Unusual fat-containing tumors of the kidney: a diagnostic dilemma.

Hélénon, O.; Merran, S.; Paraf, F; Melki, P; Corréas, Jean-Michel; Chrétien, Yves; Moreau, Jean-François

doi:10.1148/radiographics.17.1.9017804

Cited by 168 publications

(96 citation statements)

References 3 publications

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“…Renal masses have traditionally been classified as AMLs if they contain macroscopic fat that is not associated with calcification or ossification and show no evidence of invasion of perinephric or renal sinus fat [1]. Fat within RCC has been pathologically accounted for by three mechanisms [1][2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…Fat within RCC has been pathologically accounted for by three mechanisms [1][2][3][4][5]. First, RCC can engulf perinephric or renal sinus fat [6].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a distinct nodule of mature, well-circumscribed adipose tissue has been identified within an encapsulated, non-calcified RCC [9]. RCCs that contain fat because of osseous metaplasia have calcification or ossification associated with that fat [1]. Engulfed renal sinus or perirenal fat is seen in masses with an invasive appearance.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Fat within RCC has been pathologically accounted for by three mechanisms [1][2][3][4][5]. First, RCC can engulf perinephric or renal sinus fat [6].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Angiomyolipomas occur in two different clinical scenarios. Most commonly they are sporadic (80%); however, they may be associated with tuberous sclerosis (20%), in which case they tend to be multiple and bilateral (23). Patients are usually asymptomatic, and angiomyolipomas are usually incidentally discovered when the patient is imaged for another reason.…”

Section: Angiomyolipomamentioning

confidence: 99%

MRI of the kidney and urinary tract

Israel

2006

Magnetic Resonance Imaging

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MRI of the kidney and urinary tract has evolved with advancements in MR technology combined with further radiologic experience. A combination of simple pulse sequences and the use of gadolinium (Gd) allow a comprehensive evaluation of the genitourinary system and facilitate the detection and accurate characterization of renal and urinary tract masses. In this review an MRI technique used to evaluate the kidneys and urinary tract is presented with an emphasis on the characterization of renal masses. RECENT TECHNOLOGICAL ADVANCES have expanded the role of MRI in evaluating the kidney and the urinary tract. The high spatial resolution and intrinsic tissue contrast of MRI have resulted in superb detection and characterization of renal and urinary tract anatomy and pathology. Recently, new imaging methods (such as parallel imaging) have resulted in sequences with higher spatial resolution that are performed during shorter breath-holds. Gadolinium (Gd) can be administered to patients without concern for contrastinduced nephrotoxicity, and is well tolerated by patients with a history of iodinated-contrast allergy. The superior safety profile of Gd combined with the lack of ionizing radiation makes MRI an ideal modality for evaluating the genitourinary system, especially in patients who have renal disease or have undergone nephrectomy or partial nephrectomy. In this review the MRI findings of the kidneys and urinary system are discussed with an emphasis on differentiating renal masses and evaluating the collecting system. TECHNIQUEA comprehensive examination of the kidneys and collecting system includes an evaluation of the renal vasculature, parenchyma, and collecting system. Unenhanced imaging includes axial breath-hold T1-weighted gradient-echo (GRE) (performed in and out of phase), coronal or axial breath-hold T2-weighted half-Fourier single-shot fast spin-echo (FSE), and breath-hold frequency-selective fat-suppressed 3D T1-weighted spoiled GRE (Table 1) sequences. The 3D fat-suppressed T1-weighted sequence is also performed at multiple time points after intravenous Gd administration, and may be used to produce MR angiographic, venous, parenchymal, and excretory phase images. If it is necessary to determine the renal arterial anatomy (e.g., in patients about to undergo partial nephrectomy), this sequence should be performed in the oblique-coronal plane during an arterial phase. Using the proper scan delay and acquiring the low-spatial-frequency (high contrast) lines of k-space during peak arterial enhancement are critical for minimizing venous contamination and preventing scanning before sufficient contrast reaches the aorta. The arterial phase may be optimized with the use of fluoroscopic triggering (1), an automated bolus detection technique (2), a timing run (3), or a "best-guess" method. With improved gradient strength, pulse sequences, and parallel imaging methods, a "time-resolved" approach can also be used, which will obviate the need for a timing strategy (4). Scanning with rapid temporal resolution (approxi...

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“…The tendency for bleeding is multifactor and includes foci deficiency of the elastic tissue in abnormally rigid and thick blood vessels, hypervascularization and venous invasion. 3,5,7 The spontaneous rupture of an angiomiolipoma is an infrequent urological emergency, although presenting a potential risk to life. 8 The risk of bleeding is associated with a large tumor diameter.…”

Section: Introductionmentioning

confidence: 99%

Wunderlich Syndrome - Unusual Complication of Spontaneous Renal Haemorrhage

Nacif¹

2017

IJRRT

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A 50year old man went to the emergency service with an unspecific abdominal pain complaint. We performed a multidetector computed tomography (MDCT) of the abdomen, with and without iodinated intravenous contrast, that showed a hypodense nodule formation with regular and well delimited outlines, few heterogeneous foci and fat density (-35 HU), sizing about 1.8cm from the inferior pole of the left kidney (Figure 1). The patient was relieved of the pain and was discharged from hospital in the same day. After a month, the patient returned to the emergency service with a worse abdominal pain and an altered hemodynamic state. We performed another MDCT of the abdomen which detected the same nodule spontaneously dense and larger, with 2.2cm. We also detected an extend subcapsular renal and retroperitoneal hematoma, all aspects related to a spontaneous renal bleeding (Figure 2). We choose a more conservative treatment with hemodynamic support and stabilization in an intensive care unit. The patient improved in the hemodynamic parameters, after a month of hospitalization and then hospital discharge, and remains in outpatient treatment with no complaints for 1year. DiscussionThe display of fat in a kidney tumor by MDCT, as described in the case, is very suggestive of a RAML. 3 Other kidney tumors can also psent high levels of fat, such as the clear cell renal cell carcinoma, liposarcomas, atypical Wilms' tumor and teratomas. However, a cortical renal mass manly composed of fat (less than -20 HU) can be diagnosed as a RAML. 4-6Int J Radiol Radiat Ther. 2017;2(1):6-7.6

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Unusual fat-containing tumors of the kidney: a diagnostic dilemma.

Cited by 168 publications

References 3 publications

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

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

MRI of the kidney and urinary tract

Wunderlich Syndrome - Unusual Complication of Spontaneous Renal Haemorrhage

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