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Ortiz-Rey JA, García-Baizán A, Bellas-Pereira A, Barciela-Bastos A, Gómez-de María C, Conde-Ferreirós M. Myxoid Pseudotumor Changes Affecting the Distal Ureter Associated With Urothelial Carcinoma In Situ. Int J Surg Pathol 2024; 32:772-775. [PMID: 37525552 DOI: 10.1177/10668969231188894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Myxoid pseudotumor is a pseudoneoplastic fibroblastic proliferation that has been described in the perinephric and renal sinus fat tissue. It is characterized by the presence of a myxoid matrix, intermingled with the adipocytes, and a hypocellular population of spindle-shaped and stellate cells. We report a myxoid pseudotumor involving the distal ureter, which broadens the spectrum of possible localizations of this lesion around the urinary tract. It occurred in an 80-year-old patient who underwent a nephroureterectomy indicated after an incidental radiological finding of a thickening of the distal left ureter wall which suggested a ureteral neoplasm. He had two voided urine and one ureteroscopic sample cytologies diagnosed as high-grade urothelial carcinoma, as well as a retrograde ureteroscopy ureteral biopsy which was diagnosed as urothelial carcinoma in situ. This emphasizes the problem of the possible misdiagnosis of myxoid pseudotumor as a ureteral infiltrative carcinoma due to the radiological findings being badly interpreted, compounded by the preoperative cytohistologic data on malignancy. A diffuse urothelial carcinoma in situ was seen in our specimen without infiltrative or papillary tumors. This would not support an obstructive pathogenetic mechanism as has been hypothesized for myxoid pseudotumor.
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Affiliation(s)
- José A Ortiz-Rey
- Department of Pathology, Hospital Álvaro Cunqueiro, Vigo, Spain
- Uropathology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur) SERGAS-UVIGO, Vigo, Spain
| | | | | | | | - Carolina Gómez-de María
- Biobank of Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
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Broski SM, Knight JA, Larsen BT, Folpe AL, Wenger DE. Imaging features of perinephric myxoid pseudotumors of fat. Abdom Radiol (NY) 2024:10.1007/s00261-024-04294-9. [PMID: 38615061 DOI: 10.1007/s00261-024-04294-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE Retrospectively evaluate multimodality imaging features of perinephric myxoid pseudotumor of fat (PMPTF). METHODS Institutional cases of PMPTF with CT, MRI and/or ultrasound evaluation from 1/1/2020 to 9/1/2023 were retrospectively reviewed. Patient demographics and clinical history were reviewed, and imaging features recorded. RESULTS 14 patients with pathologically-proven PMPTF were identified (11 M, 3 F; mean age 66.7 ± 17.0 years; range 40-87 years). Three patients (18%) had bilateral lesions; a total of 17 PMPTFs were reviewed. 15/17 (88%) were biopsy-proven; two cases were diagnosed by imaging only in patients with a contralateral biopsy-proven PMPTF. All evaluable specimens were negative for MDM2 amplification. 11/17 (65%) occurred in patients with renal disease, including 4/17 (24%) in patients with renal transplant. 100% (17/17) had CT, 11/17 (65%) MRI, and 6/17 (35%) ultrasound. The mean largest lesion dimension was 10.9 ± 4.6 cm (range 4.3-17.0 cm). Of cases involving native kidneys, 7/13 (54%) presented as multifocal perinephric masses and 5/13 (38%) as a solitary perinephric mass. All four transplant cases presented as infiltrative-appearing masses involving the renal sinus with lesser perinephric involvement. 14/17 (82%) lesions contained macroscopic fat on CT and MRI and 3/17 (18%) showed no macroscopic fat, all involving renal transplants. All cases with MRI demonstrated T2 hyperintensity with signal dropout on opposed-phase imaging. 11/13 (85%) PMPTF showed no or equivocal CT enhancement. Enhancement was better seen on MRI in all cases evaluated by both CT and MRI. Of the six PMPTFs imaged by ultrasound, four (67%) were heterogeneously hypoechoic and two (33%) had mixed regions of hypo-, iso- and hyperechogenicity relative to adjacent renal parenchyma. CONCLUSIONS PMPTF is a rare, benign, and underrecognized lesion that may mimic malignancy, particularly retroperitoneal well-differentiated liposarcoma. The imaging features of this unusual pseudosarcoma differ in native and transplanted kidneys. Improved awareness of this entity will facilitate appropriate patient management and avoid unnecessary intervention.
