V0368:肾脏病变

九目段

以下是引用sdqzwyx在2008-1-4 19:40:00的发言：[br]临床表现：女性，42岁，因腰痛、血尿而一周。[br]影像特征：右肾体积明显增大，肾下极示一类圆形多房囊性占位，并突入肾盂，部分突出肾轮廓外，包膜完整，边界清楚，残余的肾组织在肿瘤包膜外，其结构及强化基本正常，[br]病灶内示间隔，间隔密度比正常肾实质略低，增强后间隔轻度强化，延迟间隔更清晰明显，未见明显积水梗阻。[br]拟诊：多房性囊性肾瘤（本病的名称繁多，如肾囊性腺瘤、局部多囊性肾、多发性囊性肾、良性多房性肾囊肿和多房囊性肾瘤等。近年来以良性多房性肾囊肿和多房性囊性肾瘤为多）；多房囊性肾癌不能完全排除。[br]分析：肾体积增大、说明病变生长时间较长，边界清晰锐利、光整，包膜完整，间隔清晰，周围肾组织结构正常，囊肿疝入肾盂则可有血尿，所以首先考虑良性多房囊性肾瘤。[br]而多发囊性肾癌一般认为平扫囊内平均ct值较单纯囊肿偏高，肿瘤内部有出血时，囊肿内可见不均匀的内容物；囊壁连续性中断，容易向邻近肾实质浸润；一般囊壁厚薄不均，有向囊内或囊外凸出的壁结节，可明显强化，延迟密度下降，部分囊壁模糊，平扫囊内密度不均者，增强扫描囊内可出现不均匀强化。但也不是绝对的，有时跟良性囊性病变很难鉴别，故不能完全排除。[br]

不错！都这样的话，老听的帖子就不白发。再跟着翁站走，老听该气得放羊去了，不过内蒙人到赣州当做黑社会，新疆人到赣州当小偷，又得病的也不少啊。

九目段

病例1

病例2

[本贴已被 九目段 于 2008-1-5 9:28:05 修改过]

九目段

the etiology of multilocular cystic nephroma (mcn) has
been the subject of controversy for a long period of time.
however, many currently believe that mcn is a benign
neoplasm and lies at the benign end of a continuum that
includes the cystic partially differentiated nephroblastoma
(cpdn) variants of wilms’ tumor .
     there is a bimodal age distribution. under the age of
5 years, mcn occurs most frequently in males, whereas
the adult group has a female predominance between the
ages of 40 and 60. the most common presenting symptoms
are a painless abdominal mass, abdominal or flank pain, and
occasionally hematuria .
     several authors have reported on the difficulty of
differentiating between mcn and multilocular cystic renal
cell carcinoma (mlcc). however, definitive diagnosis is
always histological.
     renal cell carcinoma may occasionally arise in a variety
of longstanding cystic diseases of the kidney, including the
cysts of multilocular cystic nephroma. however, most of the
reported malignancies in multilocular renal cysts have been
clear cell carcinomas.
     the prognosis for crcc is excellent. a recent study of 21
patients from japan reported that after surgery, 5-year and
10-year disease free specific survival for these patients were
both 100% . our patient remains free of recurrence with 4 years
follow-up.
     in summary, a multilocular renal cyst is usually considered a
benign lesion, but malignant changes in the cyst can occur, indicating
that thorough sampling should be undertaken for histology.
however, the prognosis is excellent and most patients are
likely to achieve long-term survival.

[本贴已被 九目段 于 2008-1-5 9:36:27 修改过]

九目段

听禅观竹的帖子一定要挺

ZHANGZHONGSHOU

同影异病，影像诊断确实有限度。

LIAOQIANG

囊中囊，无确切实性部份。考虑肾包虫可能性。

吕军浩

肾体积增大、说明病变生长时间较长，良性病变可能大。

汪涛同志

该病例强化有一个特点：囊内分隔动脉期轻中度强化，证明其血供是不太丰富，而静脉期的强化又略强于动脉期，持续时间较长，不太符合典型肾癌血供丰富，快进快出的特点。所以我首先倾向于良性病变：囊性肾瘤。但病人临床有血尿，而且囊内的分隔形态不规则，所以恶变是不敢排除的。至于包虫病，青海西藏西北多见，而病人雷主任说是江西赣州的，与福建相邻，在大东边，地域正好相反，这地方血吸虫多，没有听说过包虫病在这地的，如果病人是本地人，则不考虑。

听蝉观竹

请大家不要往寄生虫疾病方面考虑。

向医生

      本例表现为右肾囊性占位，囊内有多个间隔，右肾中下部体积有增大；增强扫描囊内间隔有增强但远远不及正常肾实质，囊内无明显壁结节，右肾周围未受累。结合患者病史：女性，45岁，无疫区接触史，因此，我考虑该例为右肾多房囊性肾瘤。