Pregnancy complicated with giant renal hamartoma misdiagnosis：a case report with literature review
-
摘要:
目的 探讨妊娠合并肾巨大错构瘤患者的诊治经过，分析其容易导致漏诊及误诊的原因，为临床提供借鉴。 方法 回顾性分析１例妊娠合并肾巨大错构瘤患者的病例资料及诊治经过，并结合相关文献进行分析。 结果 产妇剖宫产术后右上腹触及一肿块，超声提示后腹膜来源肿块，CT考虑脂肪肉瘤可能，错构瘤不排外。分娩4月后行瘤体剜除术，术后病理证实为错构瘤。 结论 妊娠合并肾巨大错构瘤一旦破裂同时威胁着孕妇与胎儿的生命，因此妇女在孕前应进行身体检查，有肾错构瘤病史的孕妇在孕期应加强对瘤体的监测，影像诊断医师需加强对此类疾病的认识。 Abstract: Objective To analyze the diagnosis and treatment of pregnancy complicated with renal giant hamartoma, and to explore the causes of misdiagnosis and misdiagnosis, and to provide reference for clinical treatment. Methods The clinical data, diagnosis and treatment of one cases of pregnancy complicated with giant renal hamartoma were retrospectively analyzed and analyzed in combination with related literature. Results After cesarean section abdominal palpated a mass, ultrasound retroperitoneal mass source, CT may not consider liposarcoma, hamartoma exclusion. For tumor enucleation in 4 months after delivery, postoperative pathology confirmed hamartoma. ConclusionAt the same time, threatening the pregnancy rupture in pregnant women and fetal life huge renal hamartoma, so women should perform physical examination before pregnancy, with renal hamartoma history of pregnant women should strengthen the monitoring of the tumor during pregnancy, diagnosis physicians need to strengthen the understanding of these diseases.-
Key words:
- renal hamartoma /
- pregnancy /
- misdiagnosis
-
[1] 张 凌, 刘艳萍, 黄文杰. 不典型肾血管平滑肌脂肪瘤的超声误诊分析[J]. 上海医学影像, 2009, 18(4): 288-90. http://d.wanfangdata.com.cn/Periodical/shyxyx200904006 [2] Siegel CL, Middleton WD, Teefey SA, et al. Angiomyolipoma and renal cell carcinoma:US differentiation[J]. Radiology, 1996, 198(3): 789-93. doi: 10.1148/radiology.198.3.8628873 [3] 徐作峰, 万广生, 谢晓燕, 等. 肾血管平滑肌脂肪瘤超声造影表现的研究[J]. 中国超声医学杂志, 2008, 24(11): 1046-8. doi: 10.3969/j.issn.1002-0101.2008.11.026 [4] 韩秀婕, 董宝玮, 郑 敏. 肾血管平滑肌脂肪瘤超声表现及病理对照分析[J]. 中华超声影像学杂志, 2003, 12(11): 697-8. doi: 10.3760/j.issn:1004-4477.2003.11.019 [5] 黄备建, 毛 枫, 俞 清, 等. 少脂肪肾错构瘤的超声造影表现[J]. 中国临床医学, 2010, 17(1): 126-8. http://d.wanfangdata.com.cn/Periodical/zglcyx201001044 [6] Xu ZF, Xu HX, Xie XY, et al. Renal cell carcinoma: real-time contrast-enhanced ultrasound findings[J]. Abdom Imaging, 2010, 35(6): 750-6. doi: 10.1007/s00261-009-9583-y [7] 唐光健, 许 燕. 肾血管平滑肌脂肪瘤与肾癌的CT鉴别诊断[J]. 中华放射学杂志, 2004, 38(10): 1090-3. doi: 10.3760/j.issn:1005-1201.2004.10.017 [8] 徐建玲, 黄继康. 肾血管平滑肌脂肪瘤自发性出血CT特征及鉴别诊断[J]. 实用医院临床杂志, 2008, 5(4): 107-8. http://d.wanfangdata.com.cn/Periodical/syyylczz200804050 [9] 张 雷, 范林音, 丁国军, 等. 肾脏乏脂肪血管平滑肌脂肪瘤与肾癌的MRI鉴别诊断[J]. 放射学实践, 2013, 28(9): 968-71. http://d.wanfangdata.com.cn/Periodical/fsxsj201309017 [10] 陈 雁, 朱 正, 戴景蕊, 等. 少脂肪良性肾脏血管平滑肌脂肪瘤的影像学表现[J]. 中国临床医学影像杂志, 2010, 21(10): 705-8. doi: 10.3969/j.issn.1008-1062.2010.10.007 [11] 杨 斌, 傅宁华, 沈德娟, 等. 超声造影对高回声肾肿瘤的诊断价值[J]. 