Ferrozzi F, Tognini G, Zuccoli G, Campani R, Pavone P
Istituto di Scienze Radiologiche, Università degli Studi, Parma.
Radiol Med. 2000 Mar;99(3):177-81.
To describe CT findings of calcified renal metastases focusing on differential diagnosis problems.
We retrospectively reviewed abdominal CT scans of 8000 patients with tumor, performed from 1984 to 1998. Among the 58 renal metastases, 9 showed a calcific component. We evaluated the location, morphostructural pattern, histology of the primary lesion, the synchronous or metachronous character and the type of treatment. All the lesions were pathologically proved.
The primary histotype of the 9 metastases was as follows: 4 mucin-producing adenocarcinomas of the large bowel, 1 gastric mucinous adenocarcinoma, 1 chondrosarcoma, 1 osteosarcoma, 1 melanoma, 1 papillary thyroid carcinoma. In all the cases the renal metastasis was unilateral and unifocal. Granular multiple calcifications were demonstrated within the metastases of mucin-producing adenocarcinoma of the large bowel (3), within the metastasis of chondrosarcoma (1) and of melanoma (1). Diffuse "star-like" calcifications were demonstrated in renal metastases of mucin-producing adenocarcinoma of the large bowel and of gastric mucinous adenocarcinoma (1). Peripheral "egg-shell" calcifications were demonstrated in renal metastasis from papillary thyroid carcinoma (1). Completely calcified monofocal calcification was demonstrated in renal metastasis from osteosarcoma (1).
Calcified renal metastases are rare lesions related to specific oncotypes. The differential diagnosis (carcinoma with calcifications, osteosarcoma, chondrosarcoma, nephrocalcinosis, granulomatosis, hydatidosis etc.) is particularly difficult because of the aspecificity of the morphostructural pattern. Diagnosis is based on a history of specific oncotypes (papillary and mucin-secreting carcinomas, osteosarcoma and chondrosarcoma), but in most cases it requires pathologic confirmation.
描述钙化性肾转移瘤的CT表现，重点关注鉴别诊断问题。
我们回顾性分析了1984年至1998年期间对8000例肿瘤患者进行的腹部CT扫描。在58例肾转移瘤中，9例显示有钙化成分。我们评估了病变的位置、形态结构模式、原发灶的组织学类型、同时性或异时性特征以及治疗类型。所有病变均经病理证实。
9例转移瘤的原发组织学类型如下：4例大肠黏液腺癌、1例胃黏液腺癌、1例软骨肉瘤、1例骨肉瘤、1例黑色素瘤、1例乳头状甲状腺癌。所有病例中肾转移瘤均为单侧单灶。在大肠黏液腺癌转移瘤（3例）、软骨肉瘤转移瘤（1例）和黑色素瘤转移瘤（1例）内可见颗粒状多发钙化。在大肠黏液腺癌和胃黏液腺癌（1例）的肾转移瘤中可见弥漫性“星状”钙化。在乳头状甲状腺癌的肾转移瘤（1例）中可见周边“蛋壳样”钙化。在骨肉瘤的肾转移瘤（1例）中可见完全钙化的单灶钙化。
钙化性肾转移瘤是与特定肿瘤类型相关的罕见病变。由于形态结构模式缺乏特异性，鉴别诊断（伴有钙化的癌、骨肉瘤、软骨肉瘤、肾钙质沉着症、肉芽肿病、包虫病等）特别困难。诊断基于特定肿瘤类型（乳头状和分泌黏液的癌、骨肉瘤和软骨肉瘤）的病史，但在大多数情况下需要病理证实。
