On the differential diagnosis of renal cell carcinoma

Because there are a variety of renal cell carcinoma imaging examination methods, No more preoperative diagnosis difficult. But the misdiagnosis and mistreatment still occur from time to time, sometimes causing irreparable mistake, it is necessary to pay close attention to. 1. Renal cysts: a typical renal cysts on the imaging of renal cell carcinoma is very easy to identify with, but when there are cyst bleeding or infection, often easily be misdiagnosed as cancer. Some of renal cell carcinoma internal uniformity, the hypoechoic was very weak, when in the medical screening very easily be misdiagnosed as common renal cysts. Cloix reported 32 cases of "complex cystic renal footprint" surgical exploration results and found that 41 of renal cell carcinoma. For irregular wall thickening, the center higher density benign renal cyst, a single application of any of these inspection methods are more difficult to identify, often require comprehensive analysis, judgment, if necessary, in the downlink ultrasound-guided biopsy. To give up easily or reckless conduct follow-up surgery is not advisable. 2. Renal angiomyolipoma: also known as renal angiomyolipoma, is a more common benign tumor of the kidney, along with the general imaging examination carried out, more and more common in clinical. Typical hamartoma in fat composition due to the existence of the ultrasound, CT and MRI images can be made on the diagnosis, clinical and renal cell carcinoma easy to identify. Renal angiomyolipoma ultrasonography showed a mass in the strong echoes within the district, CT CT showed a mass in the region, the negative value, enhanced scan after still negative, angiography showed that injection of adrenalin after renal tumor angiogenesis and vascular itself together contraction; renal cell carcinoma for the B-show in the hypoechoic mass, the mass of normal renal parenchyma CT, contrast-enhanced CT value after the increase, but obviously not normal renal tissue, angiography showed that the kidney after injection of epinephrine itself vasoconstriction, but not tumor vascular contraction, the more obvious characteristics of tumor blood vessels. We can see that, kidney and renal angiomyolipoma crux of the differential renal cell carcinoma with no adipose tissue and hamartoma with adipose tissue. But a few cases, renal cell carcinoma will result in containing adipose tissue, causing misdiagnosis. Also, with less fat composition of hamartoma was misdiagnosed as it is not uncommon renal cell carcinoma. By 1984-1996, I treated 49 cases of hamartoma patients, 11 cases because of preoperative ultrasonography as hypoechoic and (or) in the high-density CT for tumor was diagnosed as renal cell carcinoma. A misdiagnosis of the reasons: Some hamartoma constituted mainly by the smooth muscle, less fat ingredients; of internal bleeding, conceal fat composition, by ultrasonography and CT is unable to distinguish between tumor small volume, because volume effect, CT difficult to measure the true tumor density. For such situations, and do TLC CT scan and, if necessary, ultrasound-guided needle aspiration cytology may help diagnosis. Also writer believes that hamartoma adipose tissue hemorrhage conceal the CT features relatively significant, but the results of the B-interference less. 3. Kidney lymphoma: kidney lymphoma rare but not unusual. Dimopoulos and other reports, in 210 cases of kidney cancer patients, six cases of primary renal lymphoma. Kidney lymphoma in the lack of imaging characteristics of a multiple nodular or diffuse moist kidney, kidney shape to increase. More retroperitoneal lymph node involvement. In recent years, I have treated four cases of patients in the three cases of preoperative diagnosis has not been another one cases on preoperative biopsy confirmed this disease. 4. Kidney Xanthogranulomatous: is a rare serious chronic renal parenchymal infection special type. There are two kinds of morphological manifestations: as a diffuse, kidney volume increased, abnormal morphology, and internal structure of disorder, it is not easy to confuse with the tumor; another for Focal, kidney appeared limitations substantive nodular Echo , the lack of specificity, and sometimes difficult to identify tumor. But some patients generally have symptoms of infection, kidney and tenderness of the area can be mass, a large number of leukocytes in urine. As long as careful observation, differential diagnosis is not difficult.