DOI: 10.1148/rg.252045073
Neoplasms of the Renal Medulla: Radiologic-Pathologic Correlation1
Srinivasa R. Prasad, MD,
Peter A. Humphrey, MD, PhD,
Christine O. Menias, MD,
William D. Middleton, MD,
Marilyn J. Siegel, MD,
Kyongtae T. Bae, MD, PhD and
Jay P. Heiken, MD
1 From the Department of Radiology, University of Texas Health Science Center at San Antonio (S.R.P.); Department of Pathology and Immunology (P.A.H.) and Mallinckrodt Institute of Radiology (C.O.M., W.D.M., M.J.S., K.T.B., J.P.H.), Washington University School of Medicine, 510 S Kingshighway Blvd, 9th Fl, St Louis, MO 63110. Presented as an education exhibit at the 2002 RSNA Scientific Assembly. Received April 13, 2004; revision requested June 10 and received June 21; accepted June 22. All authors have no financial relationships to disclose.
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Figure 1a. Clear cell sarcoma of the kidney. (a) Photograph of the cut surface of a resected specimen of clear cell sarcoma of the kidney shows a well-circumscribed tumor. (Courtesy of Frances V. White, MD, Washington University School of Medicine, St Louis, Mo.) (b) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows characteristic cords of cells separated by a few "chicken wire" septa (arrow).
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Figure 1b. Clear cell sarcoma of the kidney. (a) Photograph of the cut surface of a resected specimen of clear cell sarcoma of the kidney shows a well-circumscribed tumor. (Courtesy of Frances V. White, MD, Washington University School of Medicine, St Louis, Mo.) (b) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows characteristic cords of cells separated by a few "chicken wire" septa (arrow).
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Figure 2a. Clear cell sarcoma of the kidney. (a) Coronal, gadolinium-enhanced, fat-saturated, two-dimensional gradient-echo magnetic resonance (MR) image shows a large, heterogeneous, expansile mass in the right kidney (arrows). (b) Coronal, T1-weighted gradient-echo MR image shows bone metastases from clear cell sarcoma of the kidney that involve both femurs (arrows).
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Figure 2b. Clear cell sarcoma of the kidney. (a) Coronal, gadolinium-enhanced, fat-saturated, two-dimensional gradient-echo magnetic resonance (MR) image shows a large, heterogeneous, expansile mass in the right kidney (arrows). (b) Coronal, T1-weighted gradient-echo MR image shows bone metastases from clear cell sarcoma of the kidney that involve both femurs (arrows).
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Figure 3. Clear cell sarcoma of the kidney. Contrast material–enhanced computed tomographic (CT) scan demonstrates cystic changes (arrows) in a clear cell sarcoma of the kidney.
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Figure 4a. Malignant rhabdoid tumor (a) Photograph of a cross-section of a resected rhabdoid tumor shows a lobulated, solid, white cut surface (arrow). (b) Photomicrograph (original magnification, x300; hematoxylin-eosin stain) of a rhabdoid tumor of the kidney shows sheets of rhabdoid cells with cytoplasmic inclusions (arrow).
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Figure 4b. Malignant rhabdoid tumor (a) Photograph of a cross-section of a resected rhabdoid tumor shows a lobulated, solid, white cut surface (arrow). (b) Photomicrograph (original magnification, x300; hematoxylin-eosin stain) of a rhabdoid tumor of the kidney shows sheets of rhabdoid cells with cytoplasmic inclusions (arrow).
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Figure 5. Malignant rhabdoid tumors of the kidney. Contrast-enhanced CT scan demonstrates bilateral, infiltrative renal tumors with characteristic subcapsular cystic components (arrows).
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Figure 6a. Collecting duct carcinoma. (a) Photograph of a gross specimen shows a small, well-circumscribed, nodular mass with a yellow cut surface (arrows). (b) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows an infiltrative ductal carcinoma (arrows) in basophilic stroma.
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Figure 6b. Collecting duct carcinoma. (a) Photograph of a gross specimen shows a small, well-circumscribed, nodular mass with a yellow cut surface (arrows). (b) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows an infiltrative ductal carcinoma (arrows) in basophilic stroma.
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Figure 7. Collecting duct carcinoma. Sonogram of a patient with collecting duct carcinoma shows a uniformly hypoechoic renal medullary tumor (arrows).
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Figure 8. Collecting duct carcinoma. Axial gadolinium-enhanced, fat-saturated, three-dimensional gradient-echo MR image shows a complex cystic mass (black arrows) with a mural nodule (white arrow).
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Figure 9. Medullary carcinoma. Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows an infiltrative ductal carcinoma (arrow).
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Figure 10a. Medullary carcinoma in a patient with sickle cell trait. (a) Axial, T2-weighted fast spin-echo MR image demonstrates a predominantly hypointense tumor (arrows). (b) On a corresponding axial, gadolinium-enhanced, fat-saturated two-dimensional gradient-echo MR image, the medullary carcinoma has heterogeneous contrast enhancement (arrows).
