志,2016,37(3):214-218.
[8]Riccabona M.Imaging of renal tumours in infancy and childhood[J].Eur Radiol,2003,13(6):L116-L129.
[9]Lee JS,Padilla B,Dubois SG,et al.Second malignant neoplasms among children,adolescents and young adults with Wilms tumor[J].Pediatr Blood Cancer,2015,62(7):1259-1264.
[10]Osuoji RI,Williams OM,Ajai OT,et al.Wilms'tumour:experience in a developing tertiary centre in nigeria[J].East Central African J Surg,2012,16(3):51-57.
[11]Cushing B,Slovis TL.Imaging of Wilms'tumor:what is important![J].Urol Radiol,1992,14(1):241-251.
[12]Smets AM,De KJ.Malignant tumours of the kidney:imaging strategy[J].Pediatr Radiol,2010,40(6):1010-1018.
[13]Kanoh S.With advances in medical imaging can the radiologist reliably diagnose Wilms'tumours?[J].Clin Radiol,1999,55(4):321-327.
[14]Quartuccio N.Wilms'tumor[J].Ca A Cancer J Clin,2014,46(1):46-63.
[15]张新荣,高修成,唐文伟,等.儿童肾母细胞瘤的影像诊断[J].放射学实践,2011,26(4):394-397.
[16]曹淑丽.小儿肾母细胞瘤的CT表现特征临床分析[J].现代中西医结合杂志,2015,24(9):997-999.
[17]Barber TD,Derinkuyu BE,Wickiser J,et al.Wilms tumor:preoperative risk factors identified for intraoperative tumor spill[J].JUrol,2011,185(4):1414-1418.
[18]Oue T,Fukuzawa M,Okita H,et al.Outcome of pediatric renal tumor treated using the Japan Wilms tumor study-1(JWiTS-1)protocol:a report from the JWiTS group[J].Pediatr Surg Int,2009,25(11):923-929.
[19]Geller E,Smergel EM,Lowry PA.Renal neoplasms of childhood[J].Radiol Clin North Am,1997,35(6):1391-1413.
[20]D'Angio GJ,Evans AE,Breslow N,et al.The treatment of Wilms'tumor:results of the national Wilms'tumor study[J].Cancer,1989,64(2):633-646.
[21]Oue T,Yoneda A,Usui N,et al.Image-based surgical risk factors for Wilms tumor[J].Pediatr Surg Int,2017,34(2):1-6.
[22]陈力,刘敏,何小庆,等.29例艾滋病相关淋巴瘤临床特点及预后因素分析[J].新发传染病电子杂志,2018,3(3):153-155.
[23]Irtan S,Jitlal M,Bate J,et al.Risk factors for local recurrence in Wilms tumour and the potential influence of biopsy-the United Kingdom experience[J].Eur J Cancer,2015,51(2):225-232.
[24]Diab AA,Hirmas N,Almousa A,et al.Inferior vena cava involvement in children with Wilms tumor[J].Pediatr Surg Int,2017,33(5):1-5.
[25]李红,潘海鹏,李美蓉,等.婴儿先天性中胚层肾瘤的CT表现[J].浙江临床医学,2015,17(6):1007-1008.
[26]朱明水,唐文伟,李小会,等.儿童肾透明细胞肉瘤的CT表现[J].实用放射学杂志,2016,32(9):1418-1421.