Differential diagnosis of TFE3-rearranged renal cell carcinoma and clear cell renal cell carcinoma based on dynamic-enhanced CT and clinical features

doi:10.3877/cma.j.issn.1674-3253.2025.03.008

Abstract

Abstract:

Objective

To compare the dynamic-enhanced computed tomography （DCE-CT）features and clinical features between TFE3-rearranged renal cell carcinoma （TFE3 rRCC） and clear cell renal cell carcinoma （ccRCC）.

Methods

The DCE-CT features and clinical data of 45 adult patients with TFE3 rRCC and 135 adult patients with ccRCC confirmed by postoperative molecular pathology were retrospectively analyzed， and the differences between the two groups were compared.

Results

Of the TFE3 rRCC group， the average age was （32±11） years old.Among them， 20 cases （44.4%） were accompanied by gross hematuria， and 28 cases （62.2%） were female.The overall 5-year survival rate was 62.2%.In the ccRCC group， the average age was （60±13） years， 11 cases （8.1%） were accompanied by gross hematuria， of which only 46 cases （34.1%） were female， and the overall 5-year survival rate was 80%.There were significant difference between the two groups （P＜0.05）.In unenhanced CT scan， compared to ccRCC， tumor lesions in TFE3 rRCC exhibited higher CT values than normal renal parenchyma （P＜0.001），with 35.5% exhibiting intratumoral calcification， particularly circular calcification （P＜0.001）.In dynamic enhanced CT， TFE3 rRCC demonstrated moderately heterogeneous persistent enhancement throughout the renal parenchymal phase， peaking in the medullary phase and slowly declining in the excretory phase，exhibiting a "less in and slow out" pattern.In ccRCC， after enhancement， the lesion rapidly strengthens and reaches its peak in the cortical phase， while it rapidly declines until the delayed phase in the medullary phase， exhibiting typical "fast in and fast out" pattern.

Conclusion

The high density and intratumoral calcification on CT plain scan， along with the "less in and slow out" pattern in the dynamic enhancement phase of TFE3 rRCC， combined with the clinical features of young women with high incidence and frequent hematuria， aid in distinguishing it from ccRCC.

Key words: TFE3-rearranged renal cell carcinoma, Clear cell renal cell carcinoma, Dynamic contrast enhanced computed tomography, Differential diagnosis, Molecular pathology

Qiang Ding, Xiang Dong, Weidong Gan. Differential diagnosis of TFE3-rearranged renal cell carcinoma and clear cell renal cell carcinoma based on dynamic-enhanced CT and clinical features[J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(03): 329-334.

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References 30

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项目	TFE3 rRCC	ccRCC	统计值	P值
总例数	45	135
性别（例）			χ ²=10.050	＜0.001
男	17	89
女	28	46
平均发病年龄（岁）	32±11	60±13	t=-14.470	＜0.001
肉眼血尿［例（%）］	20（44.4）	11（8.1）	χ ²=30.180	＜0.001
腰痛［例（%）］	2（4.4）	16（11.9）	χ ²=1.317	0.251
癌栓形成［例（%）］	5（11.1）	21（15.6）	χ ²=0.540	0.462
淋巴结转移［例（%）］	5（11.1）	8（5.9）	χ ²=0.712	0.406
远处转移［例（%）］	5（11.1）	4（3.0）	χ ²=0.080	0.080
分期（例）			χ ²=10.463	0.001
Ⅰ	30	119
Ⅱ	5	5
Ⅲ	5	7
Ⅳ	5	4
5年生存［例（%）］	28（62.2）	108（80.0）	χ ²=5.776	0.016
位置（例）			χ ²=11.855	0.003
皮质	2	32
皮髓交界	41	87
髓质	2	16
边界（清晰/不清晰）（例）	38/7	38/97	χ ²=43.846	＜0.001
形状（规则/不规则）（例）	18/27	103/32	χ ²=20.179	＜0.001
坏死或囊性成分［例（%）］	42（93.3）	5（3.7）	χ ²=140.527	＜0.001
瘤内钙化［例（%）］	16（35.5）	10（7.4）	χ ²=21.637	＜0.001
平扫（均匀/不均匀）（例）	10/35	43/92	χ ²=1.397	0.220
增强（均匀/不均匀）（例）	7/38	16/119	χ ²=0.397	0.519

项目	TFE3 rRCC	ccRCC	统计值	P值
总例数	45	135
性别（例）			χ ²=10.050	＜0.001
男	17	89
女	28	46
平均发病年龄（岁）	32±11	60±13	t=-14.470	＜0.001
肉眼血尿［例（%）］	20（44.4）	11（8.1）	χ ²=30.180	＜0.001
腰痛［例（%）］	2（4.4）	16（11.9）	χ ²=1.317	0.251
癌栓形成［例（%）］	5（11.1）	21（15.6）	χ ²=0.540	0.462
淋巴结转移［例（%）］	5（11.1）	8（5.9）	χ ²=0.712	0.406
远处转移［例（%）］	5（11.1）	4（3.0）	χ ²=0.080	0.080
分期（例）			χ ²=10.463	0.001
Ⅰ	30	119
Ⅱ	5	5
Ⅲ	5	7
Ⅳ	5	4
5年生存［例（%）］	28（62.2）	108（80.0）	χ ²=5.776	0.016
位置（例）			χ ²=11.855	0.003
皮质	2	32
皮髓交界	41	87
髓质	2	16
边界（清晰/不清晰）（例）	38/7	38/97	χ ²=43.846	＜0.001
形状（规则/不规则）（例）	18/27	103/32	χ ²=20.179	＜0.001
坏死或囊性成分［例（%）］	42（93.3）	5（3.7）	χ ²=140.527	＜0.001
瘤内钙化［例（%）］	16（35.5）	10（7.4）	χ ²=21.637	＜0.001
平扫（均匀/不均匀）（例）	10/35	43/92	χ ²=1.397	0.220
增强（均匀/不均匀）（例）	7/38	16/119	χ ²=0.397	0.519

CT期别	TFE3 rRCC（n=45）			ccRCC（n=135）			统计值	P值
CT期别	高密度	等密度	低密度	高密度	等密度	低密度	统计值	P值
平扫期	22	20	3	5	114	16	χ ²=54.050	＜0.001
皮质期	17	17	11	92	33	10	χ ²=11.340	0.004
髓质期	1	2	42	0	10	125	-	0.179
排泄期	0	1	44	0	1	134	-	0.412

CT期别	TFE3 rRCC（n=45）			ccRCC（n=135）			统计值	P值
CT期别	高密度	等密度	低密度	高密度	等密度	低密度	统计值	P值
平扫期	22	20	3	5	114	16	χ ²=54.050	＜0.001
皮质期	17	17	11	92	33	10	χ ²=11.340	0.004
髓质期	1	2	42	0	10	125	-	0.179
排泄期	0	1	44	0	1	134	-	0.412

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