DOI: 10.1148/rg.252045073
RadioGraphics 2005;25:369-380
© RSNA, 2005
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.
Address correspondence to J.P.H. (e-mail: heikenj{at}mir.wustl.edu).
 |
Abstract
|
|---|
Tumors of the renal medulla cover a wide spectrum, with characteristic histomorphology and variable biologic profiles. Renal medullary tumors can be categorized into benign and malignant neoplasms based on histologic features and clinico-biologic behavior. They can be further classified into pediatric and adult tumors based on the patient age group. When small, renal medullary tumors may be differentiated from the more common renal adenocarcinomas by their central location and certain demographic characteristics. Although most large malignant medullary tumors demonstrate imaging findings that are indistinguishable from those of other renal malignancies, some tumors demonstrate imaging findings that may suggest a specific diagnosis.
© RSNA, 2005
|
LEARNING OBJECTIVES FOR TEST 3
|
|---|
After reading this article and taking the test, the reader will be able to:
- Describe the cross-sectional imaging appearances of tumors of the renal medulla.
- Illustrate the gross and histopathologic features of neoplasms of the renal medulla and correlate these findings with radiologic characteristics.
|
Introduction
|
|---|
Neoplasms of the renal medulla constitute a heterogeneous group of tumors with characteristic histomorphology and variable imaging features. It is important to identify and distinguish these tumors from the common adenocarcinomas that constitute more than 90% of renal tumors. On the basis of their histologic characteristics, as well as their clinical manifestations and biologic behavior, these tumors can be classified into benign and malignant tumors. They can be further categorized into pediatric and adult tumors (Table). The purpose of this article is to describe the cross-sectional imaging appearances of tumors of the renal medulla and to correlate these findings with pathologic characteristics.
Clear Cell Sarcoma
Clear cell sarcoma is a rare neoplasm that accounts for 4% of pediatric renal tumors (1). This tumor was first described in 1970 by Kidd (2), who noted its propensity for osseous metastasis. The majority of these tumors occur during the 2nd year of life. At gross examination, clear cell sarcoma typically manifests as a large, well-circumscribed, heterogeneous mass with cystic changes that distorts or replaces the kidney (Fig 1a). Areas of necrosis and hemorrhage are present in more than 70% of the tumors. In rare cases, cystic changes may be the dominant feature (3). The classic histologic pattern of clear cell sarcoma consists of nests or cords of cells separated by characteristic arborizing, fibrovascular cellular septa (1,3) (Fig 1b). Clear cell sarcoma has a propensity to permeate the renal and perirenal lymphovascular system, a characteristic that may partially explain the high number of local recurrences and the high frequency of lymph node metastases (approximately 30% of cases) at presentation (3). At imaging, clear cell sarcoma appears as a large, well-defined, predominantly solid renal mass with cystic changes (4) (Figs 2 , 3). Extracapsular tumor spread occurs in approximately 70% of patients. Tumor extension into the renal vein is extremely rare, occurring in 5% of cases (3). The tumor metastasizes most frequently to lymph nodes, followed by bone, liver, and lung (3). Common target sites of tumor recurrence include bone, lung, nephrectomy site, brain, and liver (3). Survival rates following nephrectomy and chemotherapy are more than 95% for patients with stage 1 disease and 75% for those with stage 2 or 3 disease (3).
View larger version (156K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
View larger version (191K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
View larger version (144K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
View larger version (146K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
Malignant Rhabdoid Tumor
Malignant rhabdoid tumor is a rare tumor, accounting for 2% of pediatric renal neoplasms (5). It derives its name from its histologic similarity to skeletal muscle. It is characteristically associated with synchronous or metachronous embryonal tumors of the central nervous system (4). Para-neoplastic hypercalcemia is seen in rare cases. Malignant rhabdoid tumor originates from primitive cells in the renal medulla and frequently extends to the hilum (1). Gross examination of a resected specimen shows a lobulated, solid cut surface (Fig 4a). At histopathlogic analysis, the tumor is composed of monotonous large cells with prominent nucleoli and abundant eosinophilic cytoplasm (1) (Fig 4b). At imaging, malignant rhabdoid tumor appears as a heterogeneous tumor that is associated with a characteristic peripheral, crescentic, subcapsular fluid collection in approximately 50%–70% of cases (5–7) (Fig 5). The subcapsular fluid represents tumor necrosis or hemorrhage. The presence of a subcapsular fluid collection associated with a pediatric renal tumor is characteristic but not pathognomonic of rhabdoid tumors, because similar collections are occasionally seen with Wilms tumor, mesoblastic nephroma, and clear cell sarcoma (1,5,6). Common target sites of metastasis include regional lymph nodes and lungs, with liver, bone, and brain being infrequently involved (5–7). Malignant rhabdoid tumor demonstrates extremely aggressive biologic behavior that is uniformly associated with poor prognosis and an 18-month survival rate of approximately 20%.
