误诊为肾癌的肾血管平滑肌脂肪瘤临床诊疗分析

董小勇; 匡幼林; 李心远; 高云峰; 童行; 谭建宇; 何卫阳

doi:10.13201/j.issn.1001-1420.2019.12.002

误诊为肾癌的肾血管平滑肌脂肪瘤临床诊疗分析

- 重庆医科大学附属第一医院泌尿外科(重庆, 400016)

详细信息

通讯作者: 何卫阳,E-mail:weiyang361@163.com

中图分类号: R737.11

收稿日期: 2018-11-14

Diagnosis and treatment of renal angiomyolipoma misdiagnosed as renal cell carcinoma

- Department of Urology, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

More Information

Corresponding author: HE Weiyang, E-mail: weiyang361@163.com

Received Date: 14 November 2018

摘要

摘要: 目的：探讨肾血管平滑肌脂肪瘤（AML）术前误诊为肾癌的重要因素，总结诊治经验以指导临床。方法：回顾性分析我院2014年5月~2018年3月36例误诊为肾癌的肾AML患者的临床资料。筛选同期96例典型肾AML作为肾AML对照组及132例肾透明细胞癌作为肾癌对照组，将研究组分别与肾AML对照组和肾癌对照组进行比较分析。结果：与肾AML对照组比较，研究组肿瘤最大径更小[（3.69±3.06） cm vs.（5.77±3.45） cm]，超声低回声比例更高（58.82% vs.3.06%），CT可见脂肪密度比例较低（5.56% vs.98.98%），接受保留肾单位手术患者比例更低（75.00% vs.90.82%），两组比较差异均有统计学意义（P<0.05）。与肾癌对照组比较，研究组肿瘤最大径更小[（3.69±3.06） cm vs.（4.60±2.15） cm]，接受保留肾单位手术患者比例更高（75.00% vs.49.24%），差异均有统计学意义（P<0.05）；研究组和肾癌对照组CT可见脂肪密度的比例分别为5.56%和1.51%，差异无统计学意义。结论：肿瘤较小且脂肪密度低的肾AML极易误诊为肾癌，超声低回声及CT不可见脂肪密度是其特征，超声、CT、MRI等新技术有助于鉴别诊断。对于性质难以确定的肾肿瘤，当肿瘤<4 cm或有条件实施保留肾单位手术时，可行保留肾单位手术以免过度治疗。
- 肾血管平滑肌脂肪瘤 /
- 肾癌 /
- 误诊
Abstract: Objective: To explore the important factors involved in misdiagnosing angiomyolipoma(AML) as renal cell carcinoma(RCC) preoperatively, and summarize the diagnosis and treatment experience to guide clinical work. Method: We retrospectively analysed the clinical manifestations and imaging data of 36 renal AML patients which were misdiagnosed as RCC before surgery from May 2014 to March 2018. Then we randomly selected 96 cases of renal AML and 132 cases of RCC at the same time as control groups. Pertinent data of the study group and its matched control groups were recorded and analyzed. Result: Compared with the renal AML control group, the misdiagnosed AML group had smaller mean tumor size[(3.69±3.06) cm vs.(5.77±3.45) cm, P<0.05]. The proportion of misdiagnosed AML patients with hypoechoic on ultrasonography was higher(58.82% vs. 3.06%, P<0.05), and the proportion of patients with fat density on CT was significantly lower(5.56% vs. 98.98%, P<0.05). Compared with the RCC control group, the misdiagnosed AML group's mean tumor size was smaller[(3.69±3.06) cm vs.(4.60±2.15) cm, P<0.05]. The proportion of patients undergoing partial nephrectomy was higher(75.00% vs. 49.24%, P<0.05), but the proportion of patients with fat density on CT has no statistical significance(5.56% vs. 1.51%).Conclusion: The misdiagnosed AML of the kidney is frequently seen in people with small tumor size and low fat density. The hypoechoic on ultrasonography and the absence of fat density on CT are the major characteristics. The development of new technologies such as ultrasonography, CT, and MRI may contribute to the diagnosis of benign and malignant renal tumors. For cases with difficult clinical diagnosis, if the tumor size is <4 cm, partial nephrectomy can be used to avoid excessive treatment.
- renal angiomyolipoma /
- renal cell carcinoma /
- misdiagnosis

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参考文献(22)

