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肾平滑肌瘤课件

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肾平滑肌瘤课件 Renalleiomyomaisararebenigntumorthatisfoundinapproximately5%ofthespecimensfromautopsy.Thistumormayarisefromsmoothmusclecellsoftherenalcapsule,themuscularisoftherenalpelvis,orcorticalvascularsmoothmuscles,withtherenalcapsulebeingthemostcommonsite. Renalleiomyo...

肾平滑肌瘤课件
Renalleiomyomaisararebenigntumorthatisfoundinapproximately5%ofthespecimensfromautopsy.Thistumormayarisefromsmoothmusclecellsoftherenalcapsule,themuscularisoftherenalpelvis,orcorticalvascularsmoothmuscles,withtherenalcapsulebeingthemostcommonsite. Renalleiomyomasaremostcommonlyfoundinwhitewomen.Mostleiomyomasaresmallandareasymptomatic.Largeleiomyomasmaymanifestwithapalpableflankmassandpain.Atmacroscopicexamination,renalleiomyomaisasolidwell-circumscribedencapsulatedmasswithawhorledcutsurface,focalareasofhemorrhage,andirregularcalcifiation.Athistologicexamination,interlacingbundlesofspindlecellswithoutnuclearpleomorphismormitoticfiuresmaybeidentifid(Fig7a).Tumorcellsshowimmunoreactivitytosmoothmusclemarkerssuchasactinanddesmin.Figure7.Renalleiomyomaina39-year-oldwoman.(a)Photomicrograph(originalmagnifiation,×40;hematoxylin-eosinstain)ofaleiomyomaofthekidneyshowsfasciclesofsmoothmuscle(arrows)adjacenttorenaltubules(arrowheads).Renalleiomyomaappearsasawell-circumscribedperipherallylocatedhyperattenuatingsolidmassonCTimagesobtainedwithoutcontrastmaterial(Fig7b).ThetumortypicallydemonstratesrelativelyhomogeneousenhancementonCTimagesobtainedaftertheadministrationofcontrastmaterial(Fig7c).Largetumorsmayshowareasofhemorrhageandcysticormyxoiddegeneration.Inadditiontodemonstratinghyperattenuationonnon-enhancedCTimages,renalleiomyomatypicallyhasaperipherallocation,well-defiedmargins,andassociatedbucklingoftherenalcortex.Althoughnotpathognomonicforarenalleiomyoma,thecombinationofthesefindingsshouldprompttheinclusionofleiomyomainthedifferentialdiagnosis.AtMRimaging,leiomyomatypicallyhashomogeneouslylowsignalintensityonT1-andT2-weightedimages.Largertumorsareindistinguishablefromrenalcellcarcinomaandleiomyosarcomawithimagingstudies. Themaindifferentialdiagnosisisusuallymadewithangiomyolipomaofthekidney(AML).MostAMLsarecomposedofavariablemixtureofmaturefat,thickwalledbloodvesselsandsmoothmuscle,buttherearetimeswhenonlyasmoothcomponentisthemostrepresented.AMLsarecharacterizedbyaco-expressionofmelanocyticmarker(HMB45)andsmoothmusclemarkers.Currently,thedifferentialdiagnosisbetweenleiomyomaandleiomyosarcomaisonlyhistopathologicalafternephrectomybecausetheradiologicalaspectisnotdirimentinthediagnosis. Ultrasonographicevaluationdetectsleiomyomaasanhypoechoiclesionthatcouldappearsolidorcystic.CTscanfeaturesarehelpfulforthedifferentialdiagnosis.Thefirstfeatureisdensity.Allleiomyomasexaminedbeforecontrastwerehyperdensecomparedtothekidney,withdensitysimilartomuscles.Aftercontrastmediuminjection,thelesionshadalowerenhancementthansurroundingrenalparenchyma.Thesecondandfinalfeatureislocalizationandmargins.Usually,theselesionshaveaperipherallocationwithwell-definedmargins,withnosignsofinfiltrationintosurroundingtissues.Renalleiomyomasarebenignandtheirbehaviourisnotaggressive.Theydonotmetastasize.Theprognosis,aftersurgery,isexcellentwithoutrecurrence.Thedifferentialdiagnosisisstillpossiblebyhistologicalexamination.
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