View larger version (144K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
View larger version (198K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
View larger version (143K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 5. Malignant rhabdoid tumors of the kidney. Contrast-enhanced CT scan demonstrates bilateral, infiltrative renal tumors with characteristic subcapsular cystic components (arrows).
|
|
Collecting Duct Carcinoma
Collecting duct carcinoma is a histologically distinct tumor that accounts for 1% of all adult malignant renal tumors. Gross pathologic examination reveals a gray-white, infiltrative neoplasm centered in the pelvicaliceal system (Fig 6a). This tumor is histologically characterized by a tubulo-papillary pattern of growth, marked desmoplasia, neutrophilic infiltrate, and occasional mucin production (8) (Fig 6b). The origin of this tumor from the collecting duct is suggested by its usual medullary location and its immunoreactivity with markers similar to collecting duct cells (8). Most collecting duct carcinomas are clinically aggressive, with 40% of patients having metastatic disease at presentation. At imaging, the tumors demonstrate a variegated appearance. They may demonstrate either expansile or infiltrative growth patterns (9). At ultrasonography (US), collecting duct carcinoma may be homogeneously hyperechoic or hypoechoic relative to renal parenchyma (Fig 7). At CT, the mass appears hypoattenuating and hypovascular (9). Calcification is seen in up to 25% of patients. Collecting duct carcinoma has variable signal intensity on T1-weighted MR images and is frequently hypointense on T2-weighted MR images. Cystic changes with mural nodules may be seen (Fig 8). Imaging findings that suggest the diagnosis of collecting duct carcinoma include a medullary epicenter, hyperechogenicity on sonograms, and low signal intensity on T2-weighted MR images (9). Collecting duct carcinoma is a biologically aggressive neoplasm associated with a poor prognosis and average survival of approximately 12 months (8).
View larger version (150K):
[in this window]
[in a new window]
[Download PPT slide]
|
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.
|
|
View larger version (164K):
[in this window]
[in a new window]
[Download PPT slide]
|
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.
|
|
View larger version (152K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
Medullary Carcinoma
Renal medullary carcinoma is a highly aggressive neoplasm that almost always develops in young patients (11–39 years) with sickle cell trait. First described in 1995 by Davis et al (10), medullary carcinoma shares many histologic features with collecting duct carcinoma, such as inflammatory desmoplastic stroma and mucin production (Fig 9). In patients with sickle cell trait, there is a chronic hypoxic environment in the renal medulla that eventually leads to transitional cell proliferation involving the terminal collecting ducts and papillary epithelium (10,11). It is hypothesized that medullary carcinoma arises in this background of epithelial proliferation (11,12). At gross pathologic examination, medullary carcinoma has a central location with smaller satellite nodules in the cortex and the hilum. Hemorrhage and necrosis are usually present.
The tumor is more prevalent among men younger than 25 years (3:1 male preponderance); in patients over 25 years of age, there is no sex predilection. Patients usually present with hematuria, flank pain, and weight loss. Metastases occur, in decreasing order of frequency, to the lymph nodes, lung, adrenal gland, and liver (10). At imaging, these tumors appear as ill-defined, infiltrative masses that arise in the renal medulla and invade the renal sinus (13) (Fig 10). Caliectasis without pelviectasis is an associated finding (13). This tumor is extremely aggressive, and patients have a mean survival of 15 weeks.
View larger version (147K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
View larger version (163K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
Transitional Cell Carcinoma
Although transitional cell carcinomas constitute 90% of all urothelial tumors, primary renal pelvic transitional cell carcinoma is extremely rare, accounting for 1% of all urinary tract tumors (14). These tumors share the epidemiologic features associated with transitional cell carcinomas of the lower urinary tract and the bladder. Patients usually present with painless hematuria. Metastases occur via a lymphohematogenous route to regional lymph nodes, liver, and lungs (15). Multi-centricity of tumors is a characteristic finding. Most renal pelvic transitional cell carcinomas demonstrate exophytic growth. High-grade transitional cell carcinoma may invade the renal sinus to extend into the renal medulla (15) (Fig 11a). At histologic analysis, an infiltrative pattern of growth is apparent, with the cells arranged in nests and cords (Fig 11b). At imaging, transitional cell carcinoma appears as an ill-defined mass centered in the renal pelvis and causing obliteration of the renal sinus fat. Transitional cell carcinoma may extend into the renal medulla (15) (Fig 12). These tumors may be mixed hypoechoic and hyperechoic on sonograms, have low attenuation on CT scans, and have heterogeneous signal intensity on T1- and T2-weighted MR images. Prognosis in patients without involvement of the muscularis layer of the renal pelvis is good, with 5-year survival rates of approximately 80% (15).
