From the Archives of the AFIP 1
Infiltrative Renal Lesions: Radiologic-Pathologic Correlation
Perry J. Pickhardt, LT, MC, USN ,
Gael J. Lonergan, Lt Col, USAF, MC ,
Charles J. Davis, Jr, MD,
Naoko Kashitani, MD and
Brent J. Wagner, MD
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.
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Figure 1. Pseudocapsule formation in expansile growth. Photomicrograph (original magnification, x120; hematoxylin-eosin [H-E] stain) of renal cell carcinoma (asterisks) shows fibrous pseudocapsule formation (arrows) around the margins of the tumor.
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Figure 2. Infiltrative growth pattern. Photomicrograph (original magnification, x150; H-E stain) of lymphoma (asterisks) shows densely staining nuclei infiltrating around and between glomerulus (straight arrow) and tubules (curved arrows).
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Figure 3. Renal cell carcinoma, clear cell type. Photomicrograph (original magnification, x75; H-E stain) shows cells with small nuclei and abundant clear cytoplasm, arranged in rows resembling tubules.
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Figure 4a. Renal cell carcinoma in a 70-year-old man with recent history of lower abdominal pain and 16-lb (7.2-kg) weight loss. (a) Axial contrast material-enhanced CT scan shows a heterogeneous, poorly defined mass (arrows) in the left kidney. (b) Photograph of the bisected specimen shows the infiltrating neoplasm (arrows) in the middle and upper portions of the left kidney.
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Figure 4b. Renal cell carcinoma in a 70-year-old man with recent history of lower abdominal pain and 16-lb (7.2-kg) weight loss. (a) Axial contrast material-enhanced CT scan shows a heterogeneous, poorly defined mass (arrows) in the left kidney. (b) Photograph of the bisected specimen shows the infiltrating neoplasm (arrows) in the middle and upper portions of the left kidney.
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Figure 5a. Collecting duct carcinoma in a 68-year-old man with vague abdominal pain for several months. (a) Longitudinal sonogram through the right kidney reveals an ill-defined hyperechoic mass (arrows) in the upper pole. (b) Axial contrast-enhanced CT scan shows the low-attenuation mass (arrows) in the right kidney involving the medulla and cortex and effacing or abutting the renal sinus. (c) Axial T1-weighted MR image shows the mass (arrowheads), which is isointense relative to the renal parenchyma. (d) On a coronal T2-weighted MR image, the mass (arrow) has low signal intensity and extends into the renal sinus. (e) Photograph of the bisected gross specimen shows the infiltrating mass (arrows) in the upper half of the kidney.
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Figure 5b. Collecting duct carcinoma in a 68-year-old man with vague abdominal pain for several months. (a) Longitudinal sonogram through the right kidney reveals an ill-defined hyperechoic mass (arrows) in the upper pole. (b) Axial contrast-enhanced CT scan shows the low-attenuation mass (arrows) in the right kidney involving the medulla and cortex and effacing or abutting the renal sinus. (c) Axial T1-weighted MR image shows the mass (arrowheads), which is isointense relative to the renal parenchyma. (d) On a coronal T2-weighted MR image, the mass (arrow) has low signal intensity and extends into the renal sinus. (e) Photograph of the bisected gross specimen shows the infiltrating mass (arrows) in the upper half of the kidney.
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Figure 5c. Collecting duct carcinoma in a 68-year-old man with vague abdominal pain for several months. (a) Longitudinal sonogram through the right kidney reveals an ill-defined hyperechoic mass (arrows) in the upper pole. (b) Axial contrast-enhanced CT scan shows the low-attenuation mass (arrows) in the right kidney involving the medulla and cortex and effacing or abutting the renal sinus. (c) Axial T1-weighted MR image shows the mass (arrowheads), which is isointense relative to the renal parenchyma. (d) On a coronal T2-weighted MR image, the mass (arrow) has low signal intensity and extends into the renal sinus. (e) Photograph of the bisected gross specimen shows the infiltrating mass (arrows) in the upper half of the kidney.
