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肾癌胆囊转移

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发表于 2018-5-16 21:40:54 | 显示全部楼层 |阅读模式

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N2qIi6yOIR109fRf.jpg 影像学园
资料库,助力影像专业学习
关注 F0V53A0Jb3kJjPnG.jpg 【双语病例】 Gallbladder metastasis from renal cell carcinoma

双语学影像;病例选自《Mayo Clinic Body MRI Case Review》
OJCA7efC511p3jfG.jpg
History
80-year-old man with right upper quadrantpain and elevated liver functiontests; abdominal US performed at an outside institution showed a mass in the gallbladder
80岁男性,右上腹痛,实验室检查肝功能升高。外院超声示胆囊肿块。
Fig 3.7.1:
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Fig 3.7.2:
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Fig 3.7.3:
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Imaging Findings
Arterial (Figure 3.7.1), portal venous (Figure 3.7.2), and equilibriumphase (Figure 3.7.3) post gadolinium 3D SPGR images demonstrate a hyperenhancing masswithin the gallbladder lumen. Note also the large heterogeneous mass seen in the upper poleof the right kidney.
3D SPGR增强扫描动脉期(Figure 3.7.1)、门脉期(Figure 3.7.2)、平衡期(Figure 3.7.3)示胆囊腔内可见强化的软组织肿块。右肾上极可见一巨大不均质肿块。
Diagnosis
Gallbladder metastasis from renal cell carcinoma

肾癌胆囊转移

j2IBPzlssuz3255Z.jpg
Comment
Metastatic disease in the clinical setting of RCC is unfortunately fairlycommon. At the time of diagnosis, approximately one-third of patients have metastases, and the prognosis in this group is poor, with 5-year survival rates of 5% to 10%. Gallbladder metastases, on the other hand, are extremely rare,documented in only 0.6% of cases in a large autopsy review. They seem to be a little more common in our practice. We recently reviewed 60 cases of RCC and found gallbladder metastases in 3 patients, so it’s probably worth keeping an eye on the gallbladder when performing MRIs of patients with renal masses. A review of 24 cases of metastatic RCC to the gallbladder noted that in nearly all patients, the appearance was of a hyperenhancing polypoid mass, with the major differential diagnosis being gallbladder carcinoma. The presence of a large renal mass, as seen in this case, and the knowledge that RCC is notorious for spreading to virtually every organ make the diagnosis of gallbladder metastasis straight forward.
肾细胞癌转移临床非常多见,初诊时已有约1/3的患者发现转移,而且这类患者预后一般很差,5年生存率仅为5%-10%左右。而另一方面,胆囊的转移癌则非常少见,一组大宗病例的尸检报告指出,胆囊转移瘤仅占全部的0.6%。我们实际工作中遇到的胆囊转移瘤病例的情况略高于这个比例,最近一段时间我们遇到了60例RCC病例,其中3例有胆囊转移瘤,所以当我们以后工作中遇到RCC患者时,还是有必要注意一下胆囊有无病变。
一组24例RCC胆囊转移瘤的病例分析认为:几乎所有的RCC转移瘤均表现为胆囊壁息肉样肿块,增强扫描明显强化,这是与胆囊癌的主要鉴别点。
本例病例,我们可以看到肾脏的大肿块,而且肾癌恶性程度较高,可以转移到全身几乎所有脏器,所以胆囊转移瘤的诊断比较明确。
Some benefit may be gained in resecting metastases in patients with RCC,particularlysolitary lesions, in whom 5-year survival rates of 40% to 50% have been reported. A similar survival trend is noted in the series on gallbladder metastases; no patient who underwent cholecystectomy was reported to have local recurrence in the liver or bile ducts.
肾细胞癌转移灶切除还是有一定临床意义的,特别是孤立性病灶,据文献报道,切除后5年生存率能达到40%-50%。
另一组关于胆囊转移瘤的类似的研究指出:采取胆囊切除术的患者没有一例发现肝脏或胆道的复发。
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