CT and US Findings of Multilocular Cystic Renal Cell Carcinoma

Objective

Multilocular cystic renal cell carcinoma (MCRCC) is a recently described variety of renal cell carcinoma with characteristic pathologic and clinical features. The purpose of this study was to analyze the imaging findings of MCRCCs.

Materials and Methods

Ten adult patients with pathologically proven unilateral MCRCC who underwent renal US and CT were included in this study. The radiologic findings were retrospectively evaluated for cystic content, wall, septum, nodularity, calcification and solid portion by three radiologists who established a consensus. Imaging and postnephrectomy pathologic findings were compared.

Results

All patients were adults (six males and four females) and their ages ranged from 33 to 68 years (mean, 46). On US and CT images, all tumors appeared as well-defined multilocular cystic masses composed of serous or complicated fluid. In all patients, unenhanced CT scans revealed hypodense cystic portions, and in four tumors, due to the presence of hemorrhage or gelatinous fluid, some hyperdense areas were also noted. In no tumor was an expansile solid nodule seen in the thin septa, and in only one was there dystrophic calcification in a septum. Small areas of solid portion constituting less than 10% of the entire lesion were found in six of the ten tumors, and these areas were slightly enhanced on enhanced CT scans. In all patients, imaging and pathologic findings correlated closely.

Conclusion

On US and CT images, MCRCC appeared as a well-defined multilocular cystic mass with serous, proteinaceous or hemorrhagic fluid, with no expansile solid nodules in the thin septa, and sometimes with small slightly enhanced solid areas. Where radiologic examinations demonstrate a cystic renal mass of this kind in adult males, MCRCC should be included in the differential diagnosis.     

Bilateral renal lymphangiomatosis: US and CT findings

A case of bilateral renal lymphangiomatosis in an asymptomatic 50-year-old female is presented. Ultrasound and CT studies were performed. A finely septated fluid collection surrounding both kidneys and traversing the midline was found. Surgical biopsy was obtained and revealed findings compatible with lymphangiomatosis. A review of the literature of renal lymphangiomatosis is given. Received 24 October 1996; Revision received 10 February 1997; Accepted 11 March 1997     

Cystic renal tumors: US and CT findings

Cystic renal tumors represent a variety of lesions in which both solid and liquid components coexist. These lesions may be either benign or malignant and include the multilocular cystic nephroma (MCN), the renal cell carcinoma (RCC), and the papillary adenocarcinoma (PAC). The MCN is a rare neoplasm formed of multiple loculated cystic masses divided by septa. The tumor is benign, although there are some rare reports of malignant cases. The RCC and the PAC may appear with cystic patterns. This is rather uncommon for the RCC, which inside has a unilocular or multilocular cystic appearance, if the necrotic component is large. PAC is an infrequent renal tumor, which has a greater tendency to appear as a large mass with a unilocular large cystic space. The ultrasonography (US) and computed tomographic (CT) features of 27 cystic tumors are presented. Both US and CT allowed the recognition of the cystic components, the septa, and the vegetations. The two imaging techniques made it possible to distinguish the tumors into "unilocular" and "multilocular" masses: the former correspond to RCC and PAC, the latter to MCN and RCC. CT added some information on calcified or partially calcified tumors. CT more than US enabled the differentiation between the malignant RCC and the benign MCN for which conservative surgery may be indicated. The two techniques did not allow the differentiation between RCC and PAC, which has different prognostic behavior.     