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Figure 5d. Collecting duct carcinoma in a 68-year-old man with vague abdominal pain for several months. (a) Longitudinal sonogram through the right kidney reveals an ill-defined hyperechoic mass (arrows) in the upper pole. (b) Axial contrast-enhanced CT scan shows the low-attenuation mass (arrows) in the right kidney involving the medulla and cortex and effacing or abutting the renal sinus. (c) Axial T1-weighted MR image shows the mass (arrowheads), which is isointense relative to the renal parenchyma. (d) On a coronal T2-weighted MR image, the mass (arrow) has low signal intensity and extends into the renal sinus. (e) Photograph of the bisected gross specimen shows the infiltrating mass (arrows) in the upper half of the kidney.
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Figure 5e. Collecting duct carcinoma in a 68-year-old man with vague abdominal pain for several months. (a) Longitudinal sonogram through the right kidney reveals an ill-defined hyperechoic mass (arrows) in the upper pole. (b) Axial contrast-enhanced CT scan shows the low-attenuation mass (arrows) in the right kidney involving the medulla and cortex and effacing or abutting the renal sinus. (c) Axial T1-weighted MR image shows the mass (arrowheads), which is isointense relative to the renal parenchyma. (d) On a coronal T2-weighted MR image, the mass (arrow) has low signal intensity and extends into the renal sinus. (e) Photograph of the bisected gross specimen shows the infiltrating mass (arrows) in the upper half of the kidney.
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Figure 6. Medullary carcinoma, adenoid cystic pattern. Photomicrograph (original magnification, x40; H-E stain) shows lightly staining, irregularly shaped cells arranged in clusters (arrows) and separated by desmoplastic stromal reaction.
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Figure 7a. Medullary carcinoma in a 29-year-old black woman with flank pain and gross hematuria. (a) Longitudinal sonogram shows the right kidney (arrows), which is markedly enlarged and heterogeneously echogenic. (b) On an axial contrast-enhanced CT scan, the right kidney (arrow) enhances heterogeneously and is enlarged. (c) Photograph of the bisected gross specimen shows the infiltrative mass (arrows) replacing much of the renal parenchyma.
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Figure 7b. Medullary carcinoma in a 29-year-old black woman with flank pain and gross hematuria. (a) Longitudinal sonogram shows the right kidney (arrows), which is markedly enlarged and heterogeneously echogenic. (b) On an axial contrast-enhanced CT scan, the right kidney (arrow) enhances heterogeneously and is enlarged. (c) Photograph of the bisected gross specimen shows the infiltrative mass (arrows) replacing much of the renal parenchyma.
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Figure 7c. Medullary carcinoma in a 29-year-old black woman with flank pain and gross hematuria. (a) Longitudinal sonogram shows the right kidney (arrows), which is markedly enlarged and heterogeneously echogenic. (b) On an axial contrast-enhanced CT scan, the right kidney (arrow) enhances heterogeneously and is enlarged. (c) Photograph of the bisected gross specimen shows the infiltrative mass (arrows) replacing much of the renal parenchyma.
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Figure 8. Transitional cell carcinoma of the renal pelvis. Photomicrograph (original magnification, x75; H-E stain) shows pleomorphic cells (arrows) infiltrating the renal parenchyma in two separate areas.
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Figure 9a. Transitional cell carcinoma of the renal pelvis in a 48-year-old woman with a 1-month history of right flank pain and intermittent gross hematuria. (a) Longitudinal sonogram shows an ill-defined hyperechoic mass (arrows) in the upper pole and midportion of the right kidney. (b) Axial contrast-enhanced CT scan demonstrates the low-attenuation mass (arrow) in the upper portion of the right kidney. (c) Photograph of the bivalved specimen demonstrates the infiltrative mass (arrows) in the upper half of the kidney.