[1]	Fittschen A, Wendlik I, Oeztuerk S, et al.Prevalence of sporadic renal angiomyolipoma:a retrospective analysis of 61, 389 in-and out-patients[J].Abdom Imaging, 2014, 39(5):1009-1013.
[2]	Lienert A R, Nicol D.Renal angiomyolipoma[J].BJU Int, 2012, 110 Suppl 4:25-27.
[3]	Bauman T M, Potretzke A M, Wright A J, et al.Partial Nephrectomy for Presumed Renal-Cell Carcinoma:Incidence, Predictors, and Perioperative Outcomes of Benign Lesions[J].J Endourol, 2017, 31(4):412-417.
[4]	Schieda N, Hodgdon T, El-Khodary M, et al.Unenhanced CT for the diagnosis of minimal-fat renal angiomyolipoma[J].AJR Am J Roentgenol, 2014, 203(6):1236-1241.
[5]	Chen L S, Zhu Z Q, Wang Z T, et al.Chemical shift magnetic resonance imaging for distinguishing minimal-fat renal angiomyolipoma from renal cell carcinoma:a meta-analysis[J].Eur Radiol, 2018, 28(5):1854-1861.
[6]	Schieda N, Kielar A Z, Al Dandan O, et al.Ten uncommon and unusual variants of renal angiomyolipoma(AML):radiologic-pathologic correlation[J].Clin Radiol, 2015, 70(2):206-220.
[7]	Xu Z F, Xu H X, Xie X Y, et al.Renal cell carcinoma and renal angiomyolipoma:differential diagnosis with real-time contrast-enhanced ultrasonography[J].J Ultrasound Med, 2010, 29(5):709-717.
[8]	Woo S, Suh C H, Cho J Y, et al.Diagnostic Performance of CT for Diagnosis of Fat-Poor Angiomyolipoma in Patients With Renal Masses:A Systematic Review and Meta-Analysis[J].AJR Am J Roentgenol, 2017, 209(5):W297-W307.
[9]	Hodgdon T, McInnes M D, Schieda N, et al.Can Quantitative CT Texture Analysis be Used to Differentiate Fat-poor Renal Angiomyolipoma from Renal Cell Carcinoma on Unenhanced CT Images?[J].Radiology, 2015, 276(3):787-796.
[10]	Bagheri S M, Khajehasani F, Fatemi I, et al.Tumoral vascular pattern in renal cell carcinoma and fat-poor renal angiomyolipoma as a novel helpful differentiating factor on contrast-enhanced CT scan[J].Tumour Biol, 2017, 39(10):1010428317733144.
[11]	Chaudhry H S, Davenport M S, Nieman C M, et al.Histogram analysis of small solid renal masses:differentiating minimal fat angiomyolipoma from renal cell carcinoma[J].AJR Am J Roentgenol, 2012, 198(2):377-383.
[12]	Jinzaki M, Silverman S G, Akita H, et al.Renal angiomyolipoma:a radiological classification and update on recent developments in diagnosis and management[J].Abdom Imaging, 2014, 39(3):588-604.
[13]	Farrell C, Noyes S L, Tourojman M, et al.Renal angiomyolipoma:preoperative identification of atypical fat-poor AML[J].Curr Urol Rep, 2015, 16(3):12.
[14]	Kochhar R, Brown R K, Wong C O, et al.Role of FDG PET/CT in imaging of renal lesions[J].J Med Imaging Radiat Oncol, 2010, 54(4):347-357.
[15]	Razik A, Das C J, Sharma S.Angiomyolipoma of the Kidneys:Current Perspectives and Challenges in Diagnostic Imaging and Image-Guided Therapy[J].Curr Probl Diagn Radiol, 2018.
[16]	Sung C K, Kim S H, Woo S, et al.Angiomyolipoma with minimal fat:differentiation of morphological and enhancement features from renal cell carcinoma at CT imaging[J].Acta Radiol, 2016, 57(9):1114-1122.
[17]	Kim K H, Yun B H, Jung S I, et al.Usefulness of the ice-cream cone pattern in computed tomography for prediction of angiomyolipoma in patients with a small renal mass[J].Korean J Urol, 2013, 54(8):504-509.
[18]	Buscheck F, Fraune C, Simon R, et al.Aberrant expression of membranous carbonic anhydrase IX(CAIX) is associated with unfavorable disease course in papillary and clear cell renal cell carcinoma[J].Urol Oncol, 2018, 36(12):531.e19-531.e25.
[19]	Stillebroer A B, Franssen G M, Mulders P F, et al.ImmunoPET imaging of renal cell carcinoma with(124) I-and(89) Zr-labeled anti-CAIX monoclonal antibody cG250 in mice[J].Cancer Biother Radiopharm, 2013, 28(7):510-515.
[20]	Cho S W, Choi H J, Lee S.Rapidly Progressing Malignant Epithelioid Renal Angiomyolipoma:A Case Report[J].Urol J, 2016, 13(2):2653-2655.
[21]	Konosu-Fukaya S, Nakamura Y, Fujishima F, et al.Renal epithelioid angiomyolipoma with malignant features:Histological evaluation and novel immunohistochemical findings[J].Pathol Int, 2014, 64(3):133-141.
[22]	Lee D W, Chang H, Kim Y J, et al.Sorafenib-induced tumor response in a patient with metastatic epithelioid angiomyolipoma[J].J Clin Oncol, 2014, 32(11):e42-e45.