小肾癌超声表现的病理学基础及其相关性研究
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摘要
目的
通过对小肾癌(最大直径<3cm)病理特点的观察,探讨小肾癌超声表现与其病理类型和病理结构的相关性,从而进一步提高小肾癌的超声诊断水平。
方法
对我院2004年1月到2009年7月经手术病理证实的45例小肾癌病例进行回顾性分析,探讨小肾癌的超声回声类型与其病理类型、分化程度、镜下组织成分及细胞排列方式等之间的相关性。
结果
本研究45例小肾癌中高回声为27例,等回声为3例,低回声为15例,无回声为0例。本研究45例小肾癌病理类型主要为①透明细胞癌②嫌色细胞癌③乳头状肾细胞癌④肉瘤样癌。27例高回声中①20例②0例③6例④1例；3例等回声中①3例②0例③0例④0例；15例低回声中①14例②1例③0例④0例。将肾癌病理分化程度分为①高分化②中分化③低分化(未分化)。27例高回声中①3例②22例③2例；3例等回声中①0例②3例③0例；15例低回声中①4例②11例③0例。将小肾癌的镜下细胞排列分为①密集腺泡结构或实性结构②局灶微囊结构与密集腺泡结构③微囊结构、乳头状结构、大囊结构与密集腺泡结构④大囊结构与密集腺泡结构。通过镜下观察将囊状结构最大直径≤0.1cm认定为微囊,将囊状结构最小直径>0.1cm认定为大囊。以此为依据将小肾癌分组,27例高回声分组情况为①5例②7例③15例④0例；3例等回声分组情况为①1例②0例③2例④0例；15例低回声分组情况为①10例②1例③2例④2例。本研究45例小肾癌中大体切面未见钙化及脂肪成分,切面有出血、坏死、囊性变、粘液样变性等的为28例,其中高回声19例,等回声2例,低回声7例；切面实性均匀的为17例,其中高回声8例,等回声1例,低回声8例。将小肾癌的超声回声类型分别与其病理类型、分化程度、镜下细胞排列方式等进行统计学分析,统计学结果表明：小肾癌超声回声类型与其镜下细胞排列方式有关(P=0.001<0.05),与病理分化无关(P=0.274>0.05),与其病理类型未见明显相关(P>0.05)。
结论
小肾癌的超声回声以高回声多见,小肾癌的超声回声类型主要与镜下细胞排列方式有关,镜下成分为组织学同源、细胞排列比较整齐者,其超声回声常表现为低回声,而镜下成分为组织学同源、细胞排列多样者,则通常表现为高回声。但并非所有镜下成分为组织学同源、细胞排列方式多样者均表现为高回声,其镜下实性成分分布的方式、所占的比例及囊性结构的大小也会对其超声回声产生影响。
Objective
To observe pathological features of the small renal cell carcinoma (maximum diameter<3cm) and determine the relationship of sonographic features to the histological types and structure,and try to improve the diagnosis of SRCC in ultrasound level.
Methods
A retrospective study was performed to analyze the correlation between echo types and pathological types、differentiation microscopic arrangement in 45 consecutive cases with SRCC confirmed by operation from January 2004 to July 2009.
Results
In 45 cases of SRCC,there are different echo types,including hyperecho(27 cases), isoecho (3 cases), hypoecho (15 cases) and anecho (0 case).There are different pathologic types,including①clear cell carcinoma②chromophobe renal cell carcinoma③papillary renal cell carcinoma④sarcomatoid carcinoma. To match the echo types and pathological types,in 27 cases of hyperecho,①20 cases (2)0 case③6 cases④1 case;in 3 cases of isoecho,①3 cases②0 case③0 case④0 case;in 15 cases of hypoecho,①14 cases②1 case③0 case④0 case.Pathological differentiation of SRCC includes①high differentiated②moderate differentiated③low differentiated (undifferentiated). To match the echo types and differentiated types,in 27 cases of hyperecho,①3 cases②22 cases③2 cases;in 3 cases of isoecho,①0 case②3 cases③0 case;in 15 cases of hypoecho,①4 cases②11 cases③0 case. Microscopic arrangement of SRCC was divided into①dense acinar structure or solid structure②focal micro-cyst structure and dense acinar structure③micro-cyst structure,papillary structure,large cyst structure and dense acinar structure④large cyst structure and dense acinar structure.The maximum diameter of cystic structures≤0.1cm was identified as micro-cyst,and the minimum diameter> 0.1cm was identified as large cyst by microscopic observation.To match the echo types and microscopic arrangement,in 27 cases of hyperecho,①5 cases②7 cases③15 cases④0 case;in 3 cases of isoecho,①1 case②0 case③2 cases④0 case; in 15 cases of hypoecho①10 cases②1 case③2 cases④2 cases.Through observation of the gross pathological section of SRCC,there are no calcification and fat in 45 cases. Hemorrhage, necrosis, cystic degeneration,myxoid degeneration can be found in 28 cases,including hyperecho (19 cases), isoecho (2 cases), and hypoecho(7 cases). The gross pathological section of SRCC shows homogeneous solid in 17 cases,including hyperecho(8 cases), isoecho(1 case),and hypoecho(8 cases). To analyze the correlation between echo types and pathological types、differentiation microscopic cell arrangement in 45 cases with SRCC,the statistical results show that:echo types of SRCC are connected with microscopic cell arrangement (P=0.001<0.05).There is no correlation between echo types and pathological differentiation (P=0.274> 0.05), and no significant correlation between them and pathological types (P> 0.05).