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Figure 9b. Transitional cell carcinoma of the renal pelvis in a 48-year-old woman with a 1-month history of right flank pain and intermittent gross hematuria. (a) Longitudinal sonogram shows an ill-defined hyperechoic mass (arrows) in the upper pole and midportion of the right kidney. (b) Axial contrast-enhanced CT scan demonstrates the low-attenuation mass (arrow) in the upper portion of the right kidney. (c) Photograph of the bivalved specimen demonstrates the infiltrative mass (arrows) in the upper half of the kidney.
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Figure 9c. Transitional cell carcinoma of the renal pelvis in a 48-year-old woman with a 1-month history of right flank pain and intermittent gross hematuria. (a) Longitudinal sonogram shows an ill-defined hyperechoic mass (arrows) in the upper pole and midportion of the right kidney. (b) Axial contrast-enhanced CT scan demonstrates the low-attenuation mass (arrow) in the upper portion of the right kidney. (c) Photograph of the bivalved specimen demonstrates the infiltrative mass (arrows) in the upper half of the kidney.
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Figure 10a. Squamous cell carcinoma of the renal pelvis in a 69-year-old woman with recent weight loss. (a) Longitudinal sonogram of the left kidney shows dilated calices (arrowheads), echogenic renal calculi (curved arrow), and an ill-defined soft-tissue mass (straight arrows) filling much of the renal pelvis. (b) On an axial contrast-enhanced CT scan, the low-attenuation mass (arrow) is seen arising medial to the calculi, in the region of the middle and lower renal pelvis. (c) Photograph of the bivalved surgical specimen shows the large mass (straight arrows) replacing the lower half of the left kidney and upper pole caliectasis (curved arrow).
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Figure 10b. Squamous cell carcinoma of the renal pelvis in a 69-year-old woman with recent weight loss. (a) Longitudinal sonogram of the left kidney shows dilated calices (arrowheads), echogenic renal calculi (curved arrow), and an ill-defined soft-tissue mass (straight arrows) filling much of the renal pelvis. (b) On an axial contrast-enhanced CT scan, the low-attenuation mass (arrow) is seen arising medial to the calculi, in the region of the middle and lower renal pelvis. (c) Photograph of the bivalved surgical specimen shows the large mass (straight arrows) replacing the lower half of the left kidney and upper pole caliectasis (curved arrow).
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Figure 10c. Squamous cell carcinoma of the renal pelvis in a 69-year-old woman with recent weight loss. (a) Longitudinal sonogram of the left kidney shows dilated calices (arrowheads), echogenic renal calculi (curved arrow), and an ill-defined soft-tissue mass (straight arrows) filling much of the renal pelvis. (b) On an axial contrast-enhanced CT scan, the low-attenuation mass (arrow) is seen arising medial to the calculi, in the region of the middle and lower renal pelvis. (c) Photograph of the bivalved surgical specimen shows the large mass (straight arrows) replacing the lower half of the left kidney and upper pole caliectasis (curved arrow).
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Figure 11a. Undifferentiated renal sarcoma in a 58-year-old woman with left flank pain. (a) Axial contrast-enhanced CT scan shows an enlarged, heterogeneously enhancing left kidney (straight arrow) and soft-tissue nodules adjacent to the aorta (curved arrow). The latter subsequently proved to be metastatic adenopathy. (b) Photograph of the bisected gross specimen reveals the lobulated, poorly defined mass (arrows) replacing the upper half of the left kidney.
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Figure 11b. Undifferentiated renal sarcoma in a 58-year-old woman with left flank pain. (a) Axial contrast-enhanced CT scan shows an enlarged, heterogeneously enhancing left kidney (straight arrow) and soft-tissue nodules adjacent to the aorta (curved arrow). The latter subsequently proved to be metastatic adenopathy. (b) Photograph of the bisected gross specimen reveals the lobulated, poorly defined mass (arrows) replacing the upper half of the left kidney.
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Figure 12a. Lymphoma in a 69-year-old man with right flank pain. (a) Axial contrast-enhanced CT scan shows a low-attenuation mass arising from the right kidney, extending through the renal capsule and into the retroperitoneum (arrows). (b) Photograph of the bisected gross specimen shows the ill-defined tumor mass (arrows) in the upper half of the kidney. The retroperitoneal neoplasm is not visible on this view.
