Background/Objectives: Infiltrative renal masses, characterized by ill-defined margins and parenchymal invasion without forming a discrete mass, present a diagnostic challenge, particularly in patients without a prior history of malignancy. Differentiating among the most common malignant etiologies—renal cell carcinoma (RCC), urothelial carcinoma (UC), and lymphoma—is essential for guiding appropriate treatment. This study aimed to evaluate whether specific computed tomography (CT) features can assist in the differential diagnosis of these lesions. Methods: A retrospective review was conducted on 68 patients with infiltrative renal masses presented at a tertiary hospital’s oncologic urology committee between 2018 and 2022. Patients with prior malignancy or signs of infection were excluded. All cases underwent contrast-enhanced CT within three months of diagnosis and had histopathological confirmation. Imaging features such as necrosis, collecting system involvement, lymphadenopathy, and others were assessed and statistically analyzed. Results: RCC was the most frequent diagnosis (68%), followed by UC (18%) and lymphoma (7.4%). Significant differences were observed in imaging features: necrosis was more common in RCC (87%) than in UC (25%) and lymphoma (20%),p< 0.001; collecting system involvement was universal in UC (100%) and less common in RCC (65%) and lymphoma (40%),p= 0.009; and lymphadenopathy was more frequent in lymphoma (80%) than in UC (67%) and RCC (35%),p= 0.038. Tumor size also varied significantly, with lymphomas presenting the largest median size (11 cm), followed by RCCs (8.2 cm) and UCs (5 cm),p< 0.001. Conclusions: CT imaging features, particularly necrosis, collecting system involvement, and lymphadenopathy, can aid in distinguishing among RCC, UC, and lymphoma in patients with infiltrative renal masses and no prior cancer history. These findings may support more accurate diagnoses and inform tailored therapeutic strategies.
背景/目的：浸润性肾肿块以边界不清、浸润肾实质而不形成明确肿块为特征，其诊断具有挑战性，尤其对于无恶性肿瘤病史的患者。鉴别最常见的恶性病因——肾细胞癌（RCC）、尿路上皮癌（UC）和淋巴瘤——对于指导恰当治疗至关重要。本研究旨在评估特定的计算机断层扫描（CT）特征是否有助于这些病变的鉴别诊断。方法：回顾性分析了2018年至2022年间在某三级医院肿瘤泌尿外科委员会讨论的68例浸润性肾肿块患者。排除了既往有恶性肿瘤史或感染迹象的患者。所有病例均在诊断后三个月内接受了增强CT检查，并获得了组织病理学确认。对坏死、集合系统受累、淋巴结肿大等影像学特征进行了评估和统计分析。结果：RCC是最常见的诊断（68%），其次是UC（18%）和淋巴瘤（7.4%）。影像学特征存在显著差异：坏死在RCC（87%）中比在UC（25%）和淋巴瘤（20%）中更常见，p < 0.001；集合系统受累在UC（100%）中普遍存在，在RCC（65%）和淋巴瘤（40%）中较少见，p = 0.009；淋巴结肿大在淋巴瘤（80%）中比在UC（67%）和RCC（35%）中更常见，p = 0.038。肿瘤大小也存在显著差异，淋巴瘤的中位尺寸最大（11厘米），其次是RCC（8.2厘米）和UC（5厘米），p < 0.001。结论：对于无既往癌症史的浸润性肾肿块患者，CT影像特征，特别是坏死、集合系统受累和淋巴结肿大，有助于区分RCC、UC和淋巴瘤。这些发现可能支持更准确的诊断，并为制定个体化治疗策略提供依据。
肿瘤(癌症)患者之家