신선암의 방사선학적 영상에 관한 고찰

Abstract

[한글]

신선암은 성인에 있어서 신장암의 85-90%를 차지하고 있으며 그 임상적인 경과는 매우 다양하여 예측하기가 어려운데, 예후에 관계되는 인자로서 Charles와 Richard(1981)는 조직학적인 세포형에 따라 투명세포형이 가장 좋고 과립세포형, 방추세포형이 순으로 좋다

고 하며 Mancilla-Jimenez등(1976)은 조직학적인 성장유형을 따라 분류하여 유두상신선암이 비유두상신선암에 비하여, 진단시의 병기가 이르고, 같은 병기인 경우에도 5년 생존율이 더 높은 것을 보고하였다.

이에 저자는 신선암의 조직학적 세포형이나 성장유형과 신동맥촬영상의 혈관상, 초음파검사상 에코양상이 어떠한 관계가 있는지 알아보기 위하여 53예의 신선암환자중 초음파검사를 받은 28예와 신동맥촬영를 받은 26예를 대상으로 고찰해본 결과 다음과 같은 결론을 얻었다.

신선암의 석회화의 빈도는 7예(13%)였고 조직학적 세포형에 따른 빈도는 세포형을 알 수 있었던 36예중 투명세포형 20예(56%), 혼합세포형 11예(31%), 과립세포형 4예(11%), 육종성 세포형 1예(2%)였다.

신선암의 조직학적 성장유형에 따른 빈도는 성장유형을 알 수 있었던 31예중 유두상신선암이 14예(45%), 비유두상신선암이 17예(55%)였다.

신동맥촬영상 과혈관성신선암인 경우가 26예중 19예(73%)였고 저혈관성신선암인 6예(23%)는 모두 종양주변비정상혈관을 보였다.

신동맥촬영상 혈관상 조직학적 성장유형사이에는 특별한 상관관계를 찾을 수 없었으나 저혈관성인 경우에는 투명세포형신선암인 빈도가 높았다.

과혈관성신선암인 경우에는 높은에코우세형인 빈도가 높았고 저혈관성신선암인 경우에는 낮은에코우세형인 빈도가 높았다.

투명세포형신선암은 낮은에코우세형인 빈도가 높았다.

낮은에코우세형인 경우에는 유두상신선암인 빈도가 높았고 높은에코우세형인 경우에는 비유두상신선암인 빈도가 높았다.

이상을 종합해 보면 투명세포형신선암인 경우 신동맥촬영상 저혈관성인 빈도가 높았고, 저혈관성인 경우는 초음파사진상 낮은에코우세형인 빈도가 높았으며, 낮은에코우세형인 경우에는 유두상신선암이 많아서, 조직학적으로는 투명세포형신선암과 유두상신선암이 예후가 좋다는 Charles와 Richard(1981), Mancilla-Jimenez등(1976)의 보고에 따르면 신동맥촬영상 저혈관성인 신선암과 초음파검사상 낮은에코우세형인 신선암은 예후가 좋다고 제시할 수 있는 것으로 사료된다.

Radiologic Imaging of Hypernephroma

Sung Yee Choo

Department of Medical Science, The Graduate School, Yonsei University

(Directed by Professor Chang Yoon Park, M.D.)

Hypernephroma comprises about 85-90% of renal malignancy in adults. The natural

course of hypernephroma is very diverse and unpredictable from abrupt explosive

growth with wide spread metastasis to asymptomatic slow growth for several years.

Reports from aliens indicated that hypernephroma with histopathological papillary

growth pattern has better prognosis and more frequently hypovascular on renal

angiography and less echogenic on ultrasonography than non-papillary hypernephroma.

Reviewed there retrospectively all the patients who were admitted and diagnosed

as hypernephroma histopathologically at the Severance Hospital from March, 1973

through September, 1984, in respective of angiographic vascularity,

ultrasonographic echogenicity, histopathologic cell type and growth pattern, and

following results were obtained.

