Lhospitel S, Abeille J F, Kron P, Michel J R
Service de Radiologie urinaire, Hôpital Necker, Paris.
J Radiol. 1988 May;69(5):365-76.
Case reports were analyzed of patients with calcified renal masses observed in the department since 1968. Of the 65 radiologic reports reviewed, 7 were rejected since the course since diagnosis was unknown. Of the 58 case reports studied, 34 were of masses of certain diagnosis, 12 undetermined, 7 of masses in polycystic kidneys, 3 in tuberculous kidneys and 3 probably calcified hematomas. Analysis involved only those masses of proven diagnosis. Results confirmed the absence of specificity in favor of the cyst of peripheral character of calcifications: 33% of these masses were cancers. The existence of tissue calcification is synonymous of a solid mass, nearly always malignant (92% of cases). For peripherally calcified masses, arteriography was not sufficient to affirm benign nature of lesions, most of these masses having a particularly poorly vascularized or even avascular appearance. In these cases angiotensin was of special interest. Ultrasound imaging proved to be a reliable and perfectly sensitive examination. The presence of calcifications rarely interfered with study of tumoral contents. CT scan imaging and puncture biopsy were also perfectly sensitive and reliable examinations. Because of the high frequency of cancers in masses with peripheral calcification, all these masses should be surgically explored or at least punctured. Although a "benign" CT scan image appears sufficient to affirm the benign nature, this still requires more ample confirmation.
对自1968年以来在该科室观察到的钙化肾肿块患者的病例报告进行了分析。在审查的65份放射学报告中，7份因诊断后的病程不明而被排除。在研究的58份病例报告中，34份为确诊肿块，12份未确诊，7份为多囊肾肿块，3份为结核肾肿块，3份可能为钙化血肿。分析仅涉及那些确诊的肿块。结果证实，钙化的外周特征对囊肿并无特异性支持：这些肿块中有33%为癌症。组织钙化的存在意味着实体肿块，几乎总是恶性的（92%的病例）。对于外周钙化的肿块，动脉造影不足以确定病变的良性性质，这些肿块大多血管化特别差甚至无血管表现。在这些病例中，血管紧张素特别值得关注。超声成像被证明是一种可靠且极其敏感的检查方法。钙化的存在很少干扰对肿瘤内容物的研究。CT扫描成像和穿刺活检也是极其敏感且可靠的检查方法。由于外周钙化肿块中癌症的发生率较高，所有这些肿块都应进行手术探查或至少穿刺。尽管CT扫描的“良性”图像似乎足以确定其良性性质，但仍需要更充分的证实。