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Figure 12b. Lymphoma in a 69-year-old man with right flank pain. (a) Axial contrast-enhanced CT scan shows a low-attenuation mass arising from the right kidney, extending through the renal capsule and into the retroperitoneum (arrows). (b) Photograph of the bisected gross specimen shows the ill-defined tumor mass (arrows) in the upper half of the kidney. The retroperitoneal neoplasm is not visible on this view.
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Figure 13. Leukemia in a 3-year-old boy who presented with hypertension. Longitudinal sonogram of the right kidney (arrowheads) shows an enlarged, heterogeneous kidney and loss of normal corticomedullary differentiation. Similar findings were present in the left kidney.
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Figure 14. Chronic lymphocytic leukemia in a 51-year-old woman. Axial contrast-enhanced CT scan shows ill-defined, low-attenuation regions in both kidneys (arrows).
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Figure 15a. Plasmacytoma in a 59-year-old man with a recent 20-lb (9-kg) weight loss. (a) Axial unenhanced CT scan shows an enlarged and irregular right kidney (straight arrow) with a low-attenuation, lobulated mass (curved arrow) in the region of the renal hilum. (b) Photograph of the bivalved specimen shows the mass (black arrows) in the midportion of the kidney, with extension into the renal pelvis (white arrow).
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Figure 15b. Plasmacytoma in a 59-year-old man with a recent 20-lb (9-kg) weight loss. (a) Axial unenhanced CT scan shows an enlarged and irregular right kidney (straight arrow) with a low-attenuation, lobulated mass (curved arrow) in the region of the renal hilum. (b) Photograph of the bivalved specimen shows the mass (black arrows) in the midportion of the kidney, with extension into the renal pelvis (white arrow).
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Figure 16a. Metastatic disease in a 48-year-old man with a history of bronchogenic carcinoma 6 years earlier who presented with flank pain and gross hematuria. (a) Axial sonogram of the left kidney reveals an echogenic mass (arrows). (b) On an axial contrast-enhanced CT scan, the mass is seen as an ill-defined, low-attenuation region (arrows). (c) Photograph of the axially bisected specimen shows the light tan metastatic focus in the renal parenchyma and adjacent perinephric fat (arrows).
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Figure 16b. Metastatic disease in a 48-year-old man with a history of bronchogenic carcinoma 6 years earlier who presented with flank pain and gross hematuria. (a) Axial sonogram of the left kidney reveals an echogenic mass (arrows). (b) On an axial contrast-enhanced CT scan, the mass is seen as an ill-defined, low-attenuation region (arrows). (c) Photograph of the axially bisected specimen shows the light tan metastatic focus in the renal parenchyma and adjacent perinephric fat (arrows).
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Figure 16c. Metastatic disease in a 48-year-old man with a history of bronchogenic carcinoma 6 years earlier who presented with flank pain and gross hematuria. (a) Axial sonogram of the left kidney reveals an echogenic mass (arrows). (b) On an axial contrast-enhanced CT scan, the mass is seen as an ill-defined, low-attenuation region (arrows). (c) Photograph of the axially bisected specimen shows the light tan metastatic focus in the renal parenchyma and adjacent perinephric fat (arrows).
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Figure 17. Wilms tumor. Photomicrograph (original magnification, x100; H-E stain) depicts densely staining blastema (arrows) and primitive tubules (arrowheads) on a background of primitive stroma.
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Figure 18a. Wilms tumor in a 7-year-old girl with right abdominal pain for 3 weeks. (a) Longitudinal sonogram of the right kidney reveals a mass (arrows) replacing the upper portion of the kidney. (b) Axial contrast-enhanced CT scan shows that the mass (arrows) is heterogeneous and poorly defined, replacing normal renal parenchyma at this level. The very low attenuation areas (arrowhead) in the mass represent areas of tumor necrosis. (c) Photograph of the bivalved gross specimen shows the tumor (arrows) replacing and expanding the renal parenchyma in the upper two-thirds of the kidney.
