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Hao YW, Zhang Y, Guo HP, Xu W, Bai X, Zhao J, Ding XH, Gao S, Cui MQ, Liu BC, Ye HY, Wang HY. Differentiation between renal epithelioid angiomyolipoma and clear cell renal cell carcinoma using clear cell likelihood score. Abdom Radiol (NY) 2023; 48:3714-3727. [PMID: 37747536 DOI: 10.1007/s00261-023-04034-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Clear cell likelihood score (ccLS) may be a reliable diagnostic method for distinguishing renal epithelioid angiomyolipoma (EAML) and clear cell renal cell carcinoma (ccRCC). In this study, we aim to explore the value of ccLS in differentiating EAML from ccRCC. METHODS We performed a retrospective analysis in which 27 EAML patients and 60 ccRCC patients underwent preoperative magnetic resonance imaging (MRI) at our institution. Two radiologists trained in the ccLS algorithm scored independently and the consistency of their interpretation was evaluated. The difference of the ccLS score was compared between EAML and ccRCC in the whole study cohort and two subgroups [small renal masses (SRM; ≤ 4 cm) and large renal masses (LRM; > 4 cm)]. RESULTS In total, 87 patients (59 men, 28 women; mean age, 55±11 years) with 90 renal masses (EAML: ccRCC = 1: 2) were identified. The interobserver agreement of two radiologists for the ccLS system to differentiate EAML from ccRCC was good (k = 0.71). The ccLS score in the EAML group and the ccRCC group ranged from 1 to 5 (73.3% in scores 1-2) and 2 to 5 (76.7% in scores 4-5), respectively, with statistically significant differences (P < 0.001). With the threshold value of 2, ccLS can distinguish EAML from ccRCC with the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 87.8%, 95.0%, 73.3%, 87.7%, and 88.0%, respectively. The AUC (area under the curve) was 0.913. And the distribution of the ccLS score between the two diseases was not affected by tumor size (P = 0.780). CONCLUSION The ccLS can distinguish EAML from ccRCC with high accuracy and efficiency.
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Affiliation(s)
- Yu-Wei Hao
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yun Zhang
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- Department of Radiology, Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hui-Ping Guo
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Wei Xu
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xu Bai
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jian Zhao
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xiao-Hui Ding
- Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Sheng Gao
- Department of Radiology, Linyi Central Hospital, Shandong, China
| | - Meng-Qiu Cui
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Bai-Chuan Liu
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hui-Yi Ye
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hai-Yi Wang
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Osawa T, Oya M, Okanishi T, Kuwatsuru R, Kawano H, Tomita Y, Niida Y, Nonomura N, Hatano T, Fujii Y, Mizuguchi M, Shinohara N. Clinical Practice Guidelines for tuberous sclerosis complex-associated renal angiomyolipoma by the Japanese Urological Association: Summary of the update. Int J Urol 2023; 30:808-817. [PMID: 37278492 DOI: 10.1111/iju.15213] [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] [Received: 03/09/2023] [Accepted: 05/14/2023] [Indexed: 06/07/2023]
Abstract
New clinical issues have been raised through an interval of 7 years from the previous version (2016). In this study, we update the "Clinical Practice Guidelines for tuberous sclerosis complex-associated renal angiomyolipoma" as a 2023 version under guidance by the Japanese Urological Association. The present guidelines were cooperatively prepared by the Japanese Urological Association and Japanese Society of Tuberous Sclerosis Complex; committee members belonging to one of the two societies or specializing in the treatment of this disease were selected to prepare the guidelines in accordance with the "Guidance for preparing treatment guidelines" published by Minds (2020 version). The "Introduction" consisted of four sections, "Background Questions (BQ)" consisted of four sections, "Clinical Questions (CQ)" consisted of three sections, and "Future Questions (FQ)" consisted of three sections (total: 14 sections). Concerning CQ, an agreement was confirmed through voting by the committee members based on the direction and strength of recommendation, accuracy of evidence, and recommendation comments. The present guidelines were updated based on the current evidence. We hope that the guidelines will provide guiding principles for the treatment of tuberous sclerosis complex-associated renal angiomyolipoma to many urologists, becoming a foundation for subsequent updating.
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Affiliation(s)
- Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, School of Medicine and Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Haruna Kawano
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshihiko Tomita
- Department of Urology and Department of Molecular Oncology, Niigata University Graduate School of Medicine, Niigata, Japan
| | - Yo Niida
- Center for Clinical Genomics, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Hatano
- Department of Urology, Seirei Yokohama Hospital, Yokohama, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masashi Mizuguchi
- Department of Pediatrics, National Rehabilitation Center for Children with Disabilities, Tokyo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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3
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Lee SH, Lee JS, Kim JJ, Ko SY, Lee KR, Hwang IK, Hyun CL. Renal Epithelioid Angiomyolipoma with Epithelial Cysts Mimicking Cystic Renal Cell Carcinoma: A Case Report of Combination of Two Rare Entities. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1109-1115. [PMID: 36276212 PMCID: PMC9574272 DOI: 10.3348/jksr.2021.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/31/2021] [Accepted: 01/27/2022] [Indexed: 11/22/2022]
Abstract
Renal angiomyolipomas (AMLs) are typically solid tumors, but there have been few reports of a rare cystic variant of AML. AML with epithelial cysts, where the epithelial cyst has a cuboidal epithelial lining, account for the majority of them. Next, epithelioid AML (EAML) with cystic changes due to hemorrhage and necrosis, which is composed of epithelioid cells with abundant eosinophilic cytoplasm, have also been reported. These rare cystic types of AML can be mistaken for other cystic tumors, such as cystic renal cell carcinoma, in preoperative imaging. We report the imaging findings of a rare case of EAML with epithelial cysts.