Cystic renal masses: Usefulness of the bosniak classification

To determine the usefulness of the Bosniak classification of cystic renal masses, the computed tomographic (CT) and ultrasound findings of 16 pathologically proven cystic renal masses were retrospectively reviewed. All imaging studies were reviewed and categorized utilizing the Bosniak classification without knowledge of the final pathologic diagnosis. There were no category I lesions (classical simple cyst), four category II (minimally complicated), seven category III lesions (more complicated), and five category IV lesions (probable malignant). All category II lesions were benign, all category IV lesions were malignant. Of the seven category III lesions, three were benign and four were malignant. We conclude that the Bosniak classification is extremely useful in the management of cystic renal masses. The opinions expressed herein are those of the authors and are not to be construed as official or as reflecting the views of the Uniformed Services University of the Health Sciences, the Department of Defense, or the United States Navy     

Omental fibroma: CT and US findings

The US, CT, and X-ray findings in a patient with omental fibroma of the lesser omentum are described. Ultrasound showed a solid mass with cystic areas in the central region. At CT the lesion showed peripheral enhancement and central hypodensity. On X-ray studies with barium, there was border distortion in the lesser curvature of the stomach. The mass was resected surgically. A pathologic diagnosis of fibroma was confirmed. Received 12 May 1997; Revision received 16 January 1998; Accepted 20 January 1998     

Splenic involvement of tuberculosis: US and CT findings

Tuberculosis (TB) of spleen is rare and usually occurs in miliarv form. Macronodular form is extremely rare, Immunodeficiency associated with alcoholism IV drug abuse, diabetes, cancer, corticosteroid therapy, and AIDS are prominent risk factors. Early diagnosis and treatment are important, because untreated abdominal TB carries a 50% mortality rate. We report US and CT of five cases with splenic TB. Our cases showed multiple small hypoechoic and hypodense nodules on US and CT, respectively, except one case whose US was normal. All cases also had extrasplenic involvement. The diagnosis of TB was established in two cases by cervical and in one case by submandibular lymph node biopsy, in one case by peritoneal biopsy, and in one case by a typical spinal lesion at L2–3. The US and CT findings are not specific for TB, but especially in endemic regions TB should be included in the differential diagnosis of Splenic lesions. Correspondence to: U. Topal     

US and CT findings of small bowel neoplasms

Small bowel (SB) neoplasms are very rare tumours, but are still associated with high mortality rates, since the tumour-related symptoms occur late and are non-specific. In addition, endoscopy is not feasible in most cases, and radiological contrast studies do not reach the high accuracy obtained in the evaluation of upper and lower gastrointestinal tract. Cross-sectional imaging, and particularly CT, is becoming increasingly relevant in the diagnosis of these tumours. Both US and CT allow tumour detection, even when performed on an emergency basis, and are capable of showing the lesion as well as possible complications. Moreover, CT offers the possibility of a preoperative staging by evaluating tumour extension through the bowel wall, lymph node involvement and possible metastases. Finally, in most cases a direct correlation between cross-sectional findings and histology can be found, thus permitting tumour characterisation. Received 27 June 1996; Revision received 11 October 1996; Accepted 4 February 1997     

胰腺囊实性肿瘤的螺旋CT诊断

目的:探讨胰腺囊实性肿瘤(CSTP)的CT特征性表现。材料和方法:回顾性分析经术后病理证实的7例胰腺囊实性肿瘤的临床资料,以及术前螺旋CT平扫及增强扫描的影像学资料。病例均于注药后28及60s,分别获取增强动脉期和门静脉期扫描图像。7例CSTP均为女性,年龄13~41岁,平均24岁。结果:CT平扫见肿瘤发生在胰头部2例,胰体或胰尾部5例,肿瘤最大者为13.0cm×9.5cm,最小者为5.0cm×3.7cm,密度最低为17Hu,最高为51Hu。增强扫描示7例肿瘤的囊性部位均无增强,实性部分5例明显增强,2例无明显增强。4例可见钙化。结论:胰腺囊实性肿瘤多发生于年轻女性,肿瘤体积较大,呈囊实性改变,螺旋CT能做出正确诊断。     

Appendicular involvement in perforated sigmoid disease: US and CT findings

We describe four patients in whom ultrasound (US) and/or computed tomography (CT) demonstrated a thickened appendix, secondarily enlarged due to perforated sigmoid diverticulitis (n = 2) or carcinoma (n = 2). The underlying pathology was correctly recognized in all cases. Secondary thickening of the appendix due to perforated sigmoid disease provides a potential pitfall mainly on US and may lead to an incorrect diagnosis and thus to unnecessary surgery or a wrong surgical intervention. Although US alone is enough to diagnose periappendicitis and sigmoid disease, combined use of US and CT may improve assessment of its origin and extension. Received: 13 January 1998; Revision received: 8 May 1998; Accepted: 7 July 1998     

