《肾平滑肌瘤》ppt课件

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

2、ngthemostcommonsite.Renalleiomyomasaremostcommonlyfoundinwhitewomen.Mostleiomyomasaresmallandareasymptomatic.Largeleiomyomasmaymanifestwithapalpableflankmassandpain.PathologyAtmacroscopicexamination,renalleiomyomaisasolidwell-circumscribedencapsulatedm

3、asswithawhorledcutsurface,focalareasofhemorrhage,andirregularcalcifiation.Athistologicexamination,interlacingbundlesofspindlecellswithoutnuclearpleomorphismormitoticfiuresmaybeidentifid(Fig7a).Tumorcellsshowimmunoreactivitytosmoothmusclemarkerssuchasac

4、tinanddesmin.Figure7.Renalleiomyomaina39-year-oldwoman.(a)Photomicrograph(originalmagnifiation,×40;hematoxylin-eosinstain)ofaleiomyomaofthekidneyshowsfasciclesofsmoothmuscle(arrows)adjacenttorenaltubules(arrowheads).RadiologymanifestationRenalleiomyoma

5、appearsasawell-circumscribedperipherallylocatedhyperattenuatingsolidmassonCTimagesobtainedwithoutcontrastmaterial(Fig7b).ThetumortypicallydemonstratesrelativelyhomogeneousenhancementonCTimagesobtainedaftertheadministrationofcontrastmaterial(Fig7c).Larg

6、etumorsmayshowareasofhemorrhageandcysticormyxoiddegeneration.Inadditiontodemonstratinghyperattenuationonnon-enhancedCTimages,renalleiomyomatypicallyhasaperipherallocation,well-defiedmargins,andassociatedbucklingoftherenalcortex.Althoughnotpathognomonic

7、forarenalleiomyoma,thecombinationofthesefindingsshouldprompttheinclusionofleiomyomainthedifferentialdiagnosis.AtMRimaging,leiomyomatypicallyhashomogeneouslylowsignalintensityonT1-andT2-weightedimages.Largertumorsareindistinguishablefromrenalcellcarcino

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