腹膜后原发上皮样血管肉瘤1例

Journal of China Clinic Medical Imaging（2023）

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Abstract

病例女,44岁,因左侧腰痛伴血尿进行性加重2月入院.病程中患者未诉尿频、尿急、尿痛、腹痛、腹胀、恶心、呕吐等不适.体格检查:左侧肾区叩击痛,双侧输尿管走行区及膀胱区无压痛、叩击痛.实验室检查无特殊. 腹部CT提示左肾下方腹膜后至髂窝区可见一巨大类圆形软组织密度影、边界欠清,大小约13.4cmx9.1 cmx6.7 cm,平扫CT值约为35 HU,范围7～67 HU,增强扫描呈轻度不均匀强化,延迟期肿瘤实质部分持续强化.内部散在液化坏死区,左侧腰大肌可见小钙化斑,病灶与腰大肌、髂腰肌、左侧输尿管及左侧卵巢静脉分界不清,并推移左侧髂总动脉;左肾盂-输尿管上段轻度积水,壁增厚明显,左侧泌尿系可见双"J"管留置.CT诊断考虑左侧腰大肌间叶组织来源恶性病变,横纹肌肉瘤可能,左侧输尿管中段壁增厚明显并与腹膜后肿块分界不清,考虑受侵.

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