Liang Wenjie
From the Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2015 Jul;94(28):e1181. doi: 10.1097/MD.0000000000001181.
We describe and analyze the clinical course and imaging findings of a case of a renal inflammatory myofibroblastic tumor (IMT) that is similar to cystic renal cell carcinoma. "Solitary cysts" on the left kidney were found during a health examination of a 60-year-old female. The patient also had hypertension. She had undergone surgeries twice for limb trauma fracture and had no definite record of hepatitis. There was no tenderness with percussion of the kidney area or edema in the lower extremity. The renal function results, including serum creatinine, blood urea nitrogen, and blood urea, were within the normal range. No gross hematuria or microscopic hematuria was found. An 8.7 cm × 9.2 cm mixed echogenic mass at the upper pole of the left kidney was observed with ultrasound, the majority of which was an anechoic mass that was slightly protruding from the renal capsule and had well-circumscribed borders. After a bolus injection of an ultrasound contrast agent, the mass had rapid enhancement with fast fading. An approximately 9.4 cm × 10.1 cm round-like cyst lesion at the upper pole of the left kidney was revealed by computed tomography (CT) examination of the abdomen; it had edge finishing with well-circumscribed borders. The upper inner wall of the lesion was thick with crescentic soft tissue. The solid content had gradual enhancement on enhanced CT scans. A kidney tumor was considered based on the CT findings. Based on the preoperative examination, the left renal cystic masses were resected. Intraoperative frozen sections were used to further clarify the nature of the lesion, and no significant malignant cells were observed; therefore, the kidney was not removed. The pathological diagnosis was renal IMT. After surgery, the patient recovered and did not have recurrence or metastasis over the course of long-term follow-up. CT images of our patient with renal cystic disease are categorized as Fuhrman grade IV and typically indicate the presence of malignant lesions. However, gradual enhancement of the solid content in our case is different from typical cystic renal cell carcinoma. The nature of the lesion was further identified using intraoperative frozen sections, which helped avoid unnecessary nephrectomy.
我们描述并分析了一例类似囊性肾细胞癌的肾脏炎性肌纤维母细胞瘤（IMT）的临床病程及影像学表现。一名60岁女性在健康体检时发现左肾有“孤立性囊肿”。患者还患有高血压。她曾因肢体创伤骨折接受过两次手术，无明确肝炎病史。肾区叩击无压痛，下肢无水肿。肾功能结果，包括血清肌酐、血尿素氮和血尿素，均在正常范围内。未发现肉眼血尿或镜下血尿。超声检查发现左肾上极有一个8.7 cm×9.2 cm的混合回声团块，大部分为无回声团块，略突出于肾包膜，边界清晰。静脉注射超声造影剂后，团块快速增强且快速消退。腹部计算机断层扫描（CT）检查显示左肾上极有一个约9.4 cm×10.1 cm的类圆形囊性病变；边界清晰。病变的上内壁增厚，有新月形软组织。增强CT扫描时实性成分呈渐进性强化。根据CT表现考虑为肾肿瘤。基于术前检查，切除了左肾囊性肿块。术中冰冻切片用于进一步明确病变性质，未观察到明显恶性细胞；因此，未切除肾脏。病理诊断为肾脏IMT。术后患者恢复良好，长期随访过程中无复发或转移。我们这位肾囊性疾病患者的CT图像分类为福尔曼四级，通常提示存在恶性病变。然而，我们病例中实性成分的渐进性强化与典型的囊性肾细胞癌不同。术中冰冻切片进一步明确了病变性质，有助于避免不必要的肾切除术。