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Affiliation(s)
- Stephen M Broski
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Jennifer A Knight
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA
| | - Brandon T Larsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
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Shanbhogue KP, Ramani N, Surabhi VR, Balasubramanya R, Prasad SR. Tumefactive Nonneoplastic Proliferative Pseudotumors of the Kidneys and Urinary Tract: CT and MRI Findings with Histopathologic Correlation. Radiographics 2023; 43:e230071. [PMID: 37971934 DOI: 10.1148/rg.230071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
A diverse spectrum of pathologically distinct, nonneoplastic, proliferative conditions of the kidneys and urinary tract demonstrate a expansile growth pattern similar to that of neoplasms. The renal pseudotumors include myriad causes of infections as well as rare noninfectious causes such as sarcoidosis, amyloidosis, and immunoglobulin G4-related disease (IgG4-RD). Rare entities such as cystitis cystica, endometriosis, nephrogenic adenoma, and pseudosarcomatous myofibroblastic proliferation and distinct types of prostatitis comprise tumefactive nontumorous disorders that affect specific segments of the urinary tract. The pseudotumors of the kidneys and urinary tract demonstrate characteristic histopathologic and epidemiologic features, as well as protean clinical manifestations, natural history, and imaging findings. Many patients present with genitourinary tract-specific symptoms or systemic disease. Some cases may be incidentally discovered at imaging. Some entities such as perinephric myxoid pseudotumors, IgG4-RD, fibroepithelial polyp, and nephrogenic adenoma display specific anatomic localization and disease distribution. Imaging features of multisystem disorders such as tuberculosis, sarcoidosis, and IgG4-RD provide supportive evidence that may allow precise diagnosis. Fungal pyelonephritis, xanthogranulomatous pyelonephritis, IgG4-RD, actinomycosis, and endometriosis show markedly low signal intensity on T2-weighted MR images. Although some pseudotumors exhibit characteristic imaging findings that permit correct diagnosis, laboratory correlation and histopathologic confirmation are required for definitive characterization in most cases. A high index of suspicion is a prerequisite for diagnosis. Accurate diagnosis is critical for instituting optimal management while preventing use of inappropriate therapies or interventions. Surveillance CT and MRI are frequently used for monitoring the response of pseudotumors to therapy. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Krishna Prasad Shanbhogue
- From the Departments of Radiology (K.P.S., V.R.S., R.B., S.R.P.) and Pathology (N.R.), Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Radiology, NYU Langone Health, New York, NY (K.P.S.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (R.B.); and Department of Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1473, Houston, TX 77030 (V.R.S., S.R.P.)
| | - Nisha Ramani
- From the Departments of Radiology (K.P.S., V.R.S., R.B., S.R.P.) and Pathology (N.R.), Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Radiology, NYU Langone Health, New York, NY (K.P.S.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (R.B.); and Department of Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1473, Houston, TX 77030 (V.R.S., S.R.P.)
| | - Venkateswar R Surabhi
- From the Departments of Radiology (K.P.S., V.R.S., R.B., S.R.P.) and Pathology (N.R.), Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Radiology, NYU Langone Health, New York, NY (K.P.S.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (R.B.); and Department of Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1473, Houston, TX 77030 (V.R.S., S.R.P.)
| | - Rashmi Balasubramanya
- From the Departments of Radiology (K.P.S., V.R.S., R.B., S.R.P.) and Pathology (N.R.), Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Radiology, NYU Langone Health, New York, NY (K.P.S.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (R.B.); and Department of Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1473, Houston, TX 77030 (V.R.S., S.R.P.)
| | - Srinivasa R Prasad
- From the Departments of Radiology (K.P.S., V.R.S., R.B., S.R.P.) and Pathology (N.R.), Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Radiology, NYU Langone Health, New York, NY (K.P.S.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (R.B.); and Department of Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1473, Houston, TX 77030 (V.R.S., S.R.P.)
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