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Figure 18b. Wilms tumor in a 7-year-old girl with right abdominal pain for 3 weeks. (a) Longitudinal sonogram of the right kidney reveals a mass (arrows) replacing the upper portion of the kidney. (b) Axial contrast-enhanced CT scan shows that the mass (arrows) is heterogeneous and poorly defined, replacing normal renal parenchyma at this level. The very low attenuation areas (arrowhead) in the mass represent areas of tumor necrosis. (c) Photograph of the bivalved gross specimen shows the tumor (arrows) replacing and expanding the renal parenchyma in the upper two-thirds of the kidney.
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Figure 18c. Wilms tumor in a 7-year-old girl with right abdominal pain for 3 weeks. (a) Longitudinal sonogram of the right kidney reveals a mass (arrows) replacing the upper portion of the kidney. (b) Axial contrast-enhanced CT scan shows that the mass (arrows) is heterogeneous and poorly defined, replacing normal renal parenchyma at this level. The very low attenuation areas (arrowhead) in the mass represent areas of tumor necrosis. (c) Photograph of the bivalved gross specimen shows the tumor (arrows) replacing and expanding the renal parenchyma in the upper two-thirds of the kidney.
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Figure 19. Mesoblastic nephroma. Photomicrograph (original magnification, x25; H-E stain) shows spindle cells (straight black arrow) infiltrating between clusters of normal tubules (curved arrow) and glomeruli (white arrow).
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Figure 20a. Mesoblastic nephroma in a 2-year-old boy who presented with gross hematuria. (a) Sonogram of the left kidney depicts a mass (arrows) arising from the upper half of the kidney. (b) On an axial contrast-enhanced CT scan, the mass (arrow) has low attenuation. (c) On an axial T1-weighted MR image, the mass (arrow) is low in signal intensity compared with normal renal parenchyma. (d) On an axial T2-weighted MR image, the mass (arrow) is heterogeneous and slightly hyperintense. (e) Photograph of the bisected specimen shows the heterogeneous mass (arrows) in the middle and upper portions of the left kidney.
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Figure 20b. Mesoblastic nephroma in a 2-year-old boy who presented with gross hematuria. (a) Sonogram of the left kidney depicts a mass (arrows) arising from the upper half of the kidney. (b) On an axial contrast-enhanced CT scan, the mass (arrow) has low attenuation. (c) On an axial T1-weighted MR image, the mass (arrow) is low in signal intensity compared with normal renal parenchyma. (d) On an axial T2-weighted MR image, the mass (arrow) is heterogeneous and slightly hyperintense. (e) Photograph of the bisected specimen shows the heterogeneous mass (arrows) in the middle and upper portions of the left kidney.
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Figure 20c. Mesoblastic nephroma in a 2-year-old boy who presented with gross hematuria. (a) Sonogram of the left kidney depicts a mass (arrows) arising from the upper half of the kidney. (b) On an axial contrast-enhanced CT scan, the mass (arrow) has low attenuation. (c) On an axial T1-weighted MR image, the mass (arrow) is low in signal intensity compared with normal renal parenchyma. (d) On an axial T2-weighted MR image, the mass (arrow) is heterogeneous and slightly hyperintense. (e) Photograph of the bisected specimen shows the heterogeneous mass (arrows) in the middle and upper portions of the left kidney.
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Figure 20d. Mesoblastic nephroma in a 2-year-old boy who presented with gross hematuria. (a) Sonogram of the left kidney depicts a mass (arrows) arising from the upper half of the kidney. (b) On an axial contrast-enhanced CT scan, the mass (arrow) has low attenuation. (c) On an axial T1-weighted MR image, the mass (arrow) is low in signal intensity compared with normal renal parenchyma. (d) On an axial T2-weighted MR image, the mass (arrow) is heterogeneous and slightly hyperintense. (e) Photograph of the bisected specimen shows the heterogeneous mass (arrows) in the middle and upper portions of the left kidney.
