黄色肉芽肿性肾盂肾炎与囊实性肾盂鳞状细胞癌的CT鉴别诊断
|
摘要
目的探讨黄色肉芽肿性肾盂肾炎(XGP)与肾盂鳞状细胞癌(SCC)CT征象的差异。方法回顾性分析经手术病理证实的8例XGP和10例SCC患者的CT表现,对XGP和SCC的部分CT征象进行统计学分析。结果 18例均表现为全肾或者局部囊实性肿块。8例XGP最厚分隔为2.4~16.1 mm,△D_(max)为0.9~6.6 mm,△D_(min)为0.1~1.3 mm,分隔大多均匀强化均匀、光滑,动态增强ΔCT_(实质期-皮质期)为18~42 HU,XGP淋巴结短径为7~16mm、均匀强化,肾盂壁厚度均匀,无肾静脉充盈缺损,多数病灶囊腔与肾盂不相通且伴肾盂结石。10例SCC最厚分隔为7.4~25.0 mm,△D_(max)为1.5~13.2 mm,△D_(min)为0.4~8.2 mm,分隔多不光滑、强化不均匀,动态增强ΔCT_(实质期-皮质期)为-7~48 HU,淋巴结短径为9~29 mm且半数病例不均匀强化,6例肾盂壁厚度不均匀,9例病灶囊腔与肾盂相通,仅1例出现肾盂结石,6例出现肾静脉充盈缺损。XGP和SCC在病灶的D_(max)、△D_(max)、△D_(min)、ΔCT_(实质期-皮质期)、淋巴结短径存在统计学差异(P<0.05)。另外,XGP和SCC在分隔强化是否均匀、分隔边缘、结石分布、囊腔是否与肾盂相沟通、肾静脉充盈缺损、肾盂壁厚度是否均匀及淋巴结的强化亦存在统计学差异(P<0.05)。结论 XGP与SCC存在一些相似的CT表现,但仍可通过分析二者不同的CT特征,提高早期诊断及鉴别诊断的准确率。
ObjectiveTo investigate the differences between the CT features of xanthogranulomatous pyelonephritis(XGP)and squamous cell carcinoma of renal pelvis(SCC).Methods The CT findings of 8 XGP cases and 10 SCC cases confirmed by pathology were analyzed retrospectively.Fisher's exact-test and independent-samples T-test were applied to analyze some of the CT features of XGP and SCC lessions.Results Solid-cystic masses could be found in the whole kidneys or part of kidneys in 18 cases.Dmax(defined as the thickness of thickest partitions)in the 8 XGP cases ranged from2.4 mm to 16.1 mm,and△D_(max)(define as the differences between the thickest part and the thinnest part of the thickness partition)ranged from 0.9 mm to 6.6 mm.△D_(min)(define as the differences between the thickest part and the thinnest part of the thinnest partition)ranged from 0.1 mm to 1.3 mm.The partitions were smooth and mostly homogeneously enhanced and dynamic enhancement showed△CT_(parenchymal phase-cortical phase)(define as the CT value in parenchymal phase subtracting the CT value in cortical phase)ranging from 18 HU to 42 HU.Lymph nodes were homogeneously enhanced with small diameter of 7-16 mm.The wall of renal pelvis in all XGP patients displayed uniformity.There were no renal vein filling defect in any case of XGP.Renal pelvises in most XGP cases appeared stones and were not interlinked with the cavites of the lession.In10 SCC cases,Dmax arranged from 7.4 mm to 25.0 mm,△D_(max)from 1.5 mm to 13.2 mm,and△D_(min)from 0.4 mm to 8.2mm.The partitions were rough and inhomogeneously enhanced and dynamic enhancement showed△CT_(parenchymal phase-cortical phase )ranging from-7 HU to 48 HU.Lymph nodes in 4 SCC cases were inhomogeneously enhanced with small diameter of 9-29mm.The wall of renal pelvis in 6 SCC cases were nonuniform.Renal vein filling defect were showed in 6 SCC cases.Renal pelvises in 9 cases were interlinked with the cavites of the lession.Only 1 case possessed renal pelvic stones.Dmax,△D_(max),△D_(min),△CT_(parenchymal phase-cortical phase)and small diameter of the lymph node were significantly different between SCC and XGP(P<0.05).Among the differences of CT findings between XGP and SCC,edge and the enhancement of the partition,distribution of stones,connection between the cavites of the lession and the renal pelvis,renal vein filling defect,wall of the renal pelvis and enhancement of lymph nodes were statistically significantly different(P<0.05 for all).ConclusionXGP and SCC have some similar CT findings,but analyzing the different CT features of the two can improve the accuracy of early diagnosis and differential diagnosis.
