CT demonstration of liquid intratumoral fat layering in a necrotic renal cell carcinoma

Castoldi, M. C.; Dellafiore, L; Renne, G.; Schiaffino, E; Casolo, F

doi:10.1007/bf01213279

Cited by 23 publications

(11 citation statements)

References 11 publications

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“…The fat in these tumors is macroscopic and exhibits negative attenuation value on CT or as bright signal relative to subcutaneous or retroperitoneal fat tissue on T1-weighted MR images [2,3]. RCC, the most common malignant tumors arising from the kidney, rarely show this macroscopic fat on radiologic examinations, although rare exceptional cases have been reported sporadically [5][6][7][8][9]. With a usage of chemical-shift gradient-echo MR imaging, fat of lesser amount, or microscopic fat, which does not exhibit negative attenuation value on CT or bright signal on T1-weighted MR images, has become detectable.…”

Section: Case Reportmentioning

confidence: 96%

Fat detection in granular-cell renal cell carcinoma using chemical-shift gradient-echo MR imaging: another renal tumor that contains fat

et al. 2000

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Preoperative chemical-shift magnetic resonance images in a 56-year-old man suggested the presence of microscopic fat in the tumor. The surgical specimen showed a granular-cell renal cell carcinoma with papillary architecture, associated with abundant fat-containing foamy histiocytes in the interstitium. The radiologist should include this entity in the differential diagnoses of renal tumors that contain microscopic fat.

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Section: Case Reportmentioning

confidence: 96%

Fat detection in granular-cell renal cell carcinoma using chemical-shift gradient-echo MR imaging: another renal tumor that contains fat

et al. 2000

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“…First, RCC can engulf perinephric or renal sinus fat [6]. Second, cholesterol necrosis can be misinterpreted as macroscopic fat [7,8]. Third, osseous metaplasia of the nonepithelial stromal portion of the tumour, with growth of fatty marrow elements and trabeculae, is a rare occurrence [4].…”

Section: Discussionmentioning

confidence: 99%

Renal cell carcinoma containing macroscopic fat on CT mimics an angiomyolipoma due to bone metaplasia without macroscopic calcification

Richmond

Atri²,

Sherman³

et al. 2010

BJR

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ABSTRACT. We report a case of renal cell carcinoma (RCC) containing foci of macroscopic fat, which were pathologically proven to be areas of osseous metaplasia. The macroscopic fat was not associated with calcification on the pre-operative CT scan. To our knowledge, there are no reported cases of RCC that contain osseous metaplasia without evidence of macroscopic calcification on CT. The finding is significant because standard imaging practice is to classify a renal mass containing intratumoral macroscopic fat that is not associated with calcification, ossification or invasion of perirenal or hilar fat as an angiomyolipoma. Case reportA 61-year-old female patient with a history of multiple metachronous localised breast cancers, which had been treated with surgery, radiotherapy and tamoxifen, was found to have renal and liver masses on imaging performed in an outside institution during the staging of her most recent breast cancer. Further investigations, including biopsy of the liver masses and colonoscopy, revealed that the patient had a colon carcinoma in her cacum with three liver metastases; the renal mass was thought to be another metastasis. The patient underwent chemotherapy, which resulted in the disappearance or significant regression of the liver lesions but no change in the kidney mass. She was referred for possible excision of the cacal primary, the remaining liver disease and the renal mass.A portal venous phase enhanced CT scan was performed. In addition, the renal lesion was evaluated sonographically. The CT scan revealed an encapsulated enhancing exophytic left renal mass that measured 10 cm in maximum dimension. This heterogeneous mass contained at least three small hypoattenuating foci measuring up to 5 mm with attenuation values ranging from 219 to 232 HU, consistent with foci of macroscopic fat. No intratumoral calcium was evident on CT (Figure 1). There was no evidence of renal vein involvement or adenopathy.Sonographically, the mass was predominantly solid and hypoechoic, and multiple echogenic foci corresponding to the fat nodules were visualised (Figure 2).The imaging features of the mass were highly suggestive of an angiomyolipoma (AML); nevertheless, a biopsy was performed because of the small possibility that the fat was within a renal cell carcinoma (RCC). The pathology was consistent with a conventional clear-cell RCC rather than an AML.The patient underwent simultaneous left radical nephrectomy and right hemicolectomy. Pathological examination revealed a pT2 clear cell RCC with Fuhrman nuclear grade 2/4. There was no involvement of the perinephric or hilar fat. Histologically, small foci of metaplastic bone containing fat were visualised (Figure 3).

