Study on small renal cell carcinoma diagnosed by ultrasonography

Sixty-seven patients underwent a resection of renal cell carcinoma in our hospital between July 1984 and Mar. 1989. Out of them 31 patients with small renal cell carcinoma less than 4 cm in diameter were examined. The proportion of small renal cell carcinoma to all renal cell carcinoma was 36% (14 patients) in the first half period (July 1984-July 1987) and 61% (17 patients) in the last half (Aug. 1987-Mar. 1989), i.e. in total more than half of all the carcinomas. The patients diagnosed by ultrasonographic screening were 25 (80%) out of the 31 patients. The incidence of small renal cell carcinoma was 4 (0.06%) out of 6892 patients in our health check-up center and 6 (1.0%) out of 610 hemodialysis patients, and they were found by ultrasonic examination. The carcinoma was protruded from the renal contour in 24 patients (77%) and was inside the renal parenchyma (23%) in 7 patients. The carcinoma in the 24 patients was associated with the deformity of its outline. The patients with a positive IVP were 5 out of 31 patients and the carcinoma in 4 out of the 5 patients was inside the renal parenchyma. Of all patients with protrusion of te renal contour, only one patient was with a positive IVP. The above findings indicate that ultrasonic examination is a useful method for the early diagnosis of small renal cell carcinoma.     

Pediatric renal pelvic fullness: an ultrasonographic dilemma

PURPOSE: We conducted a prospective study to define normal renal pelvic size in children. MATERIALS AND METHODS: Institutional Review Board approved consent was obtained to perform renal ultrasound during excretory urography (IVP) scheduled for medical management. Mean patient age (17 females, 11 males) was 5.2 years. Renal ultrasound was conducted concurrent with 10-minute IVP. RESULTS: Fifty kidneys were imaged with 51 collecting systems. IVP defined 44 collecting systems as normal. Mean anteroposterior pelvic diameter on sonography for these 44 systems was 3.3 mm. One normal collecting system on IVP had a diameter greater than 10 mm on ultrasound (14 mm). No sonographic caliceal dilatation was seen in any kidney appearing normal on IVP. The 7 dilated systems on IVP had a mean ultrasound diameter of 17.1 mm. Two dilated collecting systems smaller than 10 mm in diameter on sonography had caliceal distention on ultrasound. CONCLUSIONS: Normal renal pelvis threshold diameter was 10 mm in asymptomatic children. We recommend further evaluation in children with caliceal dilatation and/or dilatation of the anteroposterior renal pelvis greater than 10 mm. Using these criteria, no system appearing abnormal on IVP would have been missed.     

Renal pseudotumors

Summary Renal pseudotumors will simulate a neoplasm on urography but are histologically composed of normal tissue. Pseudotumoral lesions of the kidney are usually discovered on urography and simulate a neoplasm, but are histologically composed of normal tissue. Various conditions such as foetal lobulation, hypertrophy of the columns of Bertin or large cloisons, nodular compensatory hypertrophy, renal sinus lipomatosis, and compression by blood vessels may simulate tumors of the kidney. It is therefore of the utmost importance to make a clear-cut diagnosis with the help of echography, CT-scan, and in some cases, arteriography.     

Resection of a lipomatous hypertrophic interatrial septum involving the right ventricle

Lipomatous hypertrophy of the interatrial septum is a rare cardiac lesion that is usually limited to the interatrial septum. We report a case of an extensive lipomatous hypertrophy, which protruded into the right and the left atrium as well as the superior and the inferior vena cava and the right ventricle. A 71-year-old woman was referred to us because of a cardiac mass on a transthoracic echocardiogram, performed on a routine check-up because of a known membranous ventricular septum defect. She underwent surgical resection of the mass and closure of the ventricular septum defect. The postoperative period was complicated by superior vena cava syndrome for which she underwent re-operation. The post mortem histopathological diagnosis was a lipomatous hypertrophic interatrial septum.     

