Clinical radiographic, and pathologic findings of multilocular cystic nephroma (MLCN) in 58 patients are presented. The lesion that affects predominantly boys in childhood and women in adulthood is usually solitary but rarely can be multiple, and it commonly occurs as an asymptomatic mass, occasionally with hematuria. Tumors may grow slowly over years or rapidly within months. A mass that is usually identified on plain radiographs occasionally has curvilinear calcification. Excretory urography and retrograde pyelography are helpful when pelvic herniation of the tumor is recognized, or when septae are noted with total body opacification. Angiography showed an avascular mass (six lesions), a hypovascular mass (14 lesions), or a hypervascular mass three lesions). Ultrasonography is helpful when multiple circumscribed sonolucent areas are identified. Similarly, a multilocular mass with septae is usually identified by computed tomography (six of seven cases). Our findings and a review of the literature indicate that this lesion is a neoplasm that can be strongly suspected preoperatively if pelvic herniation or a multilocular pattern is noted on imaging studies.
The authors studied the hypothesis that oncocytoma and adenocarcinoma of the kidney can be differentiated with computed tomographic (CT) criteria and that differences would become more apparent as tumors enlarged. On contrast material-enhanced scans, homogeneous attenuation throughout the tumor and a central, sharply marginated, stellate area of low attenuation were considered predictors of oncocytoma. Any area of decreased attenuation in the tumor except for a stellate, central area was used as a predictor of adenocarcinoma. Among oncocytomas larger than 3 cm in diameter, 67% exhibited the criteria for oncocytoma and 33% met the criterion for adenocarcinoma; among smaller oncocytomas, the respective results were 82% and 18%. Among adenocarcinomas larger than 3 cm in diameter, 84% fulfilled the criterion for malignancy and 16% were incorrectly predicted to be oncocytomas; among smaller adenocarcinomas, the respective results were 58% and 42%. The authors conclude that the CT criteria used are poor predictors of the diagnosis of oncocytoma or adenocarcinoma regardless of tumor size.
Previous reports of angiomyolipoma have emphasized the ultrasonic finding of a very echogenic intrarenal mass. Ten cases of angiomyolipoma for which ultrasound examinations were available were retrospectively reviewed and correlated with their pathologic findings, and, when available, with computed tomographic findings to determine if other sonographic patterns could be recognized. In addition to the typical echodense pattern (six cases), a mixed pattern (two cases) and a low sonodense pattern (two cases) were discovered. To determine if the typical echodense pattern is specific for angiomyolipoma, 42 cases of renal cell carcinoma for which ultrasound examinations were available were also retrospectively reviewed. In two cases of renal cell carcinoma echodense patterns that were indistinguishable from those of angiomyolipoma were found. Two conclusions are reached: (a) there is a spectrum of ultrasonic findings with angiomyolipoma, and (b) the presence of an echodense intrarenal mass, although very suggestive of angiomyolipoma, is not pathognomonic.
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