Division of Urology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT 84112, USA.
Urol Oncol. 2011 Nov-Dec;29(6):751-5. doi: 10.1016/j.urolonc.2009.10.013. Epub 2010 Jan 6.
We reviewed the imaging studies of patients with known metastatic renal cell carcinoma (RCC) in order to more accurately assess where retroperitoneal lymphadenopathy occurs.
The database of patients with metastatic RCC was reviewed and 101 patients were found from 2002 to 2006. Each patient's CT scans were then reviewed. Twenty-seven retroperitoneal sections were defined for each patient, with 3 positions in each of the x-, y-, and z-axis. Lymph nodes greater than 1 cm were then counted for each section.
Of the 101 patients, 31, of whom 28 qualified, were found to have retroperitoneal lymphadenopathy of a least 1 cm or greater. Two-thirds of nodes (87 out of 124) exhibited a suprahilar, intra-aortocaval, and retro-aortocaval trend of lymph node enlargement. Three patients (11%) had isolated infrahilar nodes, while 8 patients (29%) exhibited a skip lesion pattern by imaging criteria. Only 4 patients (14%) were noted to have lymph nodes that were confined to the ipsilateral (paraaortic or paracaval) nodes in the perihilar and infrahilar region, which would be readily accessible during renal surgery.
Lymphatic drainage in RCC is ill-defined, likely due to multiple lymphatic outflow channels. However, after a review of retroperitoneal lymphadenopathy imaging in patients with known metastatic RCC, there does seem to be a cephalad, posterior, and medial drainage pattern.
我们回顾了已知转移性肾细胞癌（RCC）患者的影像学研究，以便更准确地评估腹膜后淋巴结病发生的部位。
回顾了转移性 RCC 患者的数据库，发现 2002 年至 2006 年有 101 例患者。然后对每位患者的 CT 扫描进行了复查。为每位患者定义了 27 个腹膜后节段，每个节段在 x、y 和 z 轴上有 3 个位置。然后对每个节段的大于 1cm 的淋巴结进行计数。
在 101 例患者中，有 31 例（其中 28 例符合条件）发现腹膜后淋巴结肿大至少 1cm 或更大。三分之二的淋巴结（87 个中的 124 个）表现出嗜铬细胞、主动脉内和主动脉后淋巴结肿大的趋势。3 例（11%）患者有孤立的肾门下方淋巴结，8 例（29%）患者根据影像学标准表现出跳跃性病变模式。只有 4 例（14%）患者的淋巴结局限于同侧（主动脉旁或腔静脉旁）肾门和肾门下方区域，在肾手术中容易触及。
RCC 的淋巴引流不明确，可能是由于多个淋巴流出通道所致。然而，在回顾已知转移性 RCC 患者的腹膜后淋巴结病影像学表现后，似乎确实存在头侧、后向和内侧引流模式。