中华超声影像学杂志, 2008, 17(10): 869-71. doi: 10.3321/j.issn:1004-4477.2008.10.013 [12] Nese N, Martignoni G, Fletcher CD, et al. Pure epithelioid PEComas (So-Called epithelioid angiomyolipoma) of the kidney: a clinicopathologic study of 41 cases: detailed assessment of morphology and risk stratification[J]. Am J Surg Pathol, 2011, 35(2): 161-76. doi: 10.1097/PAS.0b013e318206f2a9 [13] 邹万忠. 2004 年WHO肾脏肿瘤组织学分类简介[J].中华病理学杂志, 2006, 35(9): 517-9. http://d.wanfangdata.com.cn/Periodical/zhblx200609002 [14] Brimo F, Robinson B, Guo C, et al. Renal epithelioid angio-myolipoma with atypia: a series of 40 cases with emphasis on clinicopathologic prognostic indicators of malignancy[J]. Am J Surg Pathol, 2010, 34(5): 715-22. [15] 曲 宁, 罗娅红, 于 韬. 肾脏上皮样血管平滑肌脂肪瘤的MSCT表现(附6例报告)[J]. 医学影像学杂志, 2016, 26(2): 284-6. http://d.wanfangdata.com.cn/Periodical/yxyxxzz201602029 [16] 庞 聪, 庞 蕾, 李春艳, 等. 磁共振成像导航系统引导下氩氦刀冷冻介入治疗18例肾错构瘤[J]. 现代泌尿外科杂志, 2014, 19(11): 743-5. http://d.wanfangdata.com.cn/Periodical/xdmnwkzz201411013 [17] 周海生, 张爱伟, 郑汉朋, 等. 肾脏乏脂肪血管平滑肌脂肪瘤的CT和MRI表现[J]. 医学影像学杂志, 2014, 24(2): 268-71. http://d.wanfangdata.com.cn/Periodical/yxyxxzz201402034 [18] 朱庆强, 朱文荣, 吴晶涛, 等. XP11.2/TFE易位基因融合相关性肾癌与乳头状肾细胞癌的CT和MRI鉴别诊断[J]. 中华医学杂志, 2014, 94(19): 1470-2. doi: 10.3760/cma.j.issn.0376-2491.2014.19.010 [19] Kochhar R, Brown RK, Wong CO, et al. Role of FDG PET/CT in imaging of renal lesions[J]. J Med Imaging Radiat Oncol, 2010, 54(4): 347-57. doi: 10.1111/ara.2010.54.issue-4 [20] 史 青, 王雪莉, 张 彬, 等. 儿童肾脏上皮样血管平滑肌脂肪瘤病理特点[J]. 临床与实验病理学杂志, 2012, 28(3): 328-9. http://d.wanfangdata.com.cn/Periodical/lcysyblxzz201203025 [21] 罗成华. 腹膜后肿瘤[M]. 北京: 人民卫生出版, 2012. [22] 黄晓辉, 李沛雨, 赵旭东, 等. 原发性腹膜后脂肪肉瘤治疗策略[J]. 中国实用外科杂志, 2013, 33(2): 156-8. [23] 陈文, 范钦和, 刘 冲. 脂肪肉瘤中AFAP1L1和AFAP1的表达及意义[J]. 临床与实验病理学杂志, 2013, 29(3): 292-6. http://d.wanfangdata.com.cn/Periodical/lcysyblxzz201303016 [24] 潘历波, 赵学武, 樊 涛, 等. 原发性腹膜后脂肪肉瘤的CT诊断[J]. 现代肿瘤医学, 2013, 21(6): 1344-7. http://d.wanfangdata.com.cn/Periodical/lcfsxzz200701012 [25] 中国研究型医院学会腹膜后与盆底疾病专业委员会. 腹膜后脂肪肉瘤诊断和治疗专家共识(2016)[J]. 中国微创外科杂志, 2016, 16(12): 1057-63. doi: 10.3969/j.issn.1009-6604.2016.12.001 [26] Ogawa S, Hida JI, Ike H, et al. Selection of lymph Node-Positive cases based on perirectal and lateral pelvic lymph nodes using magnetic resonance imaging: study of the Japanese society for Cancer of the colon and rectum[J]. Ann Surg Oncol, 2016, 23(4): 1187-94. doi: 10.1245/s10434-015-5021-2 [27] 杨建军, 吴丹西, 言莱菁. 超声和CT对巨大肾血管平滑肌脂肪瘤的对照研究[J]. 中国超声诊断杂志, 2005, 6(4): 277-9. http://d.wanfangdata.com.cn/Periodical/zgcszdzz200504014 [28] Salvi PF, Bellot TC, Giulii CM, et al. Renal giant angiomyolipoma in tuberous sclerosis complex:case report and literature review[J]. Chir, 2005, 26(11/12): 411-4. [29] 吉 梅, 林流芳, 刘玉环, 等. 妊娠合并双肾巨大错构瘤及子宫血管周上皮样瘤剖宫产分娩1例报告[J]. 第二军医大学学报, 2012, 33(5): 577-9. http://d.wanfangdata.com.cn/Periodical/dejydxxb201205029 [30] Komeya M, Matsumoto T, Fujinami K, et al. Rupture of renal angiomyolipoma during pregnancy:a case report[J]. Hinyokika Kiyo, 2010, 56(9): 261-4. [31] Rothberg BE, Grooms MC, Dharnidharka VR. Rapid growth of a kidney angiomyolipoma after initiation of oral contraceptive therapy[J]. Obstet Gynecol, 2006, 108(3, 2): 734-6. -
下载:
点击查看大图
图(3)
计量
- 文章访问数: 627
- HTML全文浏览量: 299
- PDF下载量: 2
- 被引次数: 0
