Ding Xiaobo, Ma Xiaobo, Jia Yatao, Li Hongfei, Wang Yanbo
Department of Radiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
Department of Pathology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
Oncol Lett. 2018 Aug;16(2):1912-1916. doi: 10.3892/ol.2018.8867. Epub 2018 Jun 1.
Distinguishing infiltrative renal masses (IRMs) from intrarenal urothelial cancers (IUCs) is critically important, but may be challenging for any radiologist or urologist. The present study aimed to summarize the clinical, imaging and pathological characteristics of IRM, which were postoperatively confirmed as IUC. The analysis was performed using the records of 22 patients who were preoperatively diagnosed with IRM but the results of percutaneous biopsies or postoperative pathological analyses led to diagnoses of urothelial cancers (UCs) from January 2011 to December 2017. The demographic data, computed tomography (CT) imaging features and pathological characteristics were evaluated. The present study also reviewed the literature concerning the IRM and IUC. The mean age of patients was 62 years and 86.4% of them were >55 years. The sex and tumor side distributions were equal. Hematuria and/or flank pain were observed in 86.4% of patients. All patients exhibited endophytic solid renal masses with unclear tumor boundaries on CT images. The kidneys of 81.8% of patients maintained their normal shape while mild alternations were observed in 18.2% of cases. A total of 81.8% of patients maintained the reniform shape and 18.2% exhibited mild contour change. Of all patients, all tumors exhibited less or equal attenuation on unenhanced CT images and they were mildlyimproved on enhanced CT. A total of 6 cases were confirmed by biopsy, when patients underwent laparoscopic nephroureterectomy instead of radical nephrectomy. The remaining 16 patients underwent laparoscopic nephrectomy but the postoperative pathological diagnoses revealed the presence of UCs. All postoperatively confirmed cancers were stages T3 and T4 (62.5 and 37.5%, respectively). UCs should be suspected in middle aged or elderly middle-elderly patients presenting renal masses with endophytic solid unclear tumor boundary on unenhanced and slightly enhanced CT images, accompanied with hematuria and/or flank pain. Preoperative biopsy is preferred for complicated cases.
鉴别浸润性肾肿块（IRM）与肾内尿路上皮癌（IUC）至关重要，但对任何放射科医生或泌尿科医生来说都可能具有挑战性。本研究旨在总结术后确诊为IUC的IRM的临床、影像学和病理特征。分析采用了2011年1月至2017年12月期间22例术前诊断为IRM但经皮活检或术后病理分析结果确诊为尿路上皮癌（UC）患者的记录。评估了人口统计学数据、计算机断层扫描（CT）影像特征和病理特征。本研究还回顾了有关IRM和IUC的文献。患者的平均年龄为62岁，其中86.4%的患者年龄大于55岁。性别和肿瘤侧别分布均衡。86.4%的患者出现血尿和/或胁腹疼痛。所有患者在CT图像上均表现为内生性实性肾肿块，肿瘤边界不清。81.8%患者的肾脏保持正常形态，18.2%的病例观察到轻度改变。共有81.8%的患者肾脏保持肾形，18.2%表现为轻度轮廓改变。在所有患者中，所有肿瘤在未增强CT图像上均表现为等密度或低密度，增强CT上轻度强化。共有6例患者在接受腹腔镜肾输尿管切除术而非根治性肾切除术时经活检确诊。其余16例患者接受了腹腔镜肾切除术，但术后病理诊断显示存在UC。所有术后确诊的癌症均为T3和T4期（分别为62.5%和37.5%）。对于CT平扫和轻度强化图像上出现内生性实性、肿瘤边界不清的肾肿块，同时伴有血尿和/或胁腹疼痛的中老年患者，应怀疑为UC。对于复杂病例，首选术前活检。