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Figure 20e. Mesoblastic nephroma in a 2-year-old boy who presented with gross hematuria. (a) Sonogram of the left kidney depicts a mass (arrows) arising from the upper half of the kidney. (b) On an axial contrast-enhanced CT scan, the mass (arrow) has low attenuation. (c) On an axial T1-weighted MR image, the mass (arrow) is low in signal intensity compared with normal renal parenchyma. (d) On an axial T2-weighted MR image, the mass (arrow) is heterogeneous and slightly hyperintense. (e) Photograph of the bisected specimen shows the heterogeneous mass (arrows) in the middle and upper portions of the left kidney.
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Figure 21a. Rhabdoid tumor in a 5-month-old female infant with vomiting. (a) Longitudinal sonogram reveals a heterogeneous mass (arrows) in the left flank, extending across the midline (the aorta [arrowheads] is deep to the mass and is uplifted by extension of tumor behind it). (b) Axial contrast-enhanced CT scan shows the large heterogeneous mass (curved arrows) filling the left flank. There is also a mass in the right kidney (straight arrow), which proved to be a metastasis. (c) Photograph of the gross specimen (sectioned axially, lateral aspect on the right) reveals the large tumor (arrows) extending medially from the left kidney.
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Figure 21b. Rhabdoid tumor in a 5-month-old female infant with vomiting. (a) Longitudinal sonogram reveals a heterogeneous mass (arrows) in the left flank, extending across the midline (the aorta [arrowheads] is deep to the mass and is uplifted by extension of tumor behind it). (b) Axial contrast-enhanced CT scan shows the large heterogeneous mass (curved arrows) filling the left flank. There is also a mass in the right kidney (straight arrow), which proved to be a metastasis. (c) Photograph of the gross specimen (sectioned axially, lateral aspect on the right) reveals the large tumor (arrows) extending medially from the left kidney.
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Figure 21c. Rhabdoid tumor in a 5-month-old female infant with vomiting. (a) Longitudinal sonogram reveals a heterogeneous mass (arrows) in the left flank, extending across the midline (the aorta [arrowheads] is deep to the mass and is uplifted by extension of tumor behind it). (b) Axial contrast-enhanced CT scan shows the large heterogeneous mass (curved arrows) filling the left flank. There is also a mass in the right kidney (straight arrow), which proved to be a metastasis. (c) Photograph of the gross specimen (sectioned axially, lateral aspect on the right) reveals the large tumor (arrows) extending medially from the left kidney.
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Figure 22a. Diffuse nephroblastomatosis in a 6-month-old female infant with a palpable abdominal mass. (a) Longitudinal sonogram reveals an enlarged left kidney (arrows) with loss of normal corticomedullary differentiation. (b) Axial contrast-enhanced CT scan shows the enlarged, low-attenuation left kidney (arrowheads); the remaining normal parenchyma is seen as central enhancing areas (arrows). (c) Photograph of the bisected gross specimen shows that the renal parenchyma is diffusely replaced with tan-colored tissue of nephroblastomatosis. Two central areas of nephrogenic rests (arrows) of nodular morphology are also seen. (Reprinted, with permission, from reference 81.)
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Figure 22b. Diffuse nephroblastomatosis in a 6-month-old female infant with a palpable abdominal mass. (a) Longitudinal sonogram reveals an enlarged left kidney (arrows) with loss of normal corticomedullary differentiation. (b) Axial contrast-enhanced CT scan shows the enlarged, low-attenuation left kidney (arrowheads); the remaining normal parenchyma is seen as central enhancing areas (arrows). (c) Photograph of the bisected gross specimen shows that the renal parenchyma is diffusely replaced with tan-colored tissue of nephroblastomatosis. Two central areas of nephrogenic rests (arrows) of nodular morphology are also seen. (Reprinted, with permission, from reference 81.)
