Hélénon O, Merran S, Paraf F, Melki P, Correas J M, Chrétien Y, Moreau J F
Department of Radiology, Necker Hospital, Paris, France.
Radiographics. 1997 Jan-Feb;17(1):129-44. doi: 10.1148/radiographics.17.1.9017804.
Unusual fat-containing renal tumors in a series of 27 cases comprised five categories: atypical and complicated angiomyolipomas (AMLs) (n = 15), including AMLs with extrarenal growth (n = 5), AMLs with undetectable fat (n = 4), and hemorrhagic AMLs (n = 6); fat-containing renal cell carcinomas (RCCs) (n = 9); lipoma (n = 1); liposarcoma (n = 1); and fat-containing renal oncocytoma (n = 1). Fat was present within RCCs by the following mechanisms; lipid-producing necrosis within a large RCC (n = 2), intratumoral bone metaplasia with fatty marrow elements and calcification within a small RCC (n = 2), and entrapment of perirenal (n = 4) or sinus (n = 1) fat by large irregular RCCs. Fat-containing RCC must be considered in cases of fat-containing renal tumors, even though the presence of intratumoral fat is characteristic of AML. A dedicated computed tomography scanning protocol and strict diagnostic criteria are mandatory for accurate diagnosis. Malignancy should be suspected on the basis of the following criteria: presence of intratumoral calcifications; large, irregular tumor invading the perirenal or sinus fat; large necrotic tumor with small foci of fat; and association with nonfatty lymph nodes or venous invasion.
27例特殊含脂肪肾肿瘤分为五类：非典型和复杂血管平滑肌脂肪瘤（AML）（n = 15），包括肾外生长的AML（n = 5）、脂肪不可见的AML（n = 4）和出血性AML（n = 6）；含脂肪肾细胞癌（RCC）（n = 9）；脂肪瘤（n = 1）；脂肪肉瘤（n = 1）；含脂肪肾嗜酸细胞瘤（n = 1）。RCC内脂肪的存在有以下机制：大RCC内的脂质生成性坏死（n = 2）、小RCC内伴有脂肪骨髓成分和钙化的瘤内骨化生（n = 2），以及大的不规则RCC包绕肾周（n = 4）或肾窦（n = 1）脂肪。含脂肪肾肿瘤病例中必须考虑含脂肪RCC，尽管瘤内脂肪的存在是AML的特征。准确诊断需要专门的计算机断层扫描方案和严格的诊断标准。基于以下标准应怀疑恶性肿瘤：瘤内钙化的存在；侵犯肾周或肾窦脂肪的大的不规则肿瘤；有小脂肪灶的大坏死肿瘤；以及与无脂肪的淋巴结或静脉侵犯相关。
