Secondary renal neoplasms: an autopsy study.

The records of 11,328 autopsies performed on patients who died of malignant disease between March 1944 and August 1974 were reviewed, and 816 cases (7.2%) demonstrated renal metastases. The most common primary tumors in decreasing order of frequency were lung, breast, skin (melanoma), and tumors of the genitourinary, gastrointestinal, and gynecologic tracts, respectively. Generally metastases were hematogenous, multiple, bilateral, less than 3 cm in diameter, and located throughout the renal parenchyma. Associated metastases were usually present in many other organs. Because methods to detect renal lesions depend upon their size, clinical recognition of renal metastases will be largely limited to that 10% which are greater than 3 cm in diameter.     

Metastatic carcinoma of the long bones

Breast, prostate, renal, thyroid, and lung carcinomas commonly metastasize to bone. Managing skeletal metastatic disease can be complex. Pain is the most common presenting symptom and requires thorough radiographic and laboratory evaluation. If plain-film radiography is not sufficient for diagnosis, a bone scan may detect occult lesions. Patients with lytic skeletal metastases may be at risk for impending fracture. Destructive lesions in the proximal femur and hip area are particularly worrisome. High-risk patients require immediate referral to an orthopedic surgeon. Patients who are not at risk for impending fracture can be treated with a combination of radiotherapy and adjuvant drug therapy. Bisphosphonates diminish pain and prolong the time to significant skeletal complications.     

Computed tomography of renal metastases

Since the advent of CT, secondary neoplastic lesions of the kidneys have been detected with increasing frequency. After reviewing a large series of cases of renal metastases, we have been able to classify the CT findings into seven major categories that are discussed and illustrated in this article. The differential diagnoses between metastatic disease of the kidneys and other lesions such as renal infarctions, renal lymphoma, and primary malignancies are also considered.     

18F-FDG PET/CT显像在肾脏转移瘤中的诊断价值

目的:探讨转移性肾脏肿瘤的18F-FDG PET/CT图像特点,以期提高对该病的认识。方法 :回顾性分析2013年11月-2019年8月中国科学技术大学附属第一医院经手术或穿刺病理证实的14例肾脏转移瘤。用勾画感兴趣区(ROI)法测量病灶的SUVmax,同时测量病变的大小及CT值。结果:14例患者中,共计18个病灶,其中左肾单发5例,右肾单发6例,双肾单发2例,右肾2处转移灶、左肾1处转移灶1例。结节状弥漫性高摄取病灶11个,环形高摄取病灶6个,弧形高摄取病灶1个,SUVmax(4.3~21.5),平均值11.6±5.5。等密度灶8个,低密度灶7个,高密度灶3个,CT值范围15.0~35.0 HU,平均CT值(27.9±5.2)HU,病灶最大径范围1.1~7.2 cm,最大径平均值(3.3±1.6)cm。结论 :肾脏转移瘤在18F-FDG PET/CT显像有一定特点,18FFDG PET/CT对其有很好的诊断价值。     

Sinusoidal spread of liver metastases from renal cell carcinoma: simulation of diffuse liver disease on MR imaging

Rarely, hepatic metastases can simulate hepatic infiltrative diseases. We present a case of a patient with advanced metastatic renal cell carcinoma who developed hepatomegaly and clinical signs of hepatocellular injury. On magnetic resonance imaging, the injury simulated a diffuse process, e.g., acute fulminant viral or chemical hepatitis or drug toxicity. Despite its high resolution, magnetic resonance imaging might not depict focal lesions in patients with extensive metastases. In correlation with clinical history, malignant disease should be considered when diffusely abnormal hepatic signal intensity is noted. Received: 2 April 2001/Revision accepted: 21 April 2001     

Endoscopic mucosal resection

We are now finding more malignancies in their early stages than previously. Attempts to ablate these lesions are difficult and do not provide the histological information required to decide on further treatment. Surgery is difficult to justify, as only a minority of lesions are associated with lymph node metastases and lesions may not become clinically relevant within the lifetime of an elderly patient. Endoscopic mucosal resection allows cancers to be resected at minimal cost, morbidity and mortality. It is also the most reliable investigation when assessing lesions which are suspicious for containing early cancer. After endoscopic removal, histological assessment of depth of penetration and a search for invasion into lymphatics or venules allows the risk of microscopic lymph node metastases to be predicted. The risk of developing metastatic disease can then be balanced against the risks of surgery in view of the patient's age and health.     