A case of xanthogranulomatous pyelonephritis probably derived from a renal injury

A 56-year-old women was admitted for examination of glycosuria. She had had a blunt trauma onto the left abdomen 2 years ago that could have caused renal injury. Incidentally a left renal mass was detected by ultrasonography as a low echogenic mass. CT scan revealed a 2.5 X 2.5 cm mass with lower density than the kidney. IVP and renal angiography showed no abnormal findings. Under the diagnosis of renal tumor, left nephrectomy was performed. A 2 X 2 cm butter-yellow tumor, was seen in the renal parenchyma including the renal capsule of the upper and lateral part of the kidney. The renal pelvis was normal and there were no suppurative lesions in the kidney. Histopathological diagnosis was xanthogranuloma of the kidney partly containing a subcapsular hematoma. The previous blunt trauma, presence of hematoma and no evidence of suppurative lesions suggested that the etiology of xanthogranuloma in this case was related to renal injury.     

Primary renal angiosarcoma

Primary renal Angiosarcoma is a rare neoplasm and only 24 cases have been reported in specialized literature. We describe a case of primary renal angiosarcoma in a patient presenting with hematuria, palpable abdominal mass, left flank pain and anemia. A computerized tomography of the abdomen with contrast medium showed a tumor with 15 cm diameter, in the upper pole of the left kidney, with a low-density central area, suggesting necrosis or hemorrhage. Diagnosis was given in a morphologic base and proven by an immunohistochemical study. Primary renal angiosarcoma should be included among differential diagnosis of retroperitoneal hematoma and hemorrhagic renal tumors.     

Lipomatous interatrial septal hypertrophy: an unusual cause of intracardiac mass.

Lipomatous hypertrophy of the interatrial septum is an uncommon entity that usually occurs in elderly patients. We report a patient who presented with atrial fibrillation, congestive cardiac failure and a large intracavitary mass in the right atrium on echocardiography. He underwent successful resection of the mass with septal reconstruction. Pathology was consistent with lipomatous hypertrophy of the interatrial septum.     

Rare case of the hyaline vascular type of Castleman''s disease of the kidney

Castleman's disease (CD) is a rare disorder characterized by a benign proliferation of lymphoid tissue. Most cases tend to present as a mediastinal mass. A few extrathoracic cases involving nodal and extranodal locations have previously been reported. To the best of our knowledge, however, only one case of CD of the kidney has been published in an English report. We herein report a rare case of CD presenting as a left renal tumor. A 70-year-old male was examined by computed tomography for a follow-up for colonic diverticulitis and a left renal mass measuring 2.0 cm in diameter was incidentally found. The patient underwent a left partial nephrectomy for a left renal mass and a histopathological analysis demonstrated the hyaline vascular type of CD. Based on our findings, CD should be included in the differential diagnosis of renal tumors.     

Inflammatory pseudotumor of the kidney: report of a case

We report a case of inflammatory pseudotumor of the kidney. A 73-year-old man presenting with general malaise and minimal grade fever visited a medical department in our hospital. Computerized tomography incidentally revealed a tumor, 3.5 cm in diameter, in the lower pole of the left kidney, and he was referred to our outpatient department. Selective left renal arteriography disclosed an avascular mass on the affected site. Left radical nephrectomy was performed under the diagnosis of avascular renal cell carcinoma. Histological examination demonstrated a tumor composed of spindle-shaped fibroblastic cells infiltrated by variable numbers of plasma cells, small lymphocytes and histiocytes. The pathologic diagnosis was renal inflammatory pseudotumor. Fourteen previously reported cases of this tumor have reviewed in the literature.     

肾结核的超声诊断与分型

目的：探讨肾结核超声诊断、分型及其临床价值。方法：回顾性分析资料完整的150例肾结核患者的超声声像图特点。结果：超声诊断肾结核的符合率为79．3％(119／150)，根据肾结核B超声像图特点，将肾结核分析归纳为6型，即囊肿型18例，积水型10例，积脓型6例，炎症萎缩型16例，钙化型31例，混合型38例。结论：超声检查具有价廉、无创等优点，对肾结核声像图的分型，有助于肾结核的诊断及鉴别诊断。     

Duplication of the cervical esophagus. An unrecognized cause of respiratory distress in infants

