renal hamartoma
Introduction
Introduction to renal hamartoma Renal angiomyolipoma (renal dysplasia) may be associated with tuberous sclerosis. This is an autosomal dominant gene, a hereditary familial disease. 80% of patients have butterfly-like sebaceous adenomas on the face, other organs such as the brain and eyes. There are also lesions in the bones, heart and lungs. Brain development retardation, poor intelligence, seizures, mostly multiple kidneys. The vast majority of vascular smooth muscle lipomas in China are not associated with tuberous sclerosis, 80% of which are female, and the condition is 20-50 years old, and the majority after 40 years old. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: Hypertension, pyelonephritis
Cause
Cause of renal hamartoma
(1) Causes of the disease
The cause is still unclear. Kidney hamartoma is divided into two types:
1 with nodular sclerosis: no disease, bilateral, small tumor, multiple, small age of onset.
2 do not have nodular sclerosis: often have a conscious condition, multiple or single, unilateral, large tumor, age of onset is also large, the above is the classification in the 1960s, with the advancement of imaging, especially the popularity of ultrasound , no nodular sclerosis can also be found as bilateral kidney, multiple, small lesions, no clinical symptoms, the current clinically seen renal hamartoma is often found by physical examination, the symptoms are not obvious.
(two) pathogenesis
Renal hamartoma is often bilateral, yellow or gray, often accompanied by hemorrhage, necrosis, cystic changes, calcification, the tumor is named for three major components, namely blood vessels, fat cells and smooth muscle, despite malignant reports, it is currently considered Extrarenal or lymph node involvement reflects the multicenter of the tumor, not the metastasis, which is a criterion for malignancy.
Prevention
Renal hamartoma prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease. Due to the immature blood vessels in the components of the hamartoma, the tumor may suddenly rupture, causing tumor bleeding. The patient presents with acute abdominal pain. If there is more bleeding, there may even be shock. Therefore, it is necessary to be vigilant when the above symptoms occur. Come to the hospital in time.
Complication
Renal hamartoma complications Complications, hypertension, pyelonephritis
The patient may have hypertension, pyelonephritis and the like.
Symptom
Renal hamartoma symptoms common symptoms urinary frequency proteinuria back pain, shock, hematuria, gastrointestinal symptoms, mental retardation
Urinary manifestation
Small lesions can be asymptomatic, often found accidentally during physical examination such as B-ultrasound or CT examination. Large tumors may have gastrointestinal symptoms due to compression of the duodenum or stomach. If they are caused by spontaneous rupture, they may cause tumors or tumors. Peripheral bleeding can cause pain in the lower back and even sudden pain. In severe cases, shock can occur in a short period of time, and hematuria is less common.
2. Extrarenal performance
Sebaceous adenoma with facial butterfly distribution, epilepsy, mental retardation, etc.
According to the above symptoms and signs, combined with imaging examination can confirm the diagnosis.
Examine
Renal hamartoma
As the tumor is close to the collecting system, it can cause hematuria after rupture, and urine can have occult blood. The renal dislocation tumor can have hypertension, renal insufficiency, and abnormality of serum creatinine and urea nitrogen.
1. B super is quite characteristic, the fat and blood vessels in the tumor show a dense and high echo area with uniform distribution, and the muscle and the bleeding part show the hypoechoic area.
2. X-ray Abdominal plain film see the kidney outline is unclear, the waist muscle shadow disappears, the kidney area has calcification, the urography can be seen that the tumor compresses the renal pelvis, the renal pelvis, deforms, stretches, shortens, etc., but there is no erosion.
3. CT is the main method for diagnosing renal hamartoma. It is a mass with uneven density. The T value is more fat, C-40-90Hu.
Diagnosis
Diagnosis and diagnosis of renal hamartoma
Diagnose based on
1. The above symptoms and signs;
2. Urinary angiography shows space-occupying lesions;
3. Ultrasound examination showed renal parenchymal space-occupying lesions, mostly hyperechoic masses.
4. CT examination showed a substantial occupying lesion in the kidney and a fat component with a low CT value.
5. Renal angiography showed irregular tumor blood vessels, mostly small arteries, without arteriovenous fistula.
Differential diagnosis
1. Renal cell carcinoma also manifests as low back pain, lumbar and abdominal masses and hematuria, but the painless interdental gross hematuria is more obvious. It is often found that the lumbar and abdominal masses are late, and those with shock and acute abdomen due to tumor rupture are rare. Ultrasound examination often showed hypoechoic or uneven echo. Renal angiography showed an increase in renal shadow and contrast agent aggregation. IVU showed more damage to renal pelvis and renal pelvis. CT showed uneven density in the kidney and irregular edges. The solid mass of the surrounding normal tissue is unclear. The CT value of the mass is slightly lower than that of the normal renal parenchyma. The enhanced CT shows that the CT value of the mass is higher than that of the normal renal parenchyma.
2. The main clinical manifestation of nephroblastoma is a progressively enlarged abdominal mass, but it occurs mostly in children. The disease progresses rapidly with cachexia. Ultrasonography is a small scattered echogenic spot. IVU shows renal pelvis. There is a significant damage or loss.
3. Polycystic kidney low back pain and lumbar and abdominal masses are similar to this disease, but the course of the disease is slow, hematuria, hypertension and renal dysfunction are more obvious. IVU shows double kidney shadow, irregular edge, renal pelvis elongation, Deformation, ultrasonography examination of multiple rounded anechoic dark areas in the renal parenchyma, CT examination showed an increase in both kidneys, and most cystic masses with smooth edges and varying sizes were seen in the renal parenchyma.
4. Abdominal parenchymal organ rupture manifested as sudden abdominal pain, rebound tenderness and abdominal muscle tension, resulting in shock due to severe bleeding, easily confused with spontaneous rupture of renal hamartoma, but the original dirty before bleeding Lesions, such as liver cancer, trauma or strenuous activity is often the cause of rupture and bleeding, no hematuria, IVU shows normal renal pelvis and renal sputum, ultrasound examination of the kidney as a normal sound image.