View larger version (164K):
[in this window]
[in a new window]
[Download PPT slide]
|
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.
|
|
View larger version (201K):
[in this window]
[in a new window]
[Download PPT slide]
|
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.
|
|
View larger version (161K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
Primary Sarcoma
Primary renal sarcomas are rare, constituting 1% of malignant renal tumors. Subtypes include leiomyosarcoma (the most common type), angiosarcoma, hemangiopericytoma, rhabdomyosarcoma, fibrosarcoma, and osteosarcoma. Renal sarcomas have variable histologic profiles (Fig 13), clinico-biologic behavior, and imaging findings. At imaging, renal sarcomas are indistinguishable from renal adenocarcinomas. They may appear either as well-circumscribed, expansile masses or as diffusely infiltrative neoplasms with widespread nodal and systemic metastases at presentation (15,16) (Fig 14). Prognosis is uniformly poor, with 90% of patients developing distant metastases, most commonly to the lungs.
View larger version (201K):
[in this window]
[in a new window]
[Download PPT slide]
|
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.
|
|
View larger version (176K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
Lymphoma
Primary renal lymphoma is extremely rare, with renal involvement usually resulting from systemic disease or contiguous spread from adjacent retro-peritoneal nodes (17). The prevalence of renal lymphoma is increased in the setting of either primary or secondary immunodeficiency (17). Most patients with renal lymphoma present with non-specific symptoms. In most cases, renal lymphoma is large B-cell non-Hodgkin disease (18). Gross examination frequently demonstrates fleshy, firm, yellow to gray tumors. At histologic analysis, lymphoma is characterized by uniform cells with prominent nuclei and scant cytoplasm (Fig 15). The most common imaging appearance is that of multiple, bilateral, homogeneous masses that are hypoechoic at US, low attenuation at CT, and hypointense on T2-weighted MR images (17,19). Lymphomas enhance less than the renal parenchyma following administration of contrast material on both CT and MR images. Uncommonly, renal lymphoma manifests either as a diffusely infiltrating tumor that replaces the entire kidney or as a hypovascular solitary lesion (15,17) (Fig 16). Atypical imaging findings include necrosis, cystic change, hemorrhage, and calcification (17). The prognosis for patients with primary renal lymphoma is poor, with death commonly occurring within 1 year of diagnosis.
View larger version (163K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
View larger version (132K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
|
Benign Neoplasms of the Renal Medulla
|
|---|
Mesoblastic Nephroma
Mesoblastic nephroma (fetal renal hamartoma or leiomyomatous hamartoma) is the most common solid renal neoplasm in the first 3 months of life (4). Gross pathologic examination reveals a solid, unencapsulated tumor that commonly occurs near the renal hilum (Fig 17a). Hemorrhage and necrosis are infrequent. At histologic analysis, mesoblastic nephroma is characterized by bundles of spindle cells that infiltrate between nephrons and replace the parenchyma (Fig 17b). Cellular mesoblastic nephromas demonstrate infiltrative growth that extends into the renal pelvis (1). The most common clinical presentation is a palpable abdominal mass, with hematuria occurring less frequently. At imaging, mesoblastic nephroma appears as a unicentric, relatively homogeneous, solid mass that typically involves the renal sinus (4). Mesoblastic nephroma is homogeneously hypoechoic at US, low attenuation at CT, and homogeneously hypointense on both T1- and T2-weighted MR images (4). Infrequently, areas of necrosis and hemorrhage are seen (Fig 18). Mesoblastic nephroma typically exhibits benign behavior, and nephrectomy usually suffices as treatment.