Infants with respiratory distress demand prompt action and thorough evaluation for possible causes. An urgent but infrequent source of upper airway obstruction is a duplication cyst of the cervical esophagus. Standard references omit this diagnosis in the consideration of both respiratory distress and neck masses in infants. Two patients were admitted with respiratory distress and delayed recognition of a neck mass. Contrast and sonographic studies revealed a cystic mass displacing the trachea in each case. Careful excision promptly relieved symptoms, and histopathologic evaluation confirmed the diagnosis. Duplication of the esophagus can compromise the normal airway, thereby presenting with respiratory difficulty prior to recognition of a neck mass. X-ray studies demonstrating displacement of the trachea or esophagus due to a soft-tissue mass and documentation of a cyst by ultrasound will aid in establishing the diagnosis. Surgical principles include aspiration and excision of the mucosal lining, with preservation of the muscular coat and mucosal septum. Duplication of the cervical esophagus should be considered in the differential diagnosis of both respiratory distress and an enlarging neck mass in infants.     

Diagnosis of renal trauma

We experienced 25 cases of renal trauma in our hospitals during the past 5 years, 20 cases were male and 5 cases were female, ranging in age 10 to 51 years old with average 26 years old, and the chief complaints were gross-hematuria and pain of renal region. We studied the IVP and CT patterns of these cases. IVP revealed 13 cases of renal contusion, 11 cases of renal lacerated wound and 1 case of renal fragmentation. The CT scan of 14 cases showed that it was useful for the diagnosis of the degree of renal trauma, especially, for hematoma surroundings the kidneys. The hematoma surrounding the kidneys was clearly noted in 7 cases by CT scan, but the unclearness of renal contours and iliopsoas muscle was considered to suggest the existence of hematoma surrounding the kidneys by IVP. All of the hematoma surrounding the kidneys was absorbed by conservative therapy, but 5 of the 7 cases were treated within 3 months.     

Sonographic evaluation of renal inflammatory diseases in children

Summary Based on a report of 16 patients, the authors describe and evaluate the sonographic aspects of renal inflammatory diseases (RID) in children. In acute disease, thickening of the renal pelvic wall as evidence of pyelitis was the most common pattern demonstrated. Increased renal volume, nontumoral parenchymal area of hyperechnogenicity, abscess-type mass or calcified solid mass (in the case of xanthogranulomatous pyelonephritis) were other aspects encountered. Related findings included evidence of chronic pyelonephritis (cortical thinning) and of renal malformations. In patients with RID, the role of ultrasound is doubly important. While it is being employed increasingly as a screening test, it is most useful as a follow-up technique to detect complications and assess renal growth. Nevertheless, it should be stressed that ultrasound may be totally normal in cases of RID and complementary examinations (IVP, VCUG and nuclear scanning) are still necessary.     

Renal pseudotumor: Importance of selective arteriogram

A typical case of hypertrophy of the columns of Bertin is presented, with special consideration given the importance of the selective renal arteriogram which is, in our experience, the only diagnostic procedure of accuracy. With this in mind we have avoided renal exploration. The embryogenic origin of this entity is reviewed.     

A case of distal ureteral atresia

A case of distal ureteral atresia with the chief complaint of a mass in the left lower quadrant is reported. On palpation of the abdominal region, a 3 X 4 cm mass, smooth-surfaced and movable, was palpable in the left lower quadrant, IVP failed to show the left kidney, while CT revealed an atrophic left kidney and dilated ureter. For the diagnosis of distal ureteral atresia, total left ureteronephrectomy was performed. The left kidney measured 4.5 X 3 X 3 cm and the ureter was dilated and ended blind. The pathohistological findings included dysplasia with normal nephrons here and there of the kidney. We examined the distal ureteral atresia from the renal tissue.     

Changes in size of adult renal allografts in pediatric recipients, clinicopathologic study of decreased graft size in infant recipients and hypertrophy, renal growth in older children]

It is presumed that graft size after renal transplantation from adult donor decreases in infant or very young recipient and increases in older recipient. Measurement of graft length, width, parenchymal thickness on intravenous pyelography (IVP) films, measurement of area of Bowman's capsule, glomerulus, capillary tuft and tubule on graft biopsy specimens were compared between 3 months and 1 year after renal transplantation. The graft sizes decreased in recipients below 6 years-old or body height (Ht.) 90 cm and increased in recipients above 6 years-old, Ht. 100 cm. The case of decreased graft size was found a decrease of area of Bowman's capsule, glomerulus, capillary tuft and tubule. We suggest that it is caused by a difference between renal blood flow in infant and in adult. It is suggested that graft hypertrophy depends predominantly on increased tubular size and capillary tuft enlargement occurs prior to glomerular, tubular change. But, an increase in creatinine clearance (Ccr) was not found following graft hypertrophy.     

