肾平滑肌瘤 ppt课件

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1、RenalLeiomyomaIntroductionRenalleiomyomaisararebenigntumorthatisfoundinapproximately5%ofthespecimensfromautopsy.Thistumormayarisefromsmoothmusclecellsoftherenalcapsule,themuscularisoftherenalpelvis,orcorticalvascularsmoothmuscles,withtherenalcapsulebeingthe

2、mostcommonsite.Renalleiomyomasaremostcommonlyfoundinwhitewomen.Mostleiomyomasaresmallandareasymptomatic.Largeleiomyomasmaymanifestwithapalpableflankmassandpain.PathologyAtmacroscopicexamination,renalleiomyomaisasolidwell-circumscribedencapsulatedmasswithawh

3、orledcutsurface,focalareasofhemorrhage,andirregularcalcifiation.Athistologicexamination,interlacingbundlesofspindlecellswithoutnuclearpleomorphismormitoticfiuresmaybeidentifid(Fig7a).Tumorcellsshowimmunoreactivitytosmoothmusclemarkerssuchasactinanddesmin.Fi

4、gure7.Renalleiomyomaina39-year-oldwoman.(a)Photomicrograph(originalmagnifiation,×40;hematoxylin-eosinstain)ofaleiomyomaofthekidneyshowsfasciclesofsmoothmuscle(arrows)adjacenttorenaltubules(arrowheads).RadiologymanifestationRenalleiomyomaappearsasawell-circu

5、mscribedperipherallylocatedhyperattenuatingsolidmassonCTimagesobtainedwithoutcontrastmaterial(Fig7b).ThetumortypicallydemonstratesrelativelyhomogeneousenhancementonCTimagesobtainedaftertheadministrationofcontrastmaterial(Fig7c).Largetumorsmayshowareasofhemo

6、rrhageandcysticormyxoiddegeneration.Inadditiontodemonstratinghyperattenuationonnon-enhancedCTimages,renalleiomyomatypicallyhasaperipherallocation,well-defiedmargins,andassociatedbucklingoftherenalcortex.Althoughnotpathognomonicforarenalleiomyoma,thecombinat

7、ionofthesefindingsshouldprompttheinclusionofleiomyomainthedifferentialdiagnosis.AtMRimaging,leiomyomatypicallyhashomogeneouslylowsignalintensityonT1-andT2-weightedimages.Largertumorsareindistinguishablefromrenalcellcarcinomaandleiomyosarcomawithimagingstudi

8、es.OtherCasesDifferentialdiagnosisThemaindifferentialdiagnosisisusuallymadewithangiomyolipomaofthekidney(AML).MostAMLsarecomposedofavariablemixtureofmaturefat,thickwalledbloodvesselsandsmoothmuscle,but