《肾平滑肌瘤》ppt课件

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1、RenalLeiomyomaIntroductionRenalleiomyomaisararebenigntumorthatisfoundinapproximately5%ofthespecimensfromautopsy.Thistumormayarisefromsmoothmusclecellsoftherenalcapsule,themuscularisoftherenalpelvis,orcorticalvascularsmoothmuscles,withtherenalcapsulebeingthemostcommonsite.Renallei

2、omyomasaremostcommonlyfoundinwhitewomen.Mostleiomyomasaresmallandareasymptomatic.Largeleiomyomasmaymanifestwithapalpableflankmassandpain.PathologyAtmacroscopicexamination,renalleiomyomaisasolidwell-circumscribedencapsulatedmasswithawhorledcutsurface,focalareasofhemorrhage,andirre

3、gularcalcifiation.Athistologicexamination,interlacingbundlesofspindlecellswithoutnuclearpleomorphismormitoticfiuresmaybeidentifid(Fig7a).Tumorcellsshowimmunoreactivitytosmoothmusclemarkerssuchasactinanddesmin.Figure7.Renalleiomyomaina39-year-oldwoman.(a)Photomicrograph(originalma

4、gnifiation,×40;hematoxylin-eosinstain)ofaleiomyomaofthekidneyshowsfasciclesofsmoothmuscle(arrows)adjacenttorenaltubules(arrowheads).RadiologymanifestationRenalleiomyomaappearsasawell-circumscribedperipherallylocatedhyperattenuatingsolidmassonCTimagesobtainedwithoutcontrastmateria

5、l(Fig7b).ThetumortypicallydemonstratesrelativelyhomogeneousenhancementonCTimagesobtainedaftertheadministrationofcontrastmaterial(Fig7c).Largetumorsmayshowareasofhemorrhageandcysticormyxoiddegeneration.Inadditiontodemonstratinghyperattenuationonnon-enhancedCTimages,renalleiomyomat

6、ypicallyhasaperipherallocation,well-defiedmargins,andassociatedbucklingoftherenalcortex.Althoughnotpathognomonicforarenalleiomyoma,thecombinationofthesefindingsshouldprompttheinclusionofleiomyomainthedifferentialdiagnosis.AtMRimaging,leiomyomatypicallyhashomogeneouslylowsignalint

7、ensityonT1-andT2-weightedimages.Largertumorsareindistinguishablefromrenalcellcarcinomaandleiomyosarcomawithimagingstudies.OtherCasesDifferentialdiagnosisThemaindifferentialdiagnosisisusuallymadewithangiomyolipomaofthekidney(AML).MostAMLsarecomposedofavariablemixtureofmaturefat,th

8、ickwalledbloodvesselsandsmoothmuscle,but