【作者】 李超群；

【导师】 韩秀婕；

【作者基本信息】 中国医科大学 ， 影像医学与核医学， 2010， 硕士

【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。更多还原

【Abstract】 ObjectiveTo 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.MethodsA 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.ResultsIn 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).ConclutionsIn 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.更多还原