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“…Radiographic evidence of fat within a renal mass can be seen in both AML and RCC, potentially complicating the radiographic diagnosis of AML versus RCC. Intratumoral adipose in RCC is usually associated with osseous metaplasia [1][2][3][4][5][6][7][8][9][10][11][12][13][14], but AML is also known to rarely present with calcifications [15][16][17][18][19][20]. Furthermore, RCC has been reported to contain adipose without evidence of calcification on CT and/or pathologic analysis [3,[7][8][9]14].…”

Section: Discussionmentioning

confidence: 99%

“…In RCC in which intratumoral adipose is present, the adipose is often associated with osseous metaplasia, defined as bone matrix with associated osteoblasts, osteoclasts, adipocytes, and/or hematopoietic cells [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The exact etiology of intratumoral adipose is unknown, but there are three recognized mechanisms by which Table 2) (10X magnification).…”

Section: Discussionmentioning

confidence: 99%

Clinicopathologic analysis of renal cell carcinoma containing Intratumoral fat with and without osseous metaplasia

et al. 2020

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Background: There is minimal information regarding the prevalence of intratumoral adipose in renal cell carcinoma (RCC), and no study has assessed the impact of intratumoral adipose on the preoperative imaging diagnosis. The aim of this study was to investigate the prevalence and histopathologic characteristics of entrapped adipose with or without osseous metaplasia in RCC nephrectomy specimens and to determine if this finding impacted the preoperative imaging interpretation. Methods: 704 RCC specimens were prospectively evaluated for entrapped adipose and osseous metaplasia (423 partial nephrectomies, 281 total nephrectomies; 327 pT1a, 377 ≥ pT1b; 510 clear cell, 119 papillary, 30 chromophobe, 22 clear cell papillary, 23 other). Imaging reports were obtained, and the presence of intratumoral fat or calcification and the radiologic diagnostic impression were recorded. Results: 3% (n = 21) contained microscopically identified intratumoral adipose, with a similar frequency in the main histologic subtypes (p = 0.76). Mean metaplastic deposit size was 0.4 cm, mean deposit to capsule distance 0.2 cm, and 29% involved the tumor capsule. Histologically identified adipose was infrequently noted via imaging (13%), and only 1 case with histologically identified metaplasia had a radiologic diagnostic differential of angiomyolipoma (1/704, 0.1%). Conclusion: While intratumoral adipose and/or osseous metaplasia can be observed within RCC, it is extremely rare for the radiologic diagnostic impression to have been confounded by histologically identified entrapped adipose. Awareness that metaplastic deposits are usually near the tumor capsule and may be minute could help prevent errors in diagnosis or staging.

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CT demonstration of liquid intratumoral fat layering in a necrotic renal cell carcinoma

Cited by 23 publications

References 11 publications

Fat detection in granular-cell renal cell carcinoma using chemical-shift gradient-echo MR imaging: another renal tumor that contains fat

Fat detection in granular-cell renal cell carcinoma using chemical-shift gradient-echo MR imaging: another renal tumor that contains fat

Renal cell carcinoma containing macroscopic fat on CT mimics an angiomyolipoma due to bone metaplasia without macroscopic calcification

Clinicopathologic analysis of renal cell carcinoma containing Intratumoral fat with and without osseous metaplasia

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