1. The incidence of calcification in hypernephroma was 7 cases out of 53

cases(13%).

The incidence of hypernephroma according to cell type was clear cell type 20

cases (56%), mixed cell type 11 cases (31%), granular cell type 4 cases (11%),

sarcomatous cell type 1 case (2%).

The incidence of hypernephroma according to growth pattern was papillary growth

pattern 14 cases (45%) and non-papillary growth pattern 17 cases (55%).

2. Renal angiographically, hypervascular hypernephroma was 19 cases (73%),

hypovascular hypernephromas was 6 cases (23%), all of which showed abnormal

marginal vessels.

3. Angiographically hypervascular hypernephroma had high incidence of

predominantly high echogenicity and angiographically hypovascular hypernephroma had

high incidence of predomiantly low echogenicity.

4. Clear cell type hypernephroma had high incidence of predomintly low

echogenicity on ultrasonography.

5. Predominantly low echogenic hypernephroma had high incidence of papillary

growth pattern and predominantly high echogenic hypernephroma had high incidence of

non-papillary growth pattern.

In summary, clear cell type hypernephroma had high incidence of hypovascularity

angiographically and hypovascularity on angiography was correlated with

predominantly low echogenicity on ultrasonography, and predominantly low

echogenicity had high incidence of papillary hypernephroma which was reported to

have more good prognosis than non-papillary hypernephroma. So, it can be suggested

that if a hypernephroma show hypovascularity on angiography or predominantly low

echogenicity on ultrasonography, it has a good prognosis than hypervascular or

predominantly high echogenic hypernephroma.

[영문]

Hypernephroma comprises about 85-90% of renal malignancy in adults. The natural course of hypernephroma is very diverse and unpredictable from abrupt explosive growth with wide spread metastasis to asymptomatic slow growth for several years.

Reports from aliens indicated that hypernephroma with histopathological papillary growth pattern has better prognosis and more frequently hypovascular on renal angiography and less echogenic on ultrasonography than non-papillary hypernephroma.

Reviewed there retrospectively all the patients who were admitted and diagnosed as hypernephroma histopathologically at the Severance Hospital from March, 1973 through September, 1984, in respective of angiographic vascularity, ultrasonographic echogenicity, histopathologic cell type and growth pattern, and

following results were obtained.

1. The incidence of calcification in hypernephroma was 7 cases out of 53 cases(13%).

The incidence of hypernephroma according to cell type was clear cell type 20 cases (56%), mixed cell type 11 cases (31%), granular cell type 4 cases (11%), sarcomatous cell type 1 case (2%).

The incidence of hypernephroma according to growth pattern was papillary growth pattern 14 cases (45%) and non-papillary growth pattern 17 cases (55%).

2. Renal angiographically, hypervascular hypernephroma was 19 cases (73%), hypovascular hypernephromas was 6 cases (23%), all of which showed abnormal marginal vessels.

3. Angiographically hypervascular hypernephroma had high incidence of predominantly high echogenicity and angiographically hypovascular hypernephroma had high incidence of predomiantly low echogenicity.

4. Clear cell type hypernephroma had high incidence of predomintly low echogenicity on ultrasonography.

5. Predominantly low echogenic hypernephroma had high incidence of papillary growth pattern and predominantly high echogenic hypernephroma had high incidence of non-papillary growth pattern.

In summary, clear cell type hypernephroma had high incidence of hypovascularity angiographically and hypovascularity on angiography was correlated with predominantly low echogenicity on ultrasonography, and predominantly low echogenicity had high incidence of papillary hypernephroma which was reported to

have more good prognosis than non-papillary hypernephroma. So, it can be suggested that if a hypernephroma show hypovascularity on angiography or predominantly low echogenicity on ultrasonography, it has a good prognosis than hypervascular or predominantly high echogenic hypernephroma.