Conclutions
In this study, hyperechoic masses are more often seen in SRCC. The echo types are most correlated with microscopic cell arrangement. Masses with microscopic components showing homologous tissue and more orderly arranged cells often appear hypoecho, while those with microscopic components showing homologous tissue and multiple arranged cells often appear hyperecho,but not all of them appears hyperecho,the echo types are also related with the distribution and propotion of solid part and the sizes of cystic structures.
通过对小肾癌(最大直径<3cm)病理特点的观察,探讨小肾癌超声表现与其病理类型和病理结构的相关性,从而进一步提高小肾癌的超声诊断水平。
方法
对我院2004年1月到2009年7月经手术病理证实的45例小肾癌病例进行回顾性分析,探讨小肾癌的超声回声类型与其病理类型、分化程度、镜下组织成分及细胞排列方式等之间的相关性。
结果
本研究45例小肾癌中高回声为27例,等回声为3例,低回声为15例,无回声为0例。本研究45例小肾癌病理类型主要为①透明细胞癌②嫌色细胞癌③乳头状肾细胞癌④肉瘤样癌。27例高回声中①20例②0例③6例④1例；3例等回声中①3例②0例③0例④0例；15例低回声中①14例②1例③0例④0例。将肾癌病理分化程度分为①高分化②中分化③低分化(未分化)。27例高回声中①3例②22例③2例；3例等回声中①0例②3例③0例；15例低回声中①4例②11例③0例。将小肾癌的镜下细胞排列分为①密集腺泡结构或实性结构②局灶微囊结构与密集腺泡结构③微囊结构、乳头状结构、大囊结构与密集腺泡结构④大囊结构与密集腺泡结构。通过镜下观察将囊状结构最大直径≤0.1cm认定为微囊,将囊状结构最小直径>0.1cm认定为大囊。以此为依据将小肾癌分组,27例高回声分组情况为①5例②7例③15例④0例；3例等回声分组情况为①1例②0例③2例④0例；15例低回声分组情况为①10例②1例③2例④2例。本研究45例小肾癌中大体切面未见钙化及脂肪成分,切面有出血、坏死、囊性变、粘液样变性等的为28例,其中高回声19例,等回声2例,低回声7例；切面实性均匀的为17例,其中高回声8例,等回声1例,低回声8例。将小肾癌的超声回声类型分别与其病理类型、分化程度、镜下细胞排列方式等进行统计学分析,统计学结果表明：小肾癌超声回声类型与其镜下细胞排列方式有关(P=0.001<0.05),与病理分化无关(P=0.274>0.05),与其病理类型未见明显相关(P>0.05)。
结论
小肾癌的超声回声以高回声多见,小肾癌的超声回声类型主要与镜下细胞排列方式有关,镜下成分为组织学同源、细胞排列比较整齐者,其超声回声常表现为低回声,而镜下成分为组织学同源、细胞排列多样者,则通常表现为高回声。但并非所有镜下成分为组织学同源、细胞排列方式多样者均表现为高回声,其镜下实性成分分布的方式、所占的比例及囊性结构的大小也会对其超声回声产生影响。
Objective
To observe pathological features of the small renal cell carcinoma (maximum diameter<3cm) and determine the relationship of sonographic features to the histological types and structure,and try to improve the diagnosis of SRCC in ultrasound level.
Methods
A retrospective study was performed to analyze the correlation between echo types and pathological types、differentiation microscopic arrangement in 45 consecutive cases with SRCC confirmed by operation from January 2004 to July 2009.
Results
In 45 cases of SRCC,there are different echo types,including hyperecho(27 cases), isoecho (3 cases), hypoecho (15 cases) and anecho (0 case).There are different pathologic types,including①clear cell carcinoma②chromophobe renal cell carcinoma③papillary renal cell carcinoma④sarcomatoid carcinoma. To match the echo types and pathological types,in 27 cases of hyperecho,①20 cases (2)0 case③6 cases④1 case;in 3 cases of isoecho,①3 cases②0 case③0 case④0 case;in 15 cases of hypoecho,①14 cases②1 case③0 case④0 case.Pathological differentiation of SRCC includes①high differentiated②moderate differentiated③low differentiated (undifferentiated). To match the echo types and differentiated types,in 27 cases of hyperecho,①3 cases②22 cases③2 cases;in 3 cases of isoecho,①0 case②3 cases③0 case;in 15 cases of hypoecho,①4 cases②11 cases③0 case. Microscopic arrangement of SRCC was divided into①dense acinar structure or solid structure②focal micro-cyst structure and dense acinar structure③micro-cyst structure,papillary structure,large cyst structure and dense acinar structure④large cyst structure and dense acinar structure.The maximum diameter of cystic structures≤0.1cm was identified as micro-cyst,and the minimum diameter> 0.1cm was identified as large cyst by microscopic observation.To match the echo types and microscopic arrangement,in 27 cases of hyperecho,①5 cases②7 cases③15 cases④0 case;in 3 cases of isoecho,①1 case②0 case③2 cases④0 case; in 15 cases of hypoecho①10 cases②1 case③2 cases④2 cases.Through observation of the gross pathological section of SRCC,there are no calcification and fat in 45 cases. Hemorrhage, necrosis, cystic degeneration,myxoid degeneration can be found in 28 cases,including hyperecho (19 cases), isoecho (2 cases), and hypoecho(7 cases). The gross pathological section of SRCC shows homogeneous solid in 17 cases,including hyperecho(8 cases), isoecho(1 case),and hypoecho(8 cases). To analyze the correlation between echo types and pathological types、differentiation microscopic cell arrangement in 45 cases with SRCC,the statistical results show that:echo types of SRCC are connected with microscopic cell arrangement (P=0.001<0.05).There is no correlation between echo types and pathological differentiation (P=0.274> 0.05), and no significant correlation between them and pathological types (P> 0.05).
