Choyke P L, White E M, Zeman R K, Jaffe M H, Clark L R
Radiology. 1987 Feb;162(2):359-63. doi: 10.1148/radiology.162.2.3797648.
The clinical and radiologic features of 27 patients with renal metastases arising from eight different types of nonlymphomatous primary malignancies are presented. Renal metastases were generally detected late in the course of the malignancy. In 23 patients there were no symptoms referable to the kidney. Urinalysis was normal in nine patients and showed microscopic hematuria in nine, gross hematuria in four, and proteinuria in four. Radiologically, metastases were usually multifocal; however, metastases arising from colon, lung, and breast carcinoma were sometimes large, solitary, and otherwise indistinguishable from primary renal cell carcinoma. Three of four melanoma metastases and three of seven lung metastases infiltrated the perinephric space. Computed tomography was the most sensitive modality, depicting renal metastases in all 24 cases in which it was employed, followed by ultrasound and intravenous urography. In patients with a history of malignancy, renal metastases outnumbered renal cell carcinomas by approximately 4:1. This study indicates that a new renal lesion in a patient with advanced, noncurable cancer is more likely metastatic than primary and that biopsy in this setting is unlikely to be of aid.
本文报告了27例由8种不同类型非淋巴瘤性原发性恶性肿瘤引起肾转移的患者的临床和放射学特征。肾转移通常在恶性肿瘤病程后期才被发现。23例患者无肾脏相关症状。9例患者尿液分析正常，9例显示镜下血尿，4例肉眼血尿，4例蛋白尿。放射学检查显示，转移灶通常为多灶性；然而，来自结肠癌、肺癌和乳腺癌的转移灶有时较大、孤立，在其他方面与原发性肾细胞癌难以区分。4例黑色素瘤转移灶中的3例以及7例肺转移灶中的3例侵犯了肾周间隙。计算机断层扫描是最敏感的检查方式，在其应用的所有24例病例中均显示出肾转移灶，其次是超声和静脉肾盂造影。有恶性肿瘤病史的患者中，肾转移瘤的数量大约是肾细胞癌的4倍。本研究表明，晚期不可治愈癌症患者出现的新的肾脏病变更可能是转移性的而非原发性的，在此情况下进行活检不太可能有帮助。