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Figure 22c. Diffuse nephroblastomatosis in a 6-month-old female infant with a palpable abdominal mass. (a) Longitudinal sonogram reveals an enlarged left kidney (arrows) with loss of normal corticomedullary differentiation. (b) Axial contrast-enhanced CT scan shows the enlarged, low-attenuation left kidney (arrowheads); the remaining normal parenchyma is seen as central enhancing areas (arrows). (c) Photograph of the bisected gross specimen shows that the renal parenchyma is diffusely replaced with tan-colored tissue of nephroblastomatosis. Two central areas of nephrogenic rests (arrows) of nodular morphology are also seen. (Reprinted, with permission, from reference 81.)
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Figure 23a. Primitive neuroectodermal tumor in a 36-year-old woman with right flank pain. (a) Axial contrast-enhanced CT scan shows a large heterogeneous mass (white arrow) in the right flank, extending across the midline (black arrow). (b) Coronal T1-weighted MR image shows the hypointense right flank mass (straight arrow) extending across the midline and deviating the portal vein (curved arrow) to the left. (c) Photograph of the axially bisected gross specimen shows the tumor replacing the right kidney. No remaining normal right kidney is visualized.
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Figure 23b. Primitive neuroectodermal tumor in a 36-year-old woman with right flank pain. (a) Axial contrast-enhanced CT scan shows a large heterogeneous mass (white arrow) in the right flank, extending across the midline (black arrow). (b) Coronal T1-weighted MR image shows the hypointense right flank mass
(straight arrow) extending across the midline and deviating the portal vein (curved arrow) to the left.
(c) Photograph of the axially bisected gross specimen shows the tumor replacing the right kidney. No remaining normal right kidney is visualized.
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Figure 23c. Primitive neuroectodermal tumor in a 36-year-old woman with right flank pain. (a) Axial contrast-enhanced CT scan shows a large heterogeneous mass (white arrow) in the right flank, extending across the midline (black arrow). (b) Coronal T1-weighted MR image shows the hypointense right flank mass
(straight arrow) extending across the midline and deviating the portal vein (curved arrow) to the left.
(c) Photograph of the axially bisected gross specimen shows the tumor replacing the right kidney. No remaining normal right kidney is visualized.
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Figure 24a. Pyelonephritis in four different patients, all of whom presented with fever and dysuria. (a) Longitudinal sonogram of the right kidney in an 26-year-old woman shows an echogenic upper pole (arrows). (b) Axial contrast-enhanced CT scan of a 55-year-old woman shows a striated pattern of parenchymal
enhancement in the upper pole of the right kidney (arrow). (c) Coronal gadolinium-enhanced fast inversion recovery (repetition time, 2,000 msec; echo time, 17 msec) MR image shows high signal intensity in the right upper pole (arrows). (d) Photograph of the bisected gross specimen from a 37-year-old woman demonstrates pale parenchyma and poor corticomedullary differentiation in the upper half of the kidney (arrows).
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Figure 24b. Pyelonephritis in four different patients, all of whom presented with fever and dysuria. (a) Longitudinal sonogram of the right kidney in an 26-year-old woman shows an echogenic upper pole (arrows). (b) Axial contrast-enhanced CT scan of a 55-year-old woman shows a striated pattern of parenchymal
enhancement in the upper pole of the right kidney (arrow). (c) Coronal gadolinium-enhanced fast inversion recovery (repetition time, 2,000 msec; echo time, 17 msec) MR image shows high signal intensity in the right upper pole (arrows). (d) Photograph of the bisected gross specimen from a 37-year-old woman demonstrates pale parenchyma and poor corticomedullary differentiation in the upper half of the kidney (arrows).
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Figure 24c. Pyelonephritis in four different patients, all of whom presented with fever and dysuria. (a) Longitudinal sonogram of the right kidney in an 26-year-old woman shows an echogenic upper pole (arrows). (b) Axial contrast-enhanced CT scan of a 55-year-old woman shows a striated pattern of parenchymal
enhancement in the upper pole of the right kidney (arrow). (c) Coronal gadolinium-enhanced fast inversion recovery (repetition time, 2,000 msec; echo time, 17 msec) MR image shows high signal intensity in the right upper pole (arrows). (d) Photograph of the bisected gross specimen from a 37-year-old woman demonstrates pale parenchyma and poor corticomedullary differentiation in the upper half of the kidney (arrows).