Conclutions
In this study, hyperechoic masses are more often seen in SRCC. The echo types are most correlated with microscopic cell arrangement. Masses with microscopic components showing homologous tissue and more orderly arranged cells often appear hypoecho, while those with microscopic components showing homologous tissue and multiple arranged cells often appear hyperecho,but not all of them appears hyperecho,the echo types are also related with the distribution and propotion of solid part and the sizes of cystic structures.
引文
1 Redden DN, Raj Gv,Polascik TJ.Management of small renal tumors:an overview. Am J Med,2001,110:558.
2 Bosniak MA. The small (＜ 3 cm) renal parenchymal tumor detection, diagnosis and correlation.Radiology,1991,179:307-317.
3赵军,季学闻,盛斌武,等.肾肿瘤236例病理分类及影像学检查对比分析.陕西医学杂志,2004,4：33(4)：326-328.
4施燕芸,吴秀花.超声检查诊断肾癌的价值附55例报告.新医学,2008,11；39(11)：738
5刘淑萍,姚克纯,邵波,等.超声体检对无症状肾癌和小肾癌的临床诊断价值.中国超声医学杂志,2005,21(6)：449
6魏建平,杜联芳,邢晋放,等.肾细胞癌超声表现分析.中国超声诊断杂志,2005,6(9)：674
7张武,苗立英,勇强,等.超声诊断无症状肾细胞癌和小肾细胞癌91例临床分析.中华超声影像学杂志,2000,9(11)：686-689.
8李爱民,王梅,等.肾癌的超声诊断及分期与病理结果对照分析.北京医学,2005,27(2)：124.
9徐朝霞,张学昕,耿江红,等.小肾癌的影像学分析.实用放射学杂志,2008,8：24(8)：1066-1068.
10肖峻,孙友文,周林玉,等.17例小肾癌的影像学诊断.安徽卫生职业技术学院学报,2003,2(1)： 36
11郭玉民,呼子奇.超声检查对小肾癌诊断与分析.中华中西医学杂志,2008,6(9)：75
12李维国,阮渊,朱轶勇,等.小肾癌的影像学诊断方法比较.现代泌尿外科杂志,2009,1；14(1)： 39
13 Ebele JN, Sauter G, Epstein JI, et al. Pathology and genetics of tumours of the urinary system and male genital organs[M]. Lyon:IARC,2004.12-43.
14陆敏,邹万忠.肾脏肿瘤[A].冯晓莉.泌尿系统及男性生殖器官肿瘤病理学和遗传学(译著)[M].北京：人民卫生出版社,2006.1-37.
15 Storkel S, Eble JN, Adlakha K, et al. Classification of renal cell carcinoma. Cancer, 1997,80:987-989.
16刘军,付庆国,邓尚廉,等.小肾癌的超声表现及其临床诊断价值.中国超声诊断杂志,2004,5(3)：184-187.
17蔡胜,姜玉新,李建初,等.小肾癌的声像图征象及其临床价值.中华超声影像学杂志,2001,10(7)：421-423.
18黄苏里,郝玉芝,朱利,等.小肾细胞癌的超声诊断.中国肿瘤临床与康复,2003,10(4)：341-343.
19杨培谦,吕文成,杜林栋,等.B超及CT诊断肾脏小肿瘤的临床价值(附48例报告).中华泌尿外科杂志,2004,25(12)：822-824.
20 Yamashita Y, Takahashi M, Watanabe 0, et al. Small renal cell carcinoma:pathologic and radiologic correlation. Radiology,1993 Dec;189(3):925.
21 Forman HP,Middleton WD, Melson GL, et al. Hyperechoic renal cell carcinomas: increase in detection at U S. Radio logy,1993,188:431-434.
22戴训芦,黄咏红,赵保平,等.肾癌的超声声像图与病理结构的相关性分析.中国医学计算机成像杂志,2006,12(4)：275.
23 YAMASHITA Y, UENO S, MAKITA 0, etal. Hyperechoic renal tumors:an echoicrim and intratumoral cysts in US differentiation of renal cell carcinoma from angiomyolipoma. Radiology,1993,188:179-182.
24 Siegel CL, Middleton WD, Teefey SA, et al. Angiomyolipoma and renal cell carcinoma:US differentiation. Radiology,1996,198:789-793.
25 Strotzer M, Lehner KB, Becker K. Detection of fat in a renal cell carcinoma mimicking angiomyolipoma. Radiology,1993,188:427-428.
26 Hammadeh MY, Thomas K, Philp T, et al. Renal cell carcinoma containing fat mimicking angiomyolipoma:demonstration with CT scan and histopathology. Eur Radiol,1998, 8(2):228.
27高建津,丁希芳,刘克霞等.肾肿瘤56例B超所见与病理对照.中国超声医学杂志.1993,9(2)：120.
