1、Urinary System College of Radiology Taishan Medical University LU Chuan Renal cell carcinoma Renal cell carcinoma Renal cell carcinoma(RCC)is the most common renal tumor,comprising approximately 85%of all primary malignant renal neoplasms.Renal tumors are usually solitary,although bilateral tumors a
2、re encountered in approximately 2%of patients.RCC occurs mainly in the sixth decade;they have been found in children,but only sporadically偶发的.The development is not related to ethnic groups人种.Histologically,the most common type of malignant renal cell cancer is clear cell adenocarcinoma透明细胞腺癌,with g
3、ranular 颗粒的cell carcinoma next in frequency.其次是 Papillary乳头状的 tubular adenocarcinoma defines a small group of RCC,but because of their limited blood supply,these can simulate cystic lesions and,thus,can represent a diagnostic challenge on imaging.RCC arises from the proximal convoluted卷曲的 tubule.肾曲小
4、管 RCCs are relatively slow growing and may be large before they produce symptoms.Before widespread use of 广泛使用cross-sectional imaging(US,CT,MRI),renal cell cancer often presented as an advanced disease at the time of diagnosis在就诊时.Today,however,there has been a shift to a smaller size and lower stag
5、e of renal cell cancer at the time of diagnosis.RCC may be locally aggressive侵略的,攻击性的,extending into扩散到 the renal veins and inferior vena cava(IVC)or invading adjacent soft tissue structures.RCC can metastasize by lymphatic and haematogenous routes.通过淋巴和血行转移 Common sites of haematogenous metastases
6、include bone,liver,and lungs.Nodal metastases commonly involve pararenal and para-aortic nodes and may also include mediastinal and pulmonary hilar nodes.Imaging plays an important part in the detection,characterization and staging疾病分期,肿瘤分类of renal cell cancer.Although the intravenous urogram尿路照片(IV
7、U)is still often used as the initial study in the search for renal masses,it has been shown that 已经显示in the presence of a CT-confirmed renal mass,detection by IVU is only 21%when the lesion is smaller than 2 cm,52%when the lesion is 23 cm,and 85%when the lesion is 3 cm or more in diameter.A normal I
8、VU,therefore,does not exclude the presence of a renal mass.While US is an excellent modality for the detection and characterization of renal cysts,in the detection of solid lesions US accuracy decreases considerably.Renal cell carcinoma Linear tomogram x线体层照片obtained during an intravenous pyelogram肾
9、盂造影,in a patient with a large renal cell carcinoma in the left kidney.A large mass(arrow)are seen in the left lower pole下极.When compared with CT,US demonstrates detection of 60%of lesions smaller than 2 cm and 83%of lesions between 2 and 3 cm in size.Lesion detection on contrast-enhanced MRI(9097%)e
10、quals that of CT(8999%).US,CT,and MRI have all been used with varying degrees of success in the characterization of renal masses.On US,the appearance of renal cell carcinoma is variable.Approximately 86%of tumors are isoechoic,4%are hyperechoic,and the remainder are hypoechoic as compared to the adj
11、acent renal parenchyma.Approximately 13%of renal cell carcinomas will demonstrate increased through transmission.Renal cell carcinoma Longitudinal ultrasound image through the right kidney demonstrates a heterogenous lobulated ill-defined mass arising from the upper pole(arrow)due to renal cell carc
12、inoma.These tumors have usually undergone extensive liquefaction necrosis.Colour Doppler sonography using frequency shift determinations has demonstrated some utility in differentiating benign from malignant lesions.Power Doppler sonography能量多普勒,which is even more sensitive to flow than conventional
13、 colour Doppler imaging,may provide additional information in characterizing renal lesions.Although US is useful in characterizing renal masses,it is inadequate in staging 分期renal cell carcinoma The CT appearance of renal cell carcinoma varies with tumor size and vascularity .Renal cell carcinoma 1
14、Axial enhanced？CT demonstrating a very large and partially exophytic renal cell cancer(arrows)arising from the right kidney.Renal cell carcinoma 2 Axial enhanced CT image through the kidneys,showing a renal cell carcinoma in the right kidney with extension into the right renal vein(arrow)and inferio
15、r vena cava下腔静脉.Renal cell carcinoma 3 a.Axial enhanced CT through the kidneys,showing a large hypodense mass replacing the left kidney,and extending into the left renal vein and inferior vena cava(IVC).b.Axial US of the intrahepatic IVC,showing an echogenic intraluminal filling defect(arrow)due to
16、intracaval tumor extension c.Axial enhanced CT through the heart,showing tumor(arrow)in the right atrium心房.When large enough,these tumors appear as masses that alter 改变renal contour or intrarenal architecture结构.Detection of small lesions is facilitated by 方便rapid sequence scanning techniques during administration of contrast material because abnormal enhancement may be evident even when renal contours are normal.Heterogeneous enhancement is characteristic.When intratumoral haemorrhage or necrosi