Small leiomyosarcoma of the renal capsule: CT findings

Three unusual cases of small-size leiomyosarcoma of the perirenal space were studied with CT. The renal capsule has been proved to be the origin of this type of tumor. A CT examination is accurate in suggesting the site of origin and excluding a renal cell carcinoma. However, unless evidence of invasion is noted, it is impossible on CT features to discriminate leiomyosarcoma from a benign leiomyoma. Received 11 April 1997; Revision received 2 July 1997; Accepted 4 July 1997     

Hepatic abscess caused by Brucella US,CT and MRI findings: case report and review of the literature

The authors describe the findings detected by ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) in a 42-year-old patient with a hepatic abscess due to brucellosis. This localization by Brucella (hepatic brucelloma) is quite rare and very often is asymptomatic. A review of the medical literature shows only 40 cases of an hepatic abscess due to brucellosis. The findings demonstrated by US, CT and MRI can offer important diagnostic elements, albeit not specific, which should, together with a positive serologic test, confirm the diagnosis.     

Primary epiploic appendagitis: US and CT findings

A retrospective review is presented of seven cases of epiploic appendagitis, with surgical confirmation in one case. The main clinico-analytical data and the US and CT findings are described, as well as the histopathologic features in the sole case that underwent surgical resection. We also calculated the frequency of this entity in patients undergoing emergency abdominal US on clinical suspicion of diverticulitis. In all seven cases the clinico-analytical evidence was nonspecific (localized acute abdominal pain and slight leukocytosis), mimicking in six cases the clinical presentation of sigmoid diverticulitis and in one case that of acute appendicitis. US imaging findings were characteristic: a hyperechoic mass localized under the point of maximum pain, adjacent to the anterior peritoneal wall and fixed during deep breathing. In none of the cases did color Doppler US show flow. CT findings were also typical and showed a mass with a peripheral hyperattenuated rim surrounding an area of fatty attenuation. Overall 7.1 % of patients investigated to exclude sigmoid diverticulitis finally showed findings of primary epiploic appendagitis. Primary epiploic appendagitis thus shows characteristic US and CT findings that allow its diagnosis and follow-up. This entity is much more frequent than previously reported, especially in patients referred for US to exclude sigmoid diverticulitis. Received: 1 April 1997; Revision received 19 August 1997; Accepted 2 September 1997     

Primary macronodular hepatosplenic tuberculosis: two cases with US,CT, and MR findings

We describe two cases of primary macronudular hepatosplenic tuberculosis (TB) with US, CT, and MR findings. The clinical presentation of the two patients were not alike. Whereas the first presented with a long indolent course, the second presented with an acute picture. For the first patient TB was not suspected until laparatomy; for the second the diagnosis was made by clinical evaluation with the aid of US and CT, and confirmed by biopsy. Use of MR did not add to the diagnosis. Correspondence to: H. Senturk     

Bilateral emphysematous pyelonephritis resolving to medical therapy: demonstration by US and CT

Emphysematous pyelonephritis (EPN) is an uncommon and life-threatening necrotizing infection of the renal parenchyma occurring mostly in diabetic patients. It is usually unilateral. Nephrectomy is the current therapeutic procedure. We report the plain radiograph, US and CT findings in a 26-year-old diabetic woman who presented with bilateral EPN and was cured by medical treatment alone. Received 31 May 1996; Revision received 17 September 1996; Accepted 16 October 1996     