28陈继先,苏内林,蔚锦凤.肾肿瘤的声像图与病理类型的关系.内蒙古医学杂志复 刊.1995,15(1)：50.
29张学文,曹海根,于中麟等.B超诊断肾肿瘤70例报告.中国超声医学杂志试刊号.1985,试刊号：75.
1刘复生,刘彤华,主编肿瘤病理学[M].1997,1787-1791.
2 McClennan BL.Staging and follow-up of renal and adrenal carcinoma. Cancer,1991,67(4 Supp 1):1199-1208.
3 Redden DN, Raj Gv, Polascik TJ. Management of small renal tumors:an overview. Am J Med,2001,110:558.
4潘柏年,王田,杨勇,等.小肾癌(附34例报告).中华泌尿外科杂志,1998,19：32-34.
5裴昌松,朱有华,郭义峰,等.小肾癌76例临床分析.中华泌尿外科杂志,2003,24：725-727.
6赵军,季学闻,盛斌武,等.肾肿瘤236例病理分类及影像学检查对比分析.陕西医学杂志,2004,4：33(4)：326-328.
7施燕芸,吴秀花.超声检查诊断肾癌的价值附55例报告.新医学,2008,11；39(11)：738
8刘淑萍,姚克纯,邵波,等.超声体检对无症状肾癌和小肾癌的临床诊断价值.中国超声医学杂志,2005,21(6)：449
9魏建平,杜联芳,邢晋放,等.肾细胞癌超声表现分析.中国超声诊断杂志,2005,6(9)：674
10李爱民,王梅,等.肾癌的超声诊断及分期与病理结果对照分析.北京医学,2005,27(2)：124.
11徐朝霞,张学听,耿江红,等.小肾癌的影像学分析.实用放射学杂志,2008,8：24(8)：1066-1068.
12肖峻,孙友文,周林玉,等.17例小肾癌的影像学诊断.安徽卫生职业技术学院学报,2003,2(1)： 36
13郭玉民,呼子奇.超声检查对小肾癌诊断与分析.中华中西医学杂志,2008,6(9)：75
14李维国,阮渊,朱轶勇,等.小肾癌的影像学诊断方法比较.现代泌尿外科杂志,2009,1；14(1)： 39
15 Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors:indications, techniques and outcomes. Journal of Urology,2001,166:6.
16张武,苗立英,勇强,等.超声诊断无症状肾细胞癌和小肾细胞癌91例临床分析.中华超声影像学杂志,2000,9(11)：686-689.
17郁建迪,张志根.肾癌保肾单位手术.国外医学泌尿系统分册,2003,23(1)：84-87.
18 Manikandan R, Srinivasan V, Rane A, et al. Which is the real gold standard for small-volume renal tumors?Radical nephrectomy versus nephronsparing surgery. J Endourol,2004,18(1):39.
19 Lane BR, Gill IS.5-Year outcomes of laparoscopic partial nephrectomy. J Urol,2007,177(1):70.
20 Ahrar K, Wallace MJ, Matin SF. Percutaneous radiofrequency ablation:minimally invasive therapy for renal tumors. Expert Rev Anticancer Ther.2006,6(12):1735.
21 Gupta A, Allaf ME,Kavoussi LB,et al. Computerized tomography guided percutaneous renal cryoablation with the patient under conscious sedation:initial clinical experience. J Urol,2006,175(2):447.
22 Paterson RF, Barret E, Siquesra TM, et al. Laparoscopic partial kidney Ablation with high intensity focused ultrasound. J Urol,2003,169:347.
23 Walsh PC, Retik AB, Vaugh ED, et al. Campbell's Urology.8th ED. WB Saunders Company: Philadelphia, PA,2002. p2672-2719.
24 Storkel S, Eble JN, Adlakha K, et al. Classification of renal cell carcinoma. Cancer,1997,80:987-989.
25 Delahunt B, Eble JN. Papillary renal cell carcinoma:a clinicopathologic and immunohistochemical study of 105 tumors. Mod Pathol,1997,10:537-544.
26 Delahunt B, Eble JN, McCredie MR, et al. Morphologic typing of papillary renal cell carcinoma:comparison of growth kinetics and patient survival in 66 cases. Hum Pathol, 2001,32:590-595.
27 Ebele JN, Sauter G, Epstein JI, et al. Pathology and genetics of tumours of the urinary system and male genital organs[M]. Lyon:IARC,2004.12-43.
28陆敏,邹万忠.肾脏肿瘤[A].冯晓莉.泌尿系统及男性生殖器官肿瘤病理学和遗传学(译著)[M].北京：人民卫生出版社,2006.1-37.
29 Ishikawa I,Kovacs G.High incidence of papillary renal cell tumours in patients with chronic haemodialysis. Histopathology,1993,22 (2):135-140.
30 Renshaw AA, Corless CL. Papillary renal cell carcinoma:histology and immunohistochemistry. Am J Surg Pathol,1995,19(7):842-849.
31 Amin MB, Corless CL, Renshaw AA, et al. Papillary (chromophil) renal cell carcinoma: histomorphologic characteristic and evaluation of congenital pathologic prognostic parameters in 62 cases.Am J Surg Pathol,1997,21(6):621-635.
32 Baltaci S, Orhan D, Soyupek S, et al. Influence of tumor stage size, grade, vascular involvement, histological cell type, and histological pattern on multifocality of renal cell carcinoma. J Urol,2000,164(1):36-39.
