Israel Gary M, Bosniak Morton A, Slywotzky Chrystia M, Rosen Robert J
Department of Radiology, Division of Abdominal Imaging, HW 202, New York University Medical Center, 560 First Ave., New York, NY 10016, USA.
AJR Am J Roentgenol. 2002 Sep;179(3):769-73. doi: 10.2214/ajr.179.3.1790769.
The purpose of our study was to describe the imaging findings and CT characteristics that lead to accurate distinction of large exophytic renal angiomyolipomas from retroperitoneal perirenal liposarcomas, which at times can be confused on imaging studies and even at pathologic examination.
We retrospectively analyzed CT images of 15 large exophytic renal angiomyolipomas and 12 well-differentiated perirenal liposarcomas. Pathologic correlation was available for six of 15 angiomyolipomas and all of the liposarcomas. All examinations were evaluated for lesion size, renal parenchymal defect, enlarged vessels, kidney displacement, lesion encapsulation or margination, associated hemorrhage, and additional angiomyolipomas. The records of patients with tuberous sclerosis or the forme fruste of that condition were excluded from the study.
The average size of the angiomyolipomas was 14 x 10 cm. They showed a renal parenchymal defect (n = 15), enlarged vessels (n = 12), renal displacement (n = 14), good margination without a distinct capsule (n = 14), hemorrhage (n = 1), and additional (one or two) angiomyolipomas (n = 4). The average size of the liposarcomas was 18 x 11.6 cm. They showed enlarged vessels (n = 3), renal displacement (n = 11), and encapsulation (n = 4); none showed a renal parenchymal defect, hemorrhage, or associated angiomyolipomas.
Although large exophytic angiomyolipomas and well-differentiated retroperitoneal liposarcomas may have similar appearances on imaging, careful evaluation for a defect in the renal parenchyma combined with the presence of enlarged vessels in angiomyolipomas should enable accurate differentiation in almost all cases. Achieving an accurate diagnosis can have a significant impact on patient treatment.
我们研究的目的是描述影像学表现和CT特征，以准确区分巨大外生性肾血管平滑肌脂肪瘤与腹膜后肾周脂肪肉瘤，这两种肿瘤有时在影像学检查甚至病理检查中都会被混淆。
我们回顾性分析了15例巨大外生性肾血管平滑肌脂肪瘤和12例高分化肾周脂肪肉瘤的CT图像。15例血管平滑肌脂肪瘤中的6例以及所有脂肪肉瘤均有病理对照。对所有检查评估病变大小、肾实质缺损、血管增粗、肾脏移位、病变包膜或边界、相关出血以及额外的血管平滑肌脂肪瘤。患有结节性硬化症或其顿挫型的患者记录被排除在研究之外。
血管平滑肌脂肪瘤的平均大小为14×10 cm。它们表现为肾实质缺损（n = 15）、血管增粗（n = 12）、肾脏移位（n = 14）、边界清晰无明显包膜（n = 14）、出血（n = 1）以及额外的（一或两个）血管平滑肌脂肪瘤（n = 4）。脂肪肉瘤的平均大小为18×11.6 cm。它们表现为血管增粗（n = 3）、肾脏移位（n = 11）以及包膜形成（n = 4）；均未显示肾实质缺损、出血或相关的血管平滑肌脂肪瘤。
尽管巨大外生性血管平滑肌脂肪瘤和高分化腹膜后脂肪肉瘤在影像学上可能有相似表现，但仔细评估肾实质缺损并结合血管平滑肌脂肪瘤中血管增粗的情况，几乎在所有病例中都应能实现准确鉴别。实现准确诊断对患者治疗可能有重大影响。