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Figure 24d. Pyelonephritis in four different patients, all of whom presented with fever and dysuria. (a) Longitudinal sonogram of the right kidney in an 26-year-old woman shows an echogenic upper pole (arrows). (b) Axial contrast-enhanced CT scan of a 55-year-old woman shows a striated pattern of parenchymal enhancement in the upper pole of the right kidney (arrow). (c) Coronal gadolinium-enhanced fast inversion recovery (repetition time, 2,000 msec; echo time, 17 msec) MR image shows high signal intensity in the right upper pole (arrows). (d) Photograph of the bisected gross specimen from a 37-year-old woman demonstrates pale parenchyma and poor corticomedullary differentiation in the upper half of the kidney (arrows).
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Figure 25. Xanthogranulomatous pyelonephritis. Photomicrograph (original magnification, x60; H-E stain) shows foamy macrophages (arrows) invading the renal medulla.
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Figure 26a. Xanthogranulomatous pyelonephritis in a 45-year-old woman with a 2-month history of night sweats, fever, and right flank pain. (a) Axial contrast-enhanced CT scan shows an irregularly enlarged, low-attenuation right kidney (straight arrows) with a pelvic calculus (curved arrow). (b) Photograph of the bivalved specimen shows a dilated collecting system (straight arrows) and calculi (curved arrows). (c) Photograph shows the staghorn calculus.
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Figure 26b. Xanthogranulomatous pyelonephritis in a 45-year-old woman with a 2-month history of night sweats, fever, and right flank pain. (a) Axial contrast-enhanced CT scan shows an irregularly enlarged, low-attenuation right kidney (straight arrows) with a pelvic calculus (curved arrow). (b) Photograph of the bivalved specimen shows a dilated collecting system (straight arrows) and calculi (curved arrows). (c) Photograph shows the staghorn calculus.
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Figure 26c. Xanthogranulomatous pyelonephritis in a 45-year-old woman with a 2-month history of night sweats, fever, and right flank pain. (a) Axial contrast-enhanced CT scan shows an irregularly enlarged, low-attenuation right kidney (straight arrows) with a pelvic calculus (curved arrow). (b) Photograph of the bivalved specimen shows a dilated collecting system (straight arrows) and calculi (curved arrows). (c) Photograph shows the staghorn calculus.
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Figure 27a. Malakoplakia in a 49-year-old woman with chills and fever. (a) Longitudinal sonogram demonstrates a hypoechoic heterogeneous mass (arrows) arising from the right kidney. (b) On an axial contrast-enhanced CT scan, the low-attenuation mass (arrows) with an ill-defined margin is seen in the right kidney. There is also a heterogeneously enhancing left kidney, a finding that was presumptively diagnosed as pyelonephritis. (c) Photograph of the bisected gross specimen shows the mass (arrows) extending from the kidney.
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Figure 27b. Malakoplakia in a 49-year-old woman with chills and fever. (a) Longitudinal sonogram demonstrates a hypoechoic heterogeneous mass (arrows) arising from the right kidney. (b) On an axial contrast-enhanced CT scan, the low-attenuation mass (arrows) with an ill-defined margin is seen in the right kidney. There is also a heterogeneously enhancing left kidney, a finding that was presumptively diagnosed as pyelonephritis. (c) Photograph of the bisected gross specimen shows the mass (arrows) extending from the kidney.
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Figure 27c. Malakoplakia in a 49-year-old woman with chills and fever. (a) Longitudinal sonogram demonstrates a hypoechoic heterogeneous mass (arrows) arising from the right kidney. (b) On an axial contrast-enhanced CT scan, the low-attenuation mass (arrows) with an ill-defined margin is seen in the right kidney. There is also a heterogeneously enhancing left kidney, a finding that was presumptively diagnosed as pyelonephritis. (c) Photograph of the bisected gross specimen shows the mass (arrows) extending from the kidney.
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Copyright © 2000 by the Radiological Society of North America.