Imaging findings in renal hydatid disease

The aim of this work is to describe the image findings of renal hydatid disease, especially on MR. Four cases of echinococcal involvement of the kidney were retrospectively reviewed. All patients had intravenous urography (IVU) and US performed. Computed tomography examination was available in three patients and MR in two cases. Intravenous urography demonstrated communication of the cyst to the collecting system in one case. Ultrasound revealed multicystic appearance in three cases and unilocular in one case. Computed tomography demonstrated unilocular thick-walled or multilocular cysts with well-defined walls, calcified in one case. In multilocular cysts the CT densities of the fluid of daughter cysts was significantly lower than the fluid of mother cysts. This typical appearance was present in three of our cases. The presence of a hypointense rim and a multicystic appearance were distinctive in MR imaging. The combined findings of these different imaging modalities aid greatly in establishing the correct diagnosis. Magnetic resonance imaging is of value in determining the presence of a characteristic rim and enables the evaluation of anatomical relationships. Received 19 March 1996; Revision received 28 June 1996; Accepted 4 September 1996     

US, CT, and MR evaluation of accessory renal arteries and proximal renal arterial branches

RATIONALE AND OBJECTIVES: The purpose of this study was to compare color Doppler ultrasound (US), computed tomographic (CT) angiography, and magnetic resonance (MR) angiography for the evaluation of accessory renal arteries and proximal branches of the main renal artery. MATERIALS AND METHODS: Fifty-six subjects who had undergone conventional arteriography of the renal arteries participated in a prospective comparison of Doppler US (45 patients), CT angiography (52 patients), and nonenhanced MR angiography (28 patients). Conventional arteriography depicted 28 accessory renal arteries and 21 proximal branches of the main renal artery within 2 cm of the aorta. RESULTS: US depicted five of 24 accessory renal arteries seen at arteriography but no proximal arterial branches. CT angiography depicted 24 of 26 accessory renal arteries and 13 of 17 proximal arterial branches, as well as 15 additional accessory renal arteries not seen at conventional arteriography. MR demonstrated 11 of 15 accessory arteries, as well as four additional accessory arteries not seen at conventional arteriography. MR did not depict any of nine proximal arterial branches seen at conventional arteriography. CONCLUSION: When compared with US or nonenhanced MR angiography, CT is the preferred method for evaluation of accessory renal arteries and proximal branches of the renal artery.     

Large egg-shell-like calcified cyst in a case of renal cell carcinoma

A serendipitous case is reported of a large egg-shell-like calsified renal mass woithout irregularities covering a solid nodule suggestive of a renal cell carcinoma on CT. This was confirmed after radical nephrectomy. Correspondence to: R. Oyen     

Renal replacement lipomatosis: ultrasonography and computed tomography findings

Replacement lipomatosis of the kidney is the result of severe atrophy or destruction of the renal parenchyma often caused by calculous disease with secondary marked proliferation of renal sinus, renal hilus, and perirenal fatty tissue. The diagnosis is difficult to establish with conventional radiographic methods. Although ultrasonography may show highly suggestive findings, computed tomography seems to be the most accurate method for demonstrating the distinctive features of replacement lipomatosis. Ultrasonographic and computed tomographic features in three cases of replacement lipomatosis of the kidney are reported. Received: 19 October 1998; Revision received: 8 December 1998; Accepted: 6 January 1999     

胰腺原发性类癌的CT表现

目的探讨胰腺原发性类癌的CT表现。方法回顾性分析经病理证实的5例胰腺类癌的CT表现。结果本组病例肿块最大径2．0—11．0cm，平均6．4cm。CT平扫肿瘤实质较胰腺稍低，密度均匀者2例，不均匀者3例，肿块钙化者1例。动脉期肿块不均匀明显强化者3例，轻度强化者2例，肿瘤实质密度均低于胰腺，有不同程度的坏死，其中1例中央坏死明显，无强化，整个肿块呈囊状；静脉期肿块强化程度明显，与胰腺相似或稍低；1例延迟期肿块强化程度高于胰腺。肝转移1例，同时伴腹膜后淋巴结肿大及血管侵犯。未见胆管及胰管扩张。结论胰腺类癌CT表现主要有较少引起胆道及胰管扩张，对周围血管较少累及，钙化较常见；增强后肿瘤实质明显强化，静脉期强化程度与胰腺相似，延迟期强化程度高于胰腺。