BACKGROUND The impact of mononuclear cell infiltration on renal cell carcinoma (RCC) biology has been controversial, previously reported to be associated with either a favorable or unfavorable prognosis. The objective of the current study was to evaluate associations between mononuclear cell infiltration in routinely prepared paraffin‐embedded specimens with survival in patients with clear‐cell RCC. METHODS A total of 306 patients were identified treated with nephrectomy for clear‐cell RCC between 1990 and 1994. A single urologic pathologist, blinded to patient outcome, reviewed the specimens and quantified the extent of mononuclear cell infiltration as absent, focal, moderate, or marked. Cancer‐specific survival was estimated using the Kaplan–Meier method. Associations of mononuclear cell infiltration with death from RCC were assessed using Cox proportional hazards regression models. RESULTS At last follow‐up, 173 of the 306 patients studied had died, including 96 patients who died from RCC. Mononuclear cell infiltration was absent in 165 (54%), focal in 70 (23%), moderate in 53 (17%), and marked in 18 (6%). Univariately, patients with specimens that had mononuclear cell infiltration were over 2 times more likely to die from RCC compared with patients whose specimens exhibited no mononuclear cell infiltration (risk ratio, 2.63; P<.001). After adjusting for the Mayo Clinic SSIGN (stage, size, grade, and necrosis) score, patients with specimens that had mononuclear cell infiltration exhibited a significantly increased likelihood of dying from RCC compared with patients whose specimens had no mononuclear cell infiltration (risk ratio, 1.61; P = .028). CONCLUSIONS Mononuclear cell infiltration is associated with death from RCC even after multivariate adjustment. Routine documentation of mononuclear cell infiltration is recommended during the pathologic assessment of RCC. Cancer 2006. © 2006 American Cancer Society.

Introduction: Mediastinal lesions are uncommon; studies on their distribution are, in general, small and from a single institution. Furthermore, these studies are usually based on pathology or surgical databases and, therefore, miss many lesions that did not undergo biopsy or resection. Our aim was to identify the distribution of lesions in the mediastinum in a large international, multi-institutional cohort.Methods: At each participating institution, a standardized retrospective radiology database search was performed for interpretations of computed tomography, positron emission

Eosinophilic cystitis is a rare condition with a wide range of clinical manifestations. Children can present with a bladder mass mimicking sarcoma, underscoring the need for biopsy before diagnosis and treatment of a presumed oncological process. The condition usually follows a benign course, although unremitting progression remains a possibility.

As survival rates continue to increase for patients with childhood and adult malignancies, imaging utilization in these patients will likely increase substantially. It is important to detect disease recurrence and to recognize the potential complications that occur after treatment with oncologic medications and therapeutic radiation. The most common cardiotoxic side effect of the anthracycline drug class is a dose-dependent decline in ejection fraction, which may result in dilated cardiomyopathy. Multiple-uptake gated acquisition (MUGA) scanning plays an important role in diagnosis of this subclinical cardiac dysfunction. Other less common cardiotoxic side effects of chemotherapeutic medications include arrhythmia, myocarditis, coronary artery disease, tamponade, pericarditis, and pericardial effusion. Radiation therapy can also lead to cardiotoxicity when the heart or pericardium is included in the radiation portal. Radiation-induced conditions include pericardial disease, coronary artery disease, valvular disease, and cardiomyopathy. Many of these side effects are asymptomatic until late in the course of the disease. With imaging, these pathologic conditions can often be diagnosed before symptom onset, which may allow early intervention. Radiologists should be familiar with the current knowledge and pathophysiology regarding cardiac complications related to chemotherapy and radiation therapy of malignant neoplasms and the appearances of treatment-related cardiotoxicity that can be found at radiography, nuclear medicine examinations, and cross-sectional imaging. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.336125005/-/DC1.