Surgery of pelviureteric obstruction in 101 children over one year of age

One hundred and one children over 1 year of age have had surgery for pelviureteric obstruction over an 11 year period. The common clinical features were abdominal pain, urinary infection or haematuria, but a number presented as an incidental finding. Less commonly, the patients presented with an abdominal mass or with hypertension. The diagnosis was usually made on intravenous pyelography (IVP) but in the latter part of the series, renal nuclide scan (RNS) and ultrasonography (US) were preferred. Ninety-three patients had a unilateral pyeloplasty, three had bilateral pyeloplasty and five had nephrectomy or heminephrectomy. Whereas initially nephrostomy drainage was used in the majority of patients after pyeloplasty, a trend away from nephrostomy evolved in the latter part of the series. With experience, the incidence of postoperative complications was also reduced and there was a reduction in the period of hospitalization. Clinical results were consistently satisfactory. Postoperative assessment after pyeloplasty was made by IVP and/or RNS and also US. A review of these investigations showed that RNS provided more factual information of the result when compared with the IVP.     

Renal cell carcinoma and bladder tumor observed in the Automated Multiphasic Health Testing and Services of Tokai University Hospital

From June 1975 through December 1983, 48,604 individuals consisting of 34,535 males and 14,069 females underwent health examinations at the Automated Multiphasic Health Testing and Services (AMHTS) Center in Tokai University Hospital. There were five patients with renal cell carcinoma and three with bladder cancer. We reviewed the clinical courses of these patients and discussed the early detection of urological cancers in AMHTS. Patients with renal cell carcinoma were brought to the urology department with various findings in AMHTS. A 44-year-old male was referred to us for the investigation of multiple metastatic shadows in the chest X-P and left renal tumor was diagnosed by intravenous pyelography (IVP) and computed tomography (CT). Renal tumor of a 57-year-old male was diagnosed by the investigations of abnormal renal calcifications found in AMHTS. A 39-year-old female had undergone health check-ups several times but was not found to have a renal tumor. The diagnosis of left renal tumor was made by the abdominal CT carried out after the operation on cerebellar hemangioblastoma. The fourth patient was a 60-year-old female with microscopic hematuria found in AMHTS and the diagnosis was confirmed by calyceal deformity shown in IVP. The last patient was a 64-year-old male and was accidentally demonstrated to have a right renal mass by ultrasonography when he was reexamined for the hepatic abnormality found in AMHTS. He showed microscopic hematuria in the AMHTS urinalysis. The diagnosis was confirmed by IVP, CT and renal angiography.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diagnostic importance of CT in early stage renal cell carcinoma

Our experience of finding a small renal cell carcinoma by CT suggested the diagnostic importance of CT in the early stage of the tumor. The patient was a forty-year-old woman who had suffered several times from pyelonephritis. She consulted us for detailed examination. IVP showed only slight deformity like a calyceal diverticulum at the upper pole of the left kidney. Ultrasonic tomography failed to expose the region. Enhanced CT revealed a small space occupying lesion like a simple renal cyst at the region, though plain CT revealed no abnormal findings. From the comparison of these two CT, she was diagnosed to have renal cell carcinoma which was confirmed by renal arteriography. Subsequently, transabdominal left nephrectomy was performed. Pathological diagnosis was renal cell carcinoma (clear cell type). The tumor size was very small, 1.5 cm in diameter. Comparison of plain and enhanced CT were considered important to diagnose a small tumor, and CT is now the most useful examination to detect early stage renal cell carcinoma.     

Postoperative consideration of diagnostic value of ultrasonography and excretory urography on seven patients with renal calculi

Seven patients with renal calculi were evaluated by ultrasonography and intravenous pyelography (IVP). After surgical treatment, the diagnostic value of these examinations was considered. Correct diagnosis of renal calculus size and number had been established in 4 of the 7 patients by ultrasonography, and 5 of the 7 patients by IVP. In some cases, ultrasonography gave a more accurate diagnosis of renal stone than drip intravenous pyelography.