Treatment of brain metastases from melanoma

Brain metastases from malignant melanoma have a poor prognosis, and treatment can be difficult because of rapid progression of the disease. To help define the treatment of this disease, we reviewed the published literature on brain metastases from melanoma. If a solitary metastasis is present, surgery might be beneficial, especially if systemic disease is absent. Stereotactic radiosurgery is a less invasive, attractive option for solitary or oligometastatic (up to 6) lesions. External beam whole-brain radiation therapy can produce responses and frequently palliates symptoms, but as the sole therapy, it is unlikely to eradicate brain metastases. Chemotherapy may be gaining a role with newer agents that penetrate the blood-brain barrier. Combined modality therapy appears to be the future direction of treatment of multiple metastases.     

FDG PET/CT in the liver: lesions mimicking malignancies

Purpose

18F-fluorodeoxyglucose (FDG) PET/CT is invaluable in managing liver lesions, in particular in the evaluation of suspected liver metastases. It is both sensitive and specific in detecting liver metastases from a wide range of primary cancers, and may change clinical management, most commonly by detecting additional lesions and decreasing the number of futile surgeries. However, some benign lesions may also show increased metabolic activity which can lead to false positive PET findings. We describe some of these lesions and their imaging characteristics that may help in differentiating them from malignant metastases.

Methods

We reviewed all whole body FDG PET/CT studies performed over a 5-year period in our institution, and identified those with focal liver lesions showing increased FDG uptake for which histological results were available.

Results

A majority of lesions showing increased metabolic activity were due to malignant disease, such as metastases or primary liver tumours. However, we also found increased FDG uptake in non-neoplastic lesions such as Cryptococcosis, abscesses, and secondary inflammation from cholecystitis. Increased metabolic activity was also seen in some benign neoplasms such as hepatic adenomas and hemangioendotheliomas.

Conclusion

FDG PET/CT is currently the most sensitive non-invasive imaging modality for the detection of hepatic metastases, particularly from the gastrointestinal tract. False positive results are rare, and have been described mainly in abscesses. However, other lesions can also show increased metabolic activity, and failure to differentiate these from metastases may result in inappropriate treatment.     

Renovascular hypertension secondary to spontaneous renal artery dissection and treatment with stenting

Renovascular disease is the cause of less than 1% of patients with hypertension; within this group aneurysm and dissection in renal artery are even rarer causes. It may be not only iatrogenic or traumatic, but may also develop spontaneously from fibromuscular disease or atherosclerotic lesions. We present a 26-year-old male patient with recently developed and progressive hypertension in whom renal angiography showed aneurysmal dilatation and dissection of the right renal artery. With the implantation of two stents in the true lumen, normal renal blood flow and thrombosis of the aneurysmal sac was established. As a result, stent implantation to renal artery dissection is effective, reliable and easy and can be an alternative to surgical treatment.     

Diverticular disease

Careful examination of the skin may provide clues to the presence of an underlying disorder, in particular, internal malignant disease. Occasionally, the first evidence of such malignancy is the appearance of one or more skin lesions. These lesions may represent cutaneous metastases of the primary tumor or may be one of many distinct dermatoses known to be associated with occult cancer. In the following pages, Dr Bergfeld offers a primarily pictorial presentation of cutaneous manifestations of internal malignancy.     

Magnetic resonance imaging of the kidneys and adrenal glands

A simple renal cyst will have low signal intensity on T1-weighted SE images with short TE and short TR because of the long T1 values of the cyst fluid. With increasing TE and TR, cysts demonstrate increased signal intensity due to the long T2 values of the cyst fluid. On T1-weighted images a complicated cyst will have higher signal intensity than a simple cyst; it may not be possible to differentiate these complicated cysts from solid masses. MRI seems to be useful in identifying simple cyst fluid and, therefore, has potential in characterization of cystic lesions considered complex by CT or ultrasound. Unfortunately, imaging techniques have not yet been optimized, diagnostic criteria are somewhat vague, and accuracy has not been established in a representative patient population. Solid masses often can be identified and differentiated from simple, uncomplicated cysts on MR images. The inability to differentiate among various types of solid tumors or to separate these from complicated cysts or inflammatory masses remains a limitation. Most lesions are more readily seen on contrast-enhanced CT than on MR images and therefore the role of MRI in the detection and diagnosis of renal cell carcinoma remains limited. Although the high detection rate of renal cell carcinoma is encouraging, CT is still more sensitive than MR in demonstrating solid lesions less than 3 cm in diameter. MRI cannot be used as a screening modality for renal tumors. MRI seems quite helpful in the staging of renal cell carcinoma. Macroscopic extension into the perinephric fat, tumor extension into the renal vein and the inferior vena cava, and macroscopic metastases to other organs are readily seen. Furthermore, differentiation between enlarged nodes and vessels is possible with MRI. Some authors recommended the use of MRI to stage renal cell carcinoma in patients with known contraindication to contrast, prior suboptimal bolus contrast enhanced CT scan, and equivocal CT findings. MRI can replace the inferior vena cavagram in the staging work-up and MR may be superior to CT for planning the surgical approach in Stage IIIA lesions by determining the upper extent of tumor thrombus within the inferior vena cava or the right atrium.(ABSTRACT TRUNCATED AT 400 WORDS)     