View larger version (155K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
View larger version (196K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
Multilocular Cystic Tumor
Multilocular cystic tumor is a benign, encapsulated lesion containing multiple cysts of varying sizes (Fig 19a). Septa are the only solid components of these tumors. Cysts are lined by cuboidal epithelium, which may have a hobnail appearance (Fig 19b). Necrosis, hemorrhage, and calcification are usually absent. Multilocular cystic tumor is typically unilateral and solitary. These tumors have a bimodal age and sex distribution, affecting boys between 3 months to 4 years of age and adult women over 40 years old. The most common clinical manifestation is a painless abdominal mass. Imaging studies demonstrate a well-circumscribed mass composed of multiple non-communicating cysts of varying sizes that may herniate into the renal pelvis and ureter (4) (Fig 20). The septations are usually regular, have variable thickness, and show moderate contrast enhancement on CT and MR images. On MR images, the cyst fluid may vary in signal intensity, depending on its chemical composition. The fibrous capsule is hypointense, regardless of the pulse sequences used. Nephrectomy is curative.
View larger version (146K):
[in this window]
[in a new window]
[Download PPT slide]
|
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.
|
|
View larger version (194K):
[in this window]
[in a new window]
[Download PPT slide]
|
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.
|
|
Hemangioma
Hemangioma of the kidney is a rare benign neoplasm, with 90% of the tumors occurring in the medulla (papilla) and the renal sinus (20). Most lesions are solitary, unilateral, and less than a centimeter in size. Hemangiomas may be of the capillary or cavernous type (Fig 21). They may be associated with Sturge-Weber syndrome and Klippel-Trénaunay-Weber syndrome. Patients usually present with intermittent hematuria (20,21). Hemorrhage from these submucosal lesions is thought to occur as a result of thrombosis, infarction, or neoangiogenesis and subsequent mucosal erosion (21). Renal hemangiomas are hyperechoic at US (20). At CT and MR imaging, they may demonstrate intense arterial phase contrast enhancement that persists into the venous phase (Fig 22). At MR imaging performed without contrast material, hemangiomas may appear homogeneously hypointense on T1-weighted images and homogeneously hyperintense on T2-weighted images. Preoperative diagnosis of renal hemangioma is extremely difficult, and the lesion is often mistaken for more common renal pelvic malignancies such as transitional cell carcinoma and renal adenocarcinoma.
View larger version (216K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 21. Renal hemangioma. Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows interanastomosing vascular channels (arrow) of a mixed capillary-cavernous hemangioma.
|
|
View larger version (138K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
View larger version (141K):
[in this window]
[in a new window]
[Download PPT slide]
|
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).
|
|
|
Conclusions
|
|---|
Tumors of the renal medulla have a wide spectrum of histopathologic characteristics and variable imaging findings. When small, these tumors may be differentiated from the more common renal adenocarcinomas by their central location and certain demographic characteristics. Despite considerable overlap in the radiologic appearances of renal tumors, characteristic findings of some of renal medullary neoplasms may suggest a specific diagnosis.
|
References
|
|---|
- Ordonez NG, Rosai J. Urinary tract. In: Rosai J, ed. Ackerman’s surgical pathology. 8th ed. St Louis, Mo: Mosby–Year Book, 1996; 1140–1160.
- Kidd JM. Exclusion of certain renal neoplasms from the category of Wilms tumor (abstr). Am J Pathol
1970; 58:16a.