ObjectiveTo investigate the differences between the CT features of xanthogranulomatous pyelonephritis(XGP)and squamous cell carcinoma of renal pelvis(SCC).Methods The CT findings of 8 XGP cases and 10 SCC cases confirmed by pathology were analyzed retrospectively.Fisher's exact-test and independent-samples T-test were applied to analyze some of the CT features of XGP and SCC lessions.Results Solid-cystic masses could be found in the whole kidneys or part of kidneys in 18 cases.Dmax(defined as the thickness of thickest partitions)in the 8 XGP cases ranged from2.4 mm to 16.1 mm,and△D_(max)(define as the differences between the thickest part and the thinnest part of the thickness partition)ranged from 0.9 mm to 6.6 mm.△D_(min)(define as the differences between the thickest part and the thinnest part of the thinnest partition)ranged from 0.1 mm to 1.3 mm.The partitions were smooth and mostly homogeneously enhanced and dynamic enhancement showed△CT_(parenchymal phase-cortical phase)(define as the CT value in parenchymal phase subtracting the CT value in cortical phase)ranging from 18 HU to 42 HU.Lymph nodes were homogeneously enhanced with small diameter of 7-16 mm.The wall of renal pelvis in all XGP patients displayed uniformity.There were no renal vein filling defect in any case of XGP.Renal pelvises in most XGP cases appeared stones and were not interlinked with the cavites of the lession.In10 SCC cases,Dmax arranged from 7.4 mm to 25.0 mm,△D_(max)from 1.5 mm to 13.2 mm,and△D_(min)from 0.4 mm to 8.2mm.The partitions were rough and inhomogeneously enhanced and dynamic enhancement showed△CT_(parenchymal phase-cortical phase )ranging from-7 HU to 48 HU.Lymph nodes in 4 SCC cases were inhomogeneously enhanced with small diameter of 9-29mm.The wall of renal pelvis in 6 SCC cases were nonuniform.Renal vein filling defect were showed in 6 SCC cases.Renal pelvises in 9 cases were interlinked with the cavites of the lession.Only 1 case possessed renal pelvic stones.Dmax,△D_(max),△D_(min),△CT_(parenchymal phase-cortical phase)and small diameter of the lymph node were significantly different between SCC and XGP(P<0.05).Among the differences of CT findings between XGP and SCC,edge and the enhancement of the partition,distribution of stones,connection between the cavites of the lession and the renal pelvis,renal vein filling defect,wall of the renal pelvis and enhancement of lymph nodes were statistically significantly different(P<0.05 for all).ConclusionXGP and SCC have some similar CT findings,but analyzing the different CT features of the two can improve the accuracy of early diagnosis and differential diagnosis.
引文
1黄兆民.黄色肉芽肿性肾盂肾炎的影像学诊断与鉴别诊断[J].临床放射学杂志,1999,18:314-315.
2 Ghosh P,Saha K.Primary Intraparenchymal Squamous Cell Carcinoma of the Kidney:A Rare and Unique Entity[J].Case Reports in Pathology[J].Case Rep Pathol,2014,2014:256813-256813.
3 Holmang S,Lele SM,Johansson SL.Squamous cell carcinoma of the renal pelvis and ureter:incidence,symptoms,treatment and outcome[J].J Urol,2007,178:51-56.
4 Jiang P,Wang C,Chen S,et al.Primary renal squamous cell carcinoma mimicking the renal cyst:a case report and review of the recent literature[J].BMC Urology,2015,15:69-69.
5 Palmer CJ,Atty C,Sekosan M.Squamous Cell Carcinoma of the Renal Pelvis[J].J Urol,2014,84:8-11.
6 Khoo HW,Lee CH.Renal squamous cell carcinoma mimicking xanthogranulomatous pyelonephritis:Case report and review of literature[J].Radiol Case Rep,2016,11:74-77.
7 Mardi K,Kaushal V,Sharma V.Rare coexistence of keratinizing squamous cell carcinoma with xanthogranulomatous pyelonephritis in the same kidney:report of two cases[J].J Cancer Res Ther,2010,6:339-341.
8谭公祥,余明主,熊海云.肾结石合并肾盂鳞状细胞癌2例临床分析合并文献复习[J].实用癌症杂志,2012,27:643-644.
9侯义亮,郑金锋.肾脏原发性鳞状细胞癌5例临床病理学分析[J].临床与实验病理学杂志,2015,31:443-445.
10管同郁,黄迪亚,杨宁,等.肾结石偶发肾盂鳞状细胞癌8例临床分析[J].徐州医学院学报,2003,23:170-171.
2 Ghosh P,Saha K.Primary Intraparenchymal Squamous Cell Carcinoma of the Kidney:A Rare and Unique Entity[J].Case Reports in Pathology[J].Case Rep Pathol,2014,2014:256813-256813.
3 Holmang S,Lele SM,Johansson SL.Squamous cell carcinoma of the renal pelvis and ureter:incidence,symptoms,treatment and outcome[J].J Urol,2007,178:51-56.
4 Jiang P,Wang C,Chen S,et al.Primary renal squamous cell carcinoma mimicking the renal cyst:a case report and review of the recent literature[J].BMC Urology,2015,15:69-69.
5 Palmer CJ,Atty C,Sekosan M.Squamous Cell Carcinoma of the Renal Pelvis[J].J Urol,2014,84:8-11.
6 Khoo HW,Lee CH.Renal squamous cell carcinoma mimicking xanthogranulomatous pyelonephritis:Case report and review of literature[J].Radiol Case Rep,2016,11:74-77.
7 Mardi K,Kaushal V,Sharma V.Rare coexistence of keratinizing squamous cell carcinoma with xanthogranulomatous pyelonephritis in the same kidney:report of two cases[J].J Cancer Res Ther,2010,6:339-341.
8谭公祥,余明主,熊海云.肾结石合并肾盂鳞状细胞癌2例临床分析合并文献复习[J].实用癌症杂志,2012,27:643-644.
9侯义亮,郑金锋.肾脏原发性鳞状细胞癌5例临床病理学分析[J].临床与实验病理学杂志,2015,31:443-445.
10管同郁,黄迪亚,杨宁,等.肾结石偶发肾盂鳞状细胞癌8例临床分析[J].徐州医学院学报,2003,23:170-171.