Endoscopic sonography and sonographically guided fine‐needle aspiration biopsy in the diagnosis of unusual pancreatic metastases from synovial sarcoma

Pancreatic metastases are commonly solitary solid lesions frequently derived from primary renal cell carcinoma, lung cancer, or melanoma. Very few case reports have described cystic‐appearing metastases in the pancreas and even fewer have reported a combination of cystic and solid metastatic lesions. Synovial sarcoma is a rare and aggressive soft tissue neoplasm, frequently metastasizing to the lungs and bones. We present a case of primary synovial sarcoma with multiple solid and cystic‐appearing pancreatic metastases diagnosed by endoscopic ultrasound and sonographically guided fine‐needle aspiration. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :180–182, 2014     

Neoplastic iliopsoas masses in oncology patients: CT findings

The aim of this study is to evaluate the imaging features of neoplastic iliopsoas masses detected on abdominal CT and determine the association with other metastatic sites in the abdomen. Thirty-three patients with a neoplastic mass detected in the iliopsoas muscles on a CT were included in this study. The CT were evaluated for imaging features of the focal psoas lesion and for the presence of additional metastatic disease in the abdomen. All 33 patients had a history of primary neoplasm. The most common primary neoplasms were renal in five, melanoma in four, lung in three, pharyngeal in three, colorectal in two, ovarian in two and other neoplasms in 14 patients. Although the majority of the iliopsoas masses were of lower density than the muscle, four patients had a mass with hyperdense ring and four other patients had a uniformly hyperdense mass on contrast enhanced CT. Eight (24%) patients had gluteal muscle metastases and 6 (18%) had subcutaneous metastases. Secondary iliopsoas neoplasms are most commonly hypodense lesions and are most commonly due to primary neoplasm from renal, lung, pharyngeal, ovarian, colorectal neoplasm and melanoma. The detection of an iliopsoas mass warrants a careful search for gluteal muscles and subcutaneous metastases.     

MR imaging in the evaluation of hepatic metastases

Optimal detection of focal hepatic lesions in patients with metastases can alter patient management and result in significant cost savings by reducing the number of unnecessary laparotomies for unresectable disease. Liver-specific MR imaging contrast agents (reticuloendothelial and hepatobiliary agents) offer greater lesion-to-liver contrast than the conventional extracellular fluid space MR imaging contrast agents (gadolinium chelates), which have a nonspecific distribution. For the detection of hepatic metastases, although the work of Seneterre et al suggests that the accuracy of ferumoxide-enhanced MR imaging is equivalent to that of CTAP, other studies find CTAP to be superior. Comparisons of reticuloendothelial agents and hepatobiliary agents for imaging liver metastases are lacking in the literature. Further studies comparing MR imaging enhanced with liver-specific contrast agents to CTAP are needed to determine if hepatic MR imaging can replace CTAP for the preoperative evaluation of hepatic metastases. For the characterization of focal liver lesions, MnDPDP and ferumoxides have been added to the small list of FDA-approved contrast agents, and both can help to increase diagnostic specificity. Two of the hepatobiliary agents which are not yet approved, Gd-BOPTA and Gd-EOB-DTPA, have the potential of characterizing liver lesions during dynamic contrast enhancement (similar to Gd-DTPA) and during the hepatocyte phase (similar to MnDPDP), and may increase the detection of focal liver lesions.     

磁共振全身弥散成像对恶性肿瘤检测价值探讨

目的:探讨磁共振全身弥散成像对恶性肿瘤检测价值.材料与方法:60位经临床确诊为恶性肿瘤患者作为研究对象.采用全身弥散成像,结合病变部位常规MRI扫描.统计检出率.结果:全身弥散成像,对弥散受限(≥)2.0cm的病灶具有诊断意义.恶性肿瘤及其转移灶在弥散像上均表现为高信号.全身弥散成像结合MRI常规扫描检出恶性肿瘤54例...     

Clinical utility of color Doppler sonography in the differentiation of hepatocellular carcinoma from metastases and hemangioma

The clinical utility of color Doppler sonography in the differentiation of hepatocellular carcinoma from metastases and hemangioma was investigated in 72 hepatocellular carcinomas (80 lesions), 30 metastases (82 lesions), and 39 hemangiomas (54 lesions). Overlaps of color patterns were found among hepatocellular carcinoma, metastases and hemangioma. Pulsatile waves from lesions with the basket, vessels within tumor, or spot patterns, or lesions measuring less than 3 cm with detectable signals, did not favor the diagnosis of hemangioma. In conclusion, color Doppler sonography can aid in the differentiation of hepatocellular carcinoma from hemangioma but may be unreliable in the differentiation of hepatocellular carcinoma from hypervascular metastases.     