- Argani P, Perlman EJ, Breslow NE, et al. Clear cell sarcoma of the kidney: a review of 351 cases from the National Wilms Tumor Study Group Pathology Center. Am J Surg Pathol
2000; 24:4–18.[CrossRef][Medline]
- Lowe LH, Isuani BH, Heller RM, et al. Pediatric renal masses: Wilms tumor and beyond. RadioGraphics
2000; 20:1585–1603.[Abstract/Free Full Text]
- Han TI, Kim MJ, Yoon HK, Chung JY, Choeh K. Rhabdoid tumour of the kidney: imaging findings. Pediatr Radiol
2001; 31:233–237.[CrossRef][Medline]
- Agrons GA, Kingsman KD, Wagner BJ, Sotelo-Avila C. Rhabdoid tumor of the kidney in children: a comparative study of 21 cases. AJR Am J Roentgenol
1997; 168:447–451.[Abstract/Free Full Text]
- Chung CJ, Lorenzo R, Rayder S, et al. Rhabdoid tumors of the kidney in children: CT findings. AJR Am J Roentgenol
1995; 164:697–700.[Abstract/Free Full Text]
- Chao D, Zisman A, Pantuck AJ, et al. Collecting duct renal cell carcinoma: clinical study of a rare tumor. J Urol
2002; 167:71–74.[CrossRef][Medline]
- Pickhardt PJ, Siegel CL, McLarney JK. Collecting duct carcinoma of the kidney: are imaging findings suggestive of the diagnosis? AJR Am J Roentgenol
2001; 176:627–633.[Abstract/Free Full Text]
- Davis CJ Jr, Mostofi FK, Sesterhenn IA. Renal medullary carcinoma: the seventh sickle cell nephropathy. Am J Surg Pathol
1995; 19:1–11.[Medline]
- Swartz MA, Karth J, Schneider DT, Rodriguez R, Beckwith JB, Perlman EJ. Renal medullary carcinoma: clinical, pathologic, immunohistochemical, and genetic analysis with pathogenetic implications. Urology
2002; 60:1083–1089.[CrossRef][Medline]
- Dimashkieh H, Choe J, Mutema G. Renal medullary carcinoma: a report of 2 cases and review of the literature. Arch Pathol Lab Med
2003; 127: e135–e138.[Medline]
- Davidson AJ, Choyke PL, Hartman DS, Davis CJ Jr. Renal medullary carcinoma associated with sickle cell trait: radiologic findings. Radiology
1995; 195:83–85.[Abstract/Free Full Text]
- Catalona WJ, Messing EM. Urothelial tumors of the renal pelvis and ureter. In: Walsh PC, Retic AB, Vaughan ED, et al, eds. Campbell’s urology. 7th ed. Philadelphia, Pa: Saunders, 1998; 2383–2410.
- Pickhardt PJ, Lonergan GJ, Davis CJ Jr, Kashitani N, Wagner BJ. Infiltrative renal lesions: radiologic-pathologic correlation. RadioGraphics
2000; 20: 215–243.[Abstract/Free Full Text]
- Grignon DJ, Ayala AG, Ro JY, El-Nagger A, Papadopoulos NJ. Primary sarcomas of the kidney: a clinicopathologic and DNA flow cytometric study in 17 cases. Cancer
1990; 65:1611–1618.[CrossRef][Medline]
- Urban BA, Fishman EK. Renal lymphoma: CT patterns with emphasis on helical CT. RadioGraphics
2000; 20:197–212.[Abstract/Free Full Text]
- Ferry JA, Harris NL, Papanicolaou N, Young RH. Lymphoma of the kidney: a report of 11 cases. Am J Surg Pathol
1995; 19:134–144.[Medline]
- Sheeran SR, Sussman SK. Renal lymphoma: spectrum of CT findings and potential mimics. AJR Am J Roentgenol
1998; 171:1067–1072.[Abstract/Free Full Text]
- Lee HS, Koh BH, Kim JW, et al. Radiologic findings of renal hemangioma: report of three cases. Korean J Radiol
2000; 1:60–63.[Medline]
- Daneshmand S, Huffman JL. Endoscopic management of renal hemangioma. J Urol
2002; 167(2 pt 1):488–489.[CrossRef][Medline]
This article has been cited by other articles:
|
|
|
|
 
V. R. Surabhi, C. Menias, S. R. Prasad, A. H. Patel, A. Nagar, and N. C. Dalrymple
Neoplastic and Non-neoplastic Proliferative Disorders of the Perirenal Space: Cross-sectional Imaging Findings
RadioGraphics,
July 1, 2008;
28(4):
1005 - 1017.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. R. Prasad, V. R. Surabhi, C. O. Menias, A. A. Raut, and K. N. Chintapalli
Benign Renal Neoplasms in Adults: Cross-Sectional Imaging Findings
Am. J. Roentgenol.,
January 1, 2008;
190(1):
158 - 164.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S R Prasad, V R Narra, R Shah, P A Humphrey, J Jagirdar, J R Catena, N C Dalrymple, and C L Siegel
Segmental disorders of the nephron: histopathological and imaging perspective
Br. J. Radiol.,
August 1, 2007;
80(956):
593 - 602.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. R. Prasad, P. A. Humphrey, J. R. Catena, V. R. Narra, J. R. Srigley, A. D. Cortez, N. C. Dalrymple, and K. N. Chintapalli
Common and Uncommon Histologic Subtypes of Renal Cell Carcinoma: Imaging Spectrum with Pathologic Correlation
RadioGraphics,
November 1, 2006;
26(6):
1795 - 1806.
[Abstract]
[Full Text]
[PDF]
|
|
|
Top
Abstract
LEARNING OBJECTIVES FOR TEST...