33 Chow WH, Gridley G, Fraumeni JF, et al. Obesity, hypertension, and the risk of kidney cancer in men.N Engl J Med,2000,343(18):1305-1311.
34夏同礼.现代泌尿病理学[M].北京：人民卫生出版社,2002：95-109.
35李甘地,来茂德.病理学[M].北京：人民卫生出版社,2003：333-335.
36 Moch H, Gasser T, Amin MB, et al. Prognostic utility of the recently recommended histologic classification and revised TNM staging System of renal cell carcinoma: a Swiss experience with 588 tumors. Cancer,2000,89:604-614.
37 Amin MB, Tamboli P, Javidan J, et al. Prognostic impact of histologic subtyping of adult renal epithelial neoplasms:an experience of 405 cases. Am J Surg Pathol,2002,26:281-291.
38 Motzer R J, Bacik J, Mariani T, et al. Treatment outcome and survival associated with metastatic renal cell carcinoma of non clear-cell histology. J Clin Oncol,2002,20:2376-2381.
39顾方六,肾肿瘤.见：吴阶平,主编.吴阶平泌尿外科学.济南：山东科学技术出版社,2004.889-917.
40 Michisch G, Carballido J, Hellsten S, et al. Guidelines on renal cell cancer. Eur Urol 2001,40:252-255.
41黄苏里,郝玉芝,朱利,等.小肾细胞癌的超声诊断.中国肿瘤临床与康复,2003,10(4)：341-343.
42杨培谦,吕文成,杜林栋,等.B超及CT诊断肾脏小肿瘤的临床价值(附48例报告).中华泌尿 外科杂志,2004,25(12)：822-824.
43刘军,付庆国,邓尚廉,等.小肾癌的超声表现及其临床诊断价值.中国超声诊断杂志,2004,5(3)：184-187.
44蔡胜,姜玉新,李建初等.小肾癌的声像图征象及其临床价值.中华超声影像学杂志,2001,10(7)：421-423.
45 Yamashita Y, Takahashi M, Watanabe 0, et al. Small renal cell carcinoma:pathologic and radiologic correlation. Radiology,1993 Dec;189(3):925.
46 Bosniak MA. The small (＜ 3 cm) renal parenchymal tumor detection, diagnosis and correlation. Radiology,1991,179:307-317.
47 Forman HP, Middleton WD,Melson GL, et al. Hyperechoic renal cell carcinomas: increase in detection at U S. Radio logy,1993,188:431-434.
48戴训芦,黄咏红,赵保平,等.肾癌的超声声像图与病理结构的相关性分析.中国医学计算机成像杂志,2006,12(4)：275.
49高建津,丁希芳,刘克霞等.肾肿瘤56例B超所见与病理对照.中国超声医学杂志.1993,9(2)：120.
50陈继先,苏内林,蔚锦凤.肾肿瘤的声像图与病理类型的关系.内蒙古医学杂志复刊.1995,15(1)：50.
51张学文,曹海根,于中麟等.B超诊断肾肿瘤70例报告.中国超声医学杂志试刊号.1985,试刊号：75.
52 YAMASHITA Y,UENO S,MAKITA 0, etal. Hyperechoic renal tumors:an echoicrim and intratumoral cysts in US differentiation of renal cell carcinoma from angiomyolipoma. Radiology,1993,188:179-182.
53 Siegel CL, Middleton WD, Teefey SA, et al. Angiomyolipoma and renal cell carcinoma:US differentiation. Radiology,1996,198:789-793
54 Strotzer M, Lehner KB, Becker K. Detection of fat in a renal cell carcinoma mimicking angiomyolipoma. Radiology,1993,188:427-428.
55 Hammadeh MY, Thomas K, Philp T, et al. Renal cell carcinoma containing fat mimicking angiomyolipoma:demonstration with CT scan and histopathology. Eur Radiol.1998,8(2):228.
56潘吉荣,李青.小肾癌的超声诊断进展.中国煤炭工业医学杂志,2004,7：699.
57蔡胜,姜玉新,李建初,等.小肾癌的声像图征象及其临床价值.中华超声影像学杂志,2001,10(7)：421-423.
58尹玉成,张希平,阎瑞玲,等.多普勒超声在肾肿瘤中的应用.中国超声医学杂志,1992,8(4)：274-275.
59赵诚,房世保,禹静等.小肾癌的超声诊断价值.青岛大学医学院学报,2008,44(4)：.
60董磊,李新民,赵晓峰.彩色多普勒能量图诊断小肾癌的价值.中国超声医学杂志,1999,15(6)：460-462.
61穆柯晓,孙倩.小肾癌的诊断及鉴别诊断价值.医学影像学杂志,2007,17(8)：845-847.
62叶琴,林礼务,薛恩生等.彩色多普勒超声诊断偶发小肾癌的价值.中国医学影像学杂志,2008,16(2)：112-114.
63曹海根,王金锐.实用腹部超声诊断学[M].北京：人民卫生出版社,1994：434-441.
64周永昌,郭万学.超声医学[M]第4版北京：科学技术文献出版社,2002：1150-1151.
65唐杰,董宝玮.腹部和外周血管彩色多普勒诊断学[M].第2版.北京：人民卫生出版社,1999：220.
66王艳华,王涌臻,金虹.肾癌的超声与CT诊断对比分析.内蒙古医学杂志.2008,40：1384-1385.