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Figure 10b. Medullary carcinoma in a patient with sickle cell trait. (a) Axial, T2-weighted fast spin-echo MR image demonstrates a predominantly hypointense tumor (arrows). (b) On a corresponding axial, gadolinium-enhanced, fat-saturated two-dimensional gradient-echo MR image, the medullary carcinoma has heterogeneous contrast enhancement (arrows).
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Figure 11a. Transitional cell carcinoma. (a) Photograph of a resected specimen shows solid yellow-white tumor nodules (arrows). (b) Photomicrograph (original magnification, x20; hematoxylin-eosin stain) shows the frondular growth (arrow) of the papillary transitional cell carcinoma.
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Figure 11b. Transitional cell carcinoma. (a) Photograph of a resected specimen shows solid yellow-white tumor nodules (arrows). (b) Photomicrograph (original magnification, x20; hematoxylin-eosin stain) shows the frondular growth (arrow) of the papillary transitional cell carcinoma.
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Figure 12. Transitional cell carcinoma. Coronal, gadolinium-enhanced, three-dimensional gradient-echo MR image shows a heterogeneously enhancing tumor that has its epicenter in the medulla (arrows).
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Figure 13. Undifferentiated renal sarcoma. High-power photomicrograph (original magnification, x200; hematoxylin-eosin stain) of a renal sarcoma specimen shows sheets of undifferentiated, malignant spindle cells.
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Figure 14. Undifferentiated renal sarcoma. Contrast-enhanced CT scan demonstrates an infiltrative tumor (black arrows) with tumor thrombosis of the inferior vena cava (white arrow).
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Figure 15. Lymphoma occurring in a kidney transplant. Photomicrograph (original magnification, x200; hematoxylin-eosin stain) demonstrates malignant lymphoid cell infiltration.
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Figure 16a. Lymphoma occurring in a kidney transplant. (a) Axial, T1-weighted gradient-echo image reveals a mass (arrows) that is isointense relative to the normal renal parenchyma. (b) On an axial T2-weighted fast spin-echo MR image, the tumor is hypointense (arrows).
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Figure 16b. Lymphoma occurring in a kidney transplant. (a) Axial, T1-weighted gradient-echo image reveals a mass (arrows) that is isointense relative to the normal renal parenchyma. (b) On an axial T2-weighted fast spin-echo MR image, the tumor is hypointense (arrows).
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Figure 17a. Mesoblastic nephroma. (a) Photograph of a cross-section of a resected specimen shows an infiltrative white-brown mass (straight arrow) with perinephric extension (curved arrow). (b) Photomicrograph (original magnification, x20; hematoxylin-eosin stain) demonstrates cellular bundles of spindle cell proliferation (arrow).
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Figure 17b. Mesoblastic nephroma. (a) Photograph of a cross-section of a resected specimen shows an infiltrative white-brown mass (straight arrow) with perinephric extension (curved arrow). (b) Photomicrograph (original magnification, x20; hematoxylin-eosin stain) demonstrates cellular bundles of spindle cell proliferation (arrow).
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Figure 18. Mesoblastic nephroma. Contrast-enhanced CT scan shows a large tumor with cystic areas (arrowheads). Note the indentation on the collecting system (arrow).
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Figure 19a. Multilocular cystic tumor. (a) Photograph of a resected specimen shows a multicystic mass with thin fibrous trabeculae. (b) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) shows fibrous trabeculae with central cystic space (arrowheads) lined by flattened cells that are not clear cells.
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Figure 19b. Multilocular cystic tumor. (a) Photograph of a resected specimen shows a multicystic mass with thin fibrous trabeculae. (b) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) shows fibrous trabeculae with central cystic space (arrowheads) lined by flattened cells that are not clear cells.
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Figure 20. Multilocular cystic tumor. Axial contrast-enhanced CT scan shows a large multilocular cystic tumor with thin septa (arrows).
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Figure 21. Renal hemangioma. Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows interanastomosing vascular channels (arrow) of a mixed capillary-cavernous hemangioma.
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Figure 22a. Mixed capillary-cavernous renal hemangioma. (a) Axial, T2-weighted fast spin-echo MR image shows a fairly uniform, hyperintense lesion (arrows). (b) On an axial, gadolinium-enhanced, fat-saturated two-dimensional gradient-echo image, the tumor demonstrates intense arterial phase enhancement in a flame-shaped configuration (arrows).
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Figure 22b. Mixed capillary-cavernous renal hemangioma. (a) Axial, T2-weighted fast spin-echo MR image shows a fairly uniform, hyperintense lesion (arrows). (b) On an axial, gadolinium-enhanced, fat-saturated two-dimensional gradient-echo image, the tumor demonstrates intense arterial phase enhancement in a flame-shaped configuration (arrows).
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Copyright © 2005 by the Radiological Society of North America.
