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CONTINUING EDUCATION |
1 From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (P.J.P.); the Departments of Radiologic Pathology (G.J.L., N.K., B.J.W.) and Genitourinary Pathology (C.J.D.), Armed Forces Institute of Pathology, Bldg 54, Rm M-121, 14th and Alaska NW, Washington, DC 20306-6000; the Department of Radiology, Guantanamo Bay Naval Hospital, Cuba (P.J.P.); the Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (G.J.L.); and the Department of Radiology, West Reading Radiology Associates, West Reading, Pa (B.J.W.). Received September 1, 1999; revisions requested September 20 and received October 8; accepted October 13. Address reprint requests to G.J.L.
Most renal masses exhibit an expansile growth pattern characterized by radial tumor enlargement that displaces normal renal parenchyma and forms spherical, often exophytic, lesions. These expansile masses have pushing margins that impress adjacent normal renal parenchyma but do not infiltrate it; this behavior results in a well-defined, encapsulated appearance at both radiologic and gross pathologic examination. In contrast, certain disease processes involve the kidney in an infiltrative fashion by using the normal renal architecture as scaffolding for interstitial growth. These infiltrative renal lesions lack a sharp border of demarcation with the normal parenchyma and therefore demonstrate ill-defined zones of transition between the lesion and normal parenchyma. Although infiltrative lesions frequently enlarge the kidney, its reniform shape is usually maintained. Cross-sectional imaging can often help distinguish infiltrative from expansile growth patterns through analysis of the parenchymal interface between the process and the kidney, the effect of the lesion on the collecting system and renal sinus, and the overall renal morphology. A wide variety of neoplastic and inflammatory conditions characteristically involve the kidney by cellular infiltration. Although considerable overlap of the imaging features exists among the various infiltrative processes, the correct diagnosis may be suspected when the clinical data and associated radiologic findings are considered together.
Index Terms: Kidney neoplasms, 811.3124, 811.32, 811.34 • Kidney, nephroblastomatosis, 811.325 • Nephritis, 811.212, 811.29 • Sickle cell disease (SS, SC), 811.329
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