67孔祥田,夏同礼,曾荔,等.肾血管平滑肌脂肪瘤影像学误诊原因的探讨.中华泌尿外科杂志,1998,19：658-659.
68戴晴,姜玉新,常欣.超声造影对肾脏占位病变的诊断意义.中华泌尿外科杂志,1999,20(4)：199-201.
69曹海根,王金锐主编.实用腹部超声诊断学.北京：人民卫生出版社,1994.461-466.
70刘永生,战英杰,李新等.32例肾癌超声诊断探讨.辽宁医学杂志,2008,22(2)：100-101.
2 Bosniak MA. The small (＜ 3 cm) renal parenchymal tumor detection, diagnosis and correlation.Radiology,1991,179:307-317.
3赵军,季学闻,盛斌武,等.肾肿瘤236例病理分类及影像学检查对比分析.陕西医学杂志,2004,4：33(4)：326-328.
4施燕芸,吴秀花.超声检查诊断肾癌的价值附55例报告.新医学,2008,11；39(11)：738
5刘淑萍,姚克纯,邵波,等.超声体检对无症状肾癌和小肾癌的临床诊断价值.中国超声医学杂志,2005,21(6)：449
6魏建平,杜联芳,邢晋放,等.肾细胞癌超声表现分析.中国超声诊断杂志,2005,6(9)：674
7张武,苗立英,勇强,等.超声诊断无症状肾细胞癌和小肾细胞癌91例临床分析.中华超声影像学杂志,2000,9(11)：686-689.
8李爱民,王梅,等.肾癌的超声诊断及分期与病理结果对照分析.北京医学,2005,27(2)：124.
9徐朝霞,张学昕,耿江红,等.小肾癌的影像学分析.实用放射学杂志,2008,8：24(8)：1066-1068.
10肖峻,孙友文,周林玉,等.17例小肾癌的影像学诊断.安徽卫生职业技术学院学报,2003,2(1)： 36
11郭玉民,呼子奇.超声检查对小肾癌诊断与分析.中华中西医学杂志,2008,6(9)：75
12李维国,阮渊,朱轶勇,等.小肾癌的影像学诊断方法比较.现代泌尿外科杂志,2009,1；14(1)： 39
13 Ebele JN, Sauter G, Epstein JI, et al. Pathology and genetics of tumours of the urinary system and male genital organs[M]. Lyon:IARC,2004.12-43.
14陆敏,邹万忠.肾脏肿瘤[A].冯晓莉.泌尿系统及男性生殖器官肿瘤病理学和遗传学(译著)[M].北京：人民卫生出版社,2006.1-37.
15 Storkel S, Eble JN, Adlakha K, et al. Classification of renal cell carcinoma. Cancer, 1997,80:987-989.
16刘军,付庆国,邓尚廉,等.小肾癌的超声表现及其临床诊断价值.中国超声诊断杂志,2004,5(3)：184-187.
17蔡胜,姜玉新,李建初,等.小肾癌的声像图征象及其临床价值.中华超声影像学杂志,2001,10(7)：421-423.
18黄苏里,郝玉芝,朱利,等.小肾细胞癌的超声诊断.中国肿瘤临床与康复,2003,10(4)：341-343.
19杨培谦,吕文成,杜林栋,等.B超及CT诊断肾脏小肿瘤的临床价值(附48例报告).中华泌尿外科杂志,2004,25(12)：822-824.
20 Yamashita Y, Takahashi M, Watanabe 0, et al. Small renal cell carcinoma:pathologic and radiologic correlation. Radiology,1993 Dec;189(3):925.
21 Forman HP,Middleton WD, Melson GL, et al. Hyperechoic renal cell carcinomas: increase in detection at U S. Radio logy,1993,188:431-434.
22戴训芦,黄咏红,赵保平,等.肾癌的超声声像图与病理结构的相关性分析.中国医学计算机成像杂志,2006,12(4)：275.
23 YAMASHITA Y, UENO S, MAKITA 0, etal. Hyperechoic renal tumors:an echoicrim and intratumoral cysts in US differentiation of renal cell carcinoma from angiomyolipoma. Radiology,1993,188:179-182.
24 Siegel CL, Middleton WD, Teefey SA, et al. Angiomyolipoma and renal cell carcinoma:US differentiation. Radiology,1996,198:789-793.
25 Strotzer M, Lehner KB, Becker K. Detection of fat in a renal cell carcinoma mimicking angiomyolipoma. Radiology,1993,188:427-428.
26 Hammadeh MY, Thomas K, Philp T, et al. Renal cell carcinoma containing fat mimicking angiomyolipoma:demonstration with CT scan and histopathology. Eur Radiol,1998, 8(2):228.
27高建津,丁希芳,刘克霞等.肾肿瘤56例B超所见与病理对照.中国超声医学杂志.1993,9(2)：120.
28陈继先,苏内林,蔚锦凤.肾肿瘤的声像图与病理类型的关系.内蒙古医学杂志复 刊.1995,15(1)：50.
29张学文,曹海根,于中麟等.B超诊断肾肿瘤70例报告.中国超声医学杂志试刊号.1985,试刊号：75.
1刘复生,刘彤华,主编肿瘤病理学[M].1997,1787-1791.