Opioids in context: relieving the pain of cancer. The role of comprehensive cancer management

Optimal pain control requires detailed appraisal of each symptom; in many cases definitive treatment of the underlying cause will be the most effective means of pain control. As an example back pain may be due not only to bone metastases but also enlarging lymph nodes, renal pain or retroperitoneal tumour. Benign causes including degenerative joint disease should also be considered and each cause treated specifically alongside the use of analgesics.     

XP11.2异位/TFE3基因融合相关性肾癌MRI表现(5例报道并文献复习)

目的 分析XP11.2异位/TFE3基因融合相关性肾癌MRI表现,以提高该病诊断水平。方法 回顾性分析经病理证实为XP11.2异位/TFE3基因融合相关性肾癌5例患者资料,所有患者均术前接受MRI平扫及DWI检查,其中1例患者进行PWI检查,由两位医师对肿瘤位置、大小、有无出血、坏死囊变,信号强度,强化特点等进行统计分析。结果 5例患者平均年龄50岁(20~65岁),MRI平扫上呈混杂T_1WI、混杂T_2WI信号,肿瘤实质DWI呈高信号。1例患者行PWI扫描呈轻-中度渐进性强化。2例患者伴有静脉癌栓形成,4例患者伴有腹膜后淋巴结转移,1例患者伴有肾上腺转移,1例伴双肺及多发骨转移。结论 XP11.2异位/TFE3基因融合相关性肾癌MRI上有一定特点,该病侵袭性高,易出现腹膜后淋巴结或其他部位转移。     

Thoracic calcifications in childhood

Thoracic calcifications are found in the following locations: mediastinum, lung, pleura, cardiovascular system, and thoracic wall. The calcifications of the mediastinum include mostly inflammatory lesions and malignant neoplasms. Pulmonary calcifications are mainly inflammatory lesions and metastases of osteosarcomas. Where the cardiovascular system is concerned, the most common calcifications are those of the heart relating to tumors or surgery. Calcifications of the aortic wall and valve calcifications can be found. In the thoracic wall there are calcifications of the bone and of soft tissues. The knowledge of shape and location is very useful for the diagnosis of the underlying disease. Calcifications in the thorax are frequently manifestations of previous infectious processes. Less often, they may be due to neoplasms, metabolic disorders, or previous medical therapy.     

Endoscopic findings in end-stage renal disease

BACKGROUND AND STUDY AIMS: Patients with end-stage renal disease (ESRD) may demonstrate a number of gastrointestinal lesions and suffer subsequent complications. Our aim was to investigate the endoscopic findings in these patients and identify the predisposing factors. PATIENTS AND METHODS: During a 1-year period (February 2000 to January 2001), we studied consecutive patients with end-stage renal disease who were undergoing routine endoscopy before renal transplantation. The rapid urease test was also performed to detect Helicobacter pylori infection. Demographic and clinical data were collected. Logistic regression analysis was used to determine the risk factors for important endoscopic lesions, including esophagitis, gastroduodenal erosions, and peptic ulcers. RESULTS: We studied 206 patients (124 male, 82 female, mean age 38.9). Of the patients 73.8% were asymptomatic but some patients experienced nausea (12.6%), heartburn (8.7%), and abdominal pain (7.3%). Endoscopy was normal in 74 patients (35.9%). Abnormal endoscopic findings were duodenal erosions (32.0%), antral erosions (22.8%), diffuse antral erythema (27.8%), duodenal ulcer (7.3%), esophagitis (5.8%), angiodysplasia (4.4%), nodular duodenum (2%), and inflammatory gastric polyps (1.5%). The rapid urease test was positive in 58.8% of patients. Important endoscopic lesions were more common in men and in H. pylori-infected patients. Age, duration of dialysis, cause of the ESRD, presence of any symptoms, and hemoglobin levels were not found to be related to these lesions. Most patients with peptic ulcers were asymptomatic. CONCLUSIONS: Duodenal erosions (32.0%), gastric erosions (22.8%), diffuse antral erythema (27.8%) and duodenal ulcer (7.3%) are common lesions in patients with end-stage renal disease. Male gender and H. pylori infection are associated with a higher risk of these lesions. As there is no association between patients' symptoms and gastroduodenal lesions, which may increase the risk of post-transplant complications, the development of diagnostic strategies for the detection of these lesions is recommended.