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Kim TM, Ahn H, Lee HJ, Kim MG, Cho JY, Hwang SI, Kim SY. Differentiating renal epithelioid angiomyolipoma from clear cell carcinoma: using a radiomics model combined with CT imaging characteristics. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2867-2880. [PMID: 35697856 DOI: 10.1007/s00261-022-03571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE This study aims to assess the computed tomography (CT) findings of renal epithelioid angiomyolipoma (EAML) and develop a radiomics-based model for differentiating EAMLs and clear cell renal cell carcinomas (RCCs). METHOD This two-center retrospective study included 28 histologically confirmed EAMLs and 56 size-matched clear cell RCCs with preoperative three-phase kidney CTs. We conducted subjective image analysis to determine the CT parameters that can distinguish EAMLs from clear cell RCCs. Training and test sets were divided by chronological order of CT scans, and radiomics model was built using ten selected features among radiomics and CT features. The diagnostic performance of the radiomics model was compared with that of the three radiologists using the area under the receiver-operating characteristic curve (AUC). RESULTS The mean size of the EAMLs was 6.2 ± 5.0 cm. On multivariate analysis, a snowman or ice cream cone tumor shape (OR 16.3; 95% CI 1.7-156.9, P = 0.02) and lower tumor-to-cortex (TOC) enhancement ratio in the corticomedullary phase (OR 33.4; 95% CI 5.7-197, P < 0.001) were significant independent factors for identifying EAMLs. The diagnostic performance of the radiomics model (AUC 0.89) was similar to those of genitourinary radiologists (AUC 0.78 and 0.81, P > 0.05) and superior to that of a third-year resident (AUC 0.63, P = 0.04). CONCLUSIONS A snowman or ice cream cone shape and lower TOC ratio were more closely associated with EAMLs than with clear cell RCCs. A CT radiomics model was useful for differentiating EAMLs from clear cell RCCs with better diagnostic performance than an inexperienced radiologist.
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Affiliation(s)
- Taek Min Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyungwoo Ahn
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Hyo Jeong Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Min Gwan Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, 03080, Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea. .,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
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5
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Wang D, Gong G, Fu Y, Zhu L, Yin H, Liu L, Zhu Z, Zhou G, Yan A, Lei G, Chen C, Pang P, Yi X, Kuang Y, Chen BT. CT imaging findings of renal epithelioid lipid-poor angiomyolipoma. Eur Radiol 2022; 32:4919-4930. [PMID: 35124718 DOI: 10.1007/s00330-021-08528-y] [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: 07/13/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To identify specific imaging and clinicopathological features of a rare potentially malignant epithelioid variant of renal lipid-poor angiomyolipoma (E-lpAML). METHODS A total of 20 patients with E-lpAML and 43 patients with other lpAML were retrospectively included. Multiphase computed tomography (CT) imaging features and clinicopathological findings were recorded. Independent predictors for E-lpAML were identified using multivariate logistic regression and were used to construct a diagnostic score for differentiation of E-lpAML from other lpAML. RESULTS The E-lpAML group consisted of 6 men and 14 women (age median ± SD: 39.45 ± 15.70, range: 16.0-68.0 years). E-lpAML tended to appear as hyperdense mass lesions located at the renal sinus (n = 8, 40%) or at the renal cortex (n = 12, 60%), with a "fast-in and slow-out" enhancement pattern (n = 20, 100%), cystic degeneration (n = 18, 90%), "eyeball" sign (n = 11, 55%), and tumor neo-vasculature (n = 15, 75%) on CT. Multivariate logistic regression analysis showed that the independent predictors for diagnosing E-lpAML were cystic degeneration on CT imaging and CT value of the tumor in corticomedullary phase of enhancement. A predictive model was built with the two predictors, achieving an area under the curve (AUC) of 93.5% (95% confidence interval (95%CI): 84.3-98.2%) with a sensitivity of 95.0% (95%CI: 75.1-99.9%) and a specificity of 83.72% (95%CI: 69.3-93.2%). CONCLUSION We identified specific CT imaging features and predictors that could contribute to the correct diagnosis of E-lpAML. Our findings should be helpful for clinical management of E-lpAML which could potentially be malignant and may require nephron-sparing surgery while other lpAML tumors which are benign require no intervention. KEY POINTS • It is important to differentiate renal epithelioid lipid-poor angiomyolipoma (E-lpAML) from other lpAML because of differences in clinical management. • E-lpAML tumors tend to be large hyperdense tumors in the renal sinus with cystic degeneration and "fast-in and slow-out" pattern of enhancement. • Our CT imaging-based predictive model was robust in its performance for predicting E-lpAML from other lpAML tumors.
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Affiliation(s)
- Di Wang
- Department of Radiology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, 410008, Changsha, Hunan, People's Republic of China
| | - Guanghui Gong
- Department of