2 McClennan BL.Staging and follow-up of renal and adrenal carcinoma. Cancer,1991,67(4 Supp 1):1199-1208.
3 Redden DN, Raj Gv, Polascik TJ. Management of small renal tumors:an overview. Am J Med,2001,110:558.
4潘柏年,王田,杨勇,等.小肾癌(附34例报告).中华泌尿外科杂志,1998,19：32-34.
5裴昌松,朱有华,郭义峰,等.小肾癌76例临床分析.中华泌尿外科杂志,2003,24：725-727.
6赵军,季学闻,盛斌武,等.肾肿瘤236例病理分类及影像学检查对比分析.陕西医学杂志,2004,4：33(4)：326-328.
7施燕芸,吴秀花.超声检查诊断肾癌的价值附55例报告.新医学,2008,11；39(11)：738
8刘淑萍,姚克纯,邵波,等.超声体检对无症状肾癌和小肾癌的临床诊断价值.中国超声医学杂志,2005,21(6)：449
9魏建平,杜联芳,邢晋放,等.肾细胞癌超声表现分析.中国超声诊断杂志,2005,6(9)：674
10李爱民,王梅,等.肾癌的超声诊断及分期与病理结果对照分析.北京医学,2005,27(2)：124.
11徐朝霞,张学听,耿江红,等.小肾癌的影像学分析.实用放射学杂志,2008,8：24(8)：1066-1068.
12肖峻,孙友文,周林玉,等.17例小肾癌的影像学诊断.安徽卫生职业技术学院学报,2003,2(1)： 36
13郭玉民,呼子奇.超声检查对小肾癌诊断与分析.中华中西医学杂志,2008,6(9)：75
14李维国,阮渊,朱轶勇,等.小肾癌的影像学诊断方法比较.现代泌尿外科杂志,2009,1；14(1)： 39
15 Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors:indications, techniques and outcomes. Journal of Urology,2001,166:6.
16张武,苗立英,勇强,等.超声诊断无症状肾细胞癌和小肾细胞癌91例临床分析.中华超声影像学杂志,2000,9(11)：686-689.
17郁建迪,张志根.肾癌保肾单位手术.国外医学泌尿系统分册,2003,23(1)：84-87.
18 Manikandan R, Srinivasan V, Rane A, et al. Which is the real gold standard for small-volume renal tumors?Radical nephrectomy versus nephronsparing surgery. J Endourol,2004,18(1):39.
19 Lane BR, Gill IS.5-Year outcomes of laparoscopic partial nephrectomy. J Urol,2007,177(1):70.
20 Ahrar K, Wallace MJ, Matin SF. Percutaneous radiofrequency ablation:minimally invasive therapy for renal tumors. Expert Rev Anticancer Ther.2006,6(12):1735.
21 Gupta A, Allaf ME,Kavoussi LB,et al. Computerized tomography guided percutaneous renal cryoablation with the patient under conscious sedation:initial clinical experience. J Urol,2006,175(2):447.
22 Paterson RF, Barret E, Siquesra TM, et al. Laparoscopic partial kidney Ablation with high intensity focused ultrasound. J Urol,2003,169:347.
23 Walsh PC, Retik AB, Vaugh ED, et al. Campbell's Urology.8th ED. WB Saunders Company: Philadelphia, PA,2002. p2672-2719.
24 Storkel S, Eble JN, Adlakha K, et al. Classification of renal cell carcinoma. Cancer,1997,80:987-989.
25 Delahunt B, Eble JN. Papillary renal cell carcinoma:a clinicopathologic and immunohistochemical study of 105 tumors. Mod Pathol,1997,10:537-544.
26 Delahunt B, Eble JN, McCredie MR, et al. Morphologic typing of papillary renal cell carcinoma:comparison of growth kinetics and patient survival in 66 cases. Hum Pathol, 2001,32:590-595.
27 Ebele JN, Sauter G, Epstein JI, et al. Pathology and genetics of tumours of the urinary system and male genital organs[M]. Lyon:IARC,2004.12-43.
28陆敏,邹万忠.肾脏肿瘤[A].冯晓莉.泌尿系统及男性生殖器官肿瘤病理学和遗传学(译著)[M].北京：人民卫生出版社,2006.1-37.
29 Ishikawa I,Kovacs G.High incidence of papillary renal cell tumours in patients with chronic haemodialysis. Histopathology,1993,22 (2):135-140.
30 Renshaw AA, Corless CL. Papillary renal cell carcinoma:histology and immunohistochemistry. Am J Surg Pathol,1995,19(7):842-849.
31 Amin MB, Corless CL, Renshaw AA, et al. Papillary (chromophil) renal cell carcinoma: histomorphologic characteristic and evaluation of congenital pathologic prognostic parameters in 62 cases.Am J Surg Pathol,1997,21(6):621-635.
32 Baltaci S, Orhan D, Soyupek S, et al. Influence of tumor stage size, grade, vascular involvement, histological cell type, and histological pattern on multifocality of renal cell carcinoma. J Urol,2000,164(1):36-39.
33 Chow WH, Gridley G, Fraumeni JF, et al. Obesity, hypertension, and the risk of kidney cancer in men.N Engl J Med,2000,343(18):1305-1311.
34夏同礼.现代泌尿病理学[M].北京：人民卫生出版社,2002：95-109.
35李甘地,来茂德.病理学[M].北京：人民卫生出版社,2003：333-335.
36 Moch H, Gasser T, Amin MB, et al. Prognostic utility of the recently recommended histologic classification and revised TNM staging System of renal cell carcinoma: a Swiss experience with 588 tumors. Cancer,2000,89:604-614.
