儿童肾透明细胞肉瘤与肾母细胞瘤的增强CT对照研究

A comparative study of clear cell sarcoma of the kidney and Wilms’ tumor in children by contrast-enhanced computed tomography

摘要:

目的：比较分析儿童肾透明细胞肉瘤（clear cell sarcoma of the kidney，CCSK）与良好组织分化型（favorable histology，FH）Wilms’瘤（Wilms’ tumor，WT）患儿的主要CT征象，以期发现可资鉴别的影像学特征。方法：收集我院2013年3月至2018年6月病理确诊的22例CCSK患儿的临床、影像和病理资料，以同一时期44例WT（FH）连续病例作为对照，提炼并分析2组疾病的8个CT主要影像特征。数据由统计软件SPSS 17.0使用卡方检验进行统计分析，并对P值进行Bonferroni校正。复习具有统计学差异的影像特征的患儿病理切片。结果：对2组患儿的8个CT影像征象的数据分析显示，仅“肿块边缘小囊征”的发生率具有统计学差异（?字2=7.857，P=0.040，Bonferroni校正后），CCSK和WT的95%可信区间分别为0.32~0.77和0.08~0.33，提示该征象可能对CCSK和WT的鉴别诊断有临床意义。病理研究显示，小囊状结构为水样囊腔，囊壁由单层上皮或复层上皮构成，符合集合小管或肾盏的解剖特点。结论：CCSK与WT（FH）有许多共同的CT影像特点，术前鉴别诊断困难。“肿块边缘小囊征”可能是诊断CCSK有潜在诊断意义的CT征象。

Abstract:

Objective：To compare the major computed tomography（CT） imaging features between clear cell sarcoma of the kidney（CCSK） and favorable histology（FH） Wilms’ tumor（WT） in children，and to identify imaging features for distinguishing between these two diseases. Methods：The clinical，imaging，and pathological data were collected from 22 children pathologically diagnosed with CCSK in our hospital from March 2013 to June 2018. Within the same period，44 consecutive children with WT（FH） were used as controls. Eight major CT imaging features were identified and analyzed in the two groups. The statistical analysis of the data was performed by chi-square test using SPSS 17.0. P-values were adjusted by Bonferroni adjustment. The pathological tissue sections that were significantly different from others were further reviewed. Results：Among the eight major CT imaging features，only the incidence of the sign of “dilated peritumoral cysts” showed a significant difference between the two groups（?字2=7.857，Bonferroni-adjusted P=0.040，95% confidence interval：0.32-0.77 for CCSK and 0.08-0.33 for WT），suggesting that this feature might have clinical signifi－cance in distinguishing between CCSK and WT. The pathological study demonstrated that the structure of the small cyst was a liquid-containing cavity with monolayer or multilayer epithelial cells lining the cyst wall，which accorded with the anatomical features of col－lecting tubules or renal pelvis. Conclusion：It is hard to distinguish CCSK from WT（FH） in preoperative diagnosis because they share many common CT imaging features. “Dilated peritumoral cysts” may be a CT feature with potential significance in the diagnosis of CCSK.