No abstract

No abstract

Purpose:To use velocity-encoded phase contrast (PC) MRI in assessing the effect of coronary microembolization on longitudinal and radial myocardial strain. Materials and Methods:A combined X-ray and MR system (XMR) was used for selective left anterior descending artery catheterization and microinfarct assessment in swine (n ϭ 6). The embolized area at risk was defined on perfusion MRI followed by administration of a 7500 count (size ϭ 100 -300 m) of the embolic agent. Quantification of strain and microinfarction was performed at 1 h and 1 week using PC-MRI and delayed enhancement (DE) MRI, respectively. At postmortem, sliced hearts were stained to define microinfarction.Results: Baseline longitudinal and radial strain did not differ between area-at-risk and remote myocardium. The embolized territory (area at risk) showed significant decline in longitudinal strain from Ϫ11.5 Ϯ 3.2% to 1.8 Ϯ 2.5% at 1 h (P Ͻ 0.05) and Ϫ3.9 Ϯ 1.1% at 1 week (P Ͻ 0.05). Similarly, regional radial strain progressively declined from 23.6 Ϯ 2.5% at baseline to 12.5 Ϯ 3.7% at 1 h (P Ͻ 0.05) and 4.8 Ϯ 5.0% at 1 week (P Ͻ 0.01). The size of microinfarction was not significantly different between DE-MRI and histochemical staining. Conclusion:PC-MRI is sensitive in assessing changes in regional longitudinal and radial strain after coronary embolization. Longitudinal and radial strain of the hyperenhanced patchy microinfarction demonstrates persistent decline over the course of 1 week.

A myloidosis is a condition in which misfolded proteins form insoluble deposits in the extracellular space of various tissues and organs, leading to interstitial expansion and disruption of structure and function. Light-chain (AL) amyloidosis is caused by an underlying plasma cell dyscrasia; cardiac involvement is common, is present in ≈50% of patients at presentation, and is a principal driver of morbidity and mortality.1 In practice, there has been reliance on ECG and echocardiographic features, as well as serum cardiac biomarkers, such as pro-brain natriuretic peptide and troponin T concentrations, for prognostic purposes and correlation to clinical response to treatment. However, these parameters can be of limited use because of concomitant etiologies for left ventricular (LV) hypertrophy and coexisting renal impairment. T1 relaxation time for hydrogen magnetization in the myocardium, an intrinsic characteristic of tissue, has been studied in a variety of pathologies with diffuse processes, including amyloidosis. Native, also known as noncontrast or precontrast, T1 mapping can be performed without the use of gadolinium-based contrast in patients with significantly reduced glomerular filtration rate. The technique of T1 mapping with cardiovascular magnetic resonance (CMR), in which T1 relaxation times for all pixels in the acquired image of the heart are measured, has been used for purposes of tissue characterization in regards to the diagnosis of cardiac involvement 2 and prognosis in AL amyloidosis 3 at single time point evaluations. Here we present a case using serial CMR native T1 mapping to assess treatment response of AL amyloidosis in a patient with renal failure.A 60-year-old Caucasian woman with a past medical history of hyperlipidemia, chronic obstructive pulmonary disease, and chronic kidney disease experienced progressive symptoms of fatigue over the course of a year with ongoing declining renal function. As part of the work-up, a renal biopsy demonstrated AL amyloidosis, and a bone marrow biopsy demonstrated the presence of a plasma cell neoplasm. In addition, she had elevated beta-2 microglobulin (20.03 mg/L; reference range ≤2.64), immunoglobulin kappa-free light chains (58.10 mg/dL; reference range 0.33-1.94), and kappa:lambda-free light chains ratio (24.94; reference range 0.26-1.65) values, as well as abnormal troponin T (0.17 ng/mL; reference range <0.01) and pro-brain natriuretic peptide (>70 000 pg/mL; reference range <300). The AL amyloidosis was treated with a course of cyclophosphamide, bortezomib, and dexamethasone for the first 8 months, followed by pomalidomide for maintenance therapy. She was referred for onco-cardiology evaluation and followup during chemotherapy treatment, given the cardiac findings of low-voltage ECG (Figure 1), LV hypertrophy, and diastolic dysfunction (Figure 2) on transthoracic echocardiography and abnormal cardiac biomarkers. Her ongoing renal failure with a glomerular filtration rate of <30 mL/min/m 2 led to the initiation of hemodialysis. As her renal fail...