37 Amin MB, Tamboli P, Javidan J, et al. Prognostic impact of histologic subtyping of adult renal epithelial neoplasms:an experience of 405 cases. Am J Surg Pathol,2002,26:281-291.
38 Motzer R J, Bacik J, Mariani T, et al. Treatment outcome and survival associated with metastatic renal cell carcinoma of non clear-cell histology. J Clin Oncol,2002,20:2376-2381.
39顾方六,肾肿瘤.见：吴阶平,主编.吴阶平泌尿外科学.济南：山东科学技术出版社,2004.889-917.
40 Michisch G, Carballido J, Hellsten S, et al. Guidelines on renal cell cancer. Eur Urol 2001,40:252-255.
41黄苏里,郝玉芝,朱利,等.小肾细胞癌的超声诊断.中国肿瘤临床与康复,2003,10(4)：341-343.
42杨培谦,吕文成,杜林栋,等.B超及CT诊断肾脏小肿瘤的临床价值(附48例报告).中华泌尿 外科杂志,2004,25(12)：822-824.
43刘军,付庆国,邓尚廉,等.小肾癌的超声表现及其临床诊断价值.中国超声诊断杂志,2004,5(3)：184-187.
44蔡胜,姜玉新,李建初等.小肾癌的声像图征象及其临床价值.中华超声影像学杂志,2001,10(7)：421-423.
45 Yamashita Y, Takahashi M, Watanabe 0, et al. Small renal cell carcinoma:pathologic and radiologic correlation. Radiology,1993 Dec;189(3):925.
46 Bosniak MA. The small (＜ 3 cm) renal parenchymal tumor detection, diagnosis and correlation. Radiology,1991,179:307-317.
47 Forman HP, Middleton WD,Melson GL, et al. Hyperechoic renal cell carcinomas: increase in detection at U S. Radio logy,1993,188:431-434.
48戴训芦,黄咏红,赵保平,等.肾癌的超声声像图与病理结构的相关性分析.中国医学计算机成像杂志,2006,12(4)：275.
49高建津,丁希芳,刘克霞等.肾肿瘤56例B超所见与病理对照.中国超声医学杂志.1993,9(2)：120.
50陈继先,苏内林,蔚锦凤.肾肿瘤的声像图与病理类型的关系.内蒙古医学杂志复刊.1995,15(1)：50.
51张学文,曹海根,于中麟等.B超诊断肾肿瘤70例报告.中国超声医学杂志试刊号.1985,试刊号：75.
52 YAMASHITA Y,UENO S,MAKITA 0, etal. Hyperechoic renal tumors:an echoicrim and intratumoral cysts in US differentiation of renal cell carcinoma from angiomyolipoma. Radiology,1993,188:179-182.
53 Siegel CL, Middleton WD, Teefey SA, et al. Angiomyolipoma and renal cell carcinoma:US differentiation. Radiology,1996,198:789-793
54 Strotzer M, Lehner KB, Becker K. Detection of fat in a renal cell carcinoma mimicking angiomyolipoma. Radiology,1993,188:427-428.
55 Hammadeh MY, Thomas K, Philp T, et al. Renal cell carcinoma containing fat mimicking angiomyolipoma:demonstration with CT scan and histopathology. Eur Radiol.1998,8(2):228.
56潘吉荣,李青.小肾癌的超声诊断进展.中国煤炭工业医学杂志,2004,7：699.
57蔡胜,姜玉新,李建初,等.小肾癌的声像图征象及其临床价值.中华超声影像学杂志,2001,10(7)：421-423.
58尹玉成,张希平,阎瑞玲,等.多普勒超声在肾肿瘤中的应用.中国超声医学杂志,1992,8(4)：274-275.
59赵诚,房世保,禹静等.小肾癌的超声诊断价值.青岛大学医学院学报,2008,44(4)：.
60董磊,李新民,赵晓峰.彩色多普勒能量图诊断小肾癌的价值.中国超声医学杂志,1999,15(6)：460-462.
61穆柯晓,孙倩.小肾癌的诊断及鉴别诊断价值.医学影像学杂志,2007,17(8)：845-847.
62叶琴,林礼务,薛恩生等.彩色多普勒超声诊断偶发小肾癌的价值.中国医学影像学杂志,2008,16(2)：112-114.
63曹海根,王金锐.实用腹部超声诊断学[M].北京：人民卫生出版社,1994：434-441.
64周永昌,郭万学.超声医学[M]第4版北京：科学技术文献出版社,2002：1150-1151.
65唐杰,董宝玮.腹部和外周血管彩色多普勒诊断学[M].第2版.北京：人民卫生出版社,1999：220.
66王艳华,王涌臻,金虹.肾癌的超声与CT诊断对比分析.内蒙古医学杂志.2008,40：1384-1385.
67孔祥田,夏同礼,曾荔,等.肾血管平滑肌脂肪瘤影像学误诊原因的探讨.中华泌尿外科杂志,1998,19：658-659.
68戴晴,姜玉新,常欣.超声造影对肾脏占位病变的诊断意义.中华泌尿外科杂志,1999,20(4)：199-201.
69曹海根,王金锐主编.实用腹部超声诊断学.北京：人民卫生出版社,1994.461-466.
70刘永生,战英杰,李新等.32例肾癌超声诊断探讨.辽宁医学杂志,2008,22(2)：100-101.