威耳姆氏瘤之超音波及電腦斷層表徵

威耳姆氏瘤(Wilms' tumor)是幼兒常見的腹部惡性腫瘤。台中榮民總醫院自民國72年l月至80年7月止，共有18例經開刀與病理切片證實為威耳姆氏瘤的病人，其中13例於開刀前曾於本院接受腹部超音波檢查，全部為單側侵犯，腫瘤皆呈巨大卵圓形，且有平滑及界限清楚的外綠。腫瘤實質的回音從大致上均勻(homogeneous)到明顯的不均勻(heterogeneous)都有。所有的腫瘤皆有多處低回音或無回音區(multiple hypoechoic or anechoic areas)散布其內。13例中有5例含有高回音且伴有音影的點或區域。常見的圖樣可為三種型態：第一型有8例，可見到腫瘤由腎臟長出來，將殘留之正常腎臟撐開而呈所謂的爪形徵象(claw sign)。第二型有3例，只見到巨大腫瘤而找不到同側腎臟，且腫瘤並無鈣化者。第三型有2例，只見巨大腫瘤而找不到腎臟，且腫瘤有鈣化者。13例之中又有7例曾接受電腦斷層檢查。在對比劑注射後的影像中，腫瘤實質由均勻到不均勻都有。每一個腫瘤都有大小不一形狀不同、數目不等的壞死區，7例當中有3例有鈣化區。電腦斷層掃描比超音波更清楚的呈現腫瘤的外綠及與周圍組織的關係。電腦斷層顯示7例均為第一型腫瘤。一般而言，超音波是篩選診斷及手術後追蹤的主要檢查工具，但是當超音波的發現有疑問時，電腦斷層掃描是有幫助的。

關鍵字

腎臟腫瘤；腎臟超音波檢查；腎臟電腦斷層掃描；嬰幼兒泌尿生殖系統疾患

並列摘要

The ultrasound features of 13 cases of Wilms' tumor are presented. There were 7 males and 6 females, ranging in age from 5 months to 13 years with an average of 4.4 years. Tumors were generally oval in shape, well marginated and the size varied from 19x18x17 cm to 7x7x6 cm. The echotexture of the tumor varied from largely homogeneous to markedly heterogeneous, with multiple hypoechoic or anechoic areas which varied in size, shape and number. Eight tumors arising from renal parenchyma were well marginated; and claw sign was present in these cases. Three patients had huge tumors without remained normal renal tissue. In the other 2 patients scattered calcifications were identified in the tumor. We found IVC thrombosis in 2 cases and retroperitoneal lymph node metastasis in another 2 cases. CT scan was performed in 7 cases and was proved to be superior to ultrasound in defining tumor extents and depicting its relationships to surrounding structures. Moreover, CT scan identified two pattern-I tumors which were misclassified into pattern-Ⅱ and pattern-Ⅲ respectively by ultrasound. Ultrasound is the main method for primary diagnosis and follow-up study of this disease. If ultrasound findings are equivocal, CT scan is helpful.

並列關鍵字

kidney, neoplasm ； kidney, ultrasound ； kidney, CT ； children and infants, genitourinary system

國際替代計量

威耳姆氏瘤之超音波及電腦斷層表徵

全文下載

主題瀏覽