Steiner M, Quinlan D, Goldman S M, Millmond S, Hallowell M J, Stutzman R E, Korobkin M
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Urol. 1990 May;143(5):994-8. doi: 10.1016/s0022-5347(17)40163-7.
Renal leiomyoma is a challenging diagnostic and therapeutic condition. It is clinically similar in presentation and radiographic appearance to its malignant counterpart, leiomyosarcoma. We review 30 cases of clinically diagnosed leiomyoma of the kidney from the literature, including 4 new cases with emphasis on the computerized tomography findings. Computerized tomography may locate a renal leiomyoma serendipitously in an asymptomatic patient. If the lesion is peripheral or in the parapelvic area and a plane can be seen between the tumor and kidney a capsular tumor, such as a leiomyoma of the kidney, might be considered in addition to the more common renal cell carcinoma. Renal leiomyomas have a variable radiographic pattern from that of a pure cystic to a mixed solid/cystic to an entirely solid lesion. Renal leiomyomas usually are sharply demarcated from the surroundings. Although computerized tomography cannot distinguish a renal leiomyoma from other benign or malignant renal processes the presence of invasion can virtually eliminate this benign tumor as a diagnosis. Since a preoperative diagnosis cannot be made, management involves renal exploration and radical nephrectomy in the larger lesions with a renal-sparing operation possible in selected cases. After treatment patients have a uniformly excellent prognosis.
肾平滑肌瘤是一种在诊断和治疗上具有挑战性的病症。其临床表现和影像学表现与恶性对应物平滑肌肉瘤相似。我们从文献中回顾了30例临床诊断为肾平滑肌瘤的病例，包括4例新病例，并重点关注计算机断层扫描结果。计算机断层扫描可能会在无症状患者中偶然发现肾平滑肌瘤。如果病变位于周边或肾盂旁区域，且在肿瘤与肾脏之间可见一个平面，则除了更常见的肾细胞癌外，还可能考虑包膜肿瘤，如肾平滑肌瘤。肾平滑肌瘤的影像学表现多样，从单纯囊性到混合实性/囊性再到完全实性病变。肾平滑肌瘤通常与周围组织界限清晰。虽然计算机断层扫描无法将肾平滑肌瘤与其他良性或恶性肾脏病变区分开来，但存在浸润实际上可以排除这种良性肿瘤的诊断。由于无法进行术前诊断，对于较大的病变，治疗方法包括肾脏探查和根治性肾切除术，在某些选定的病例中可能可行保留肾单位手术。治疗后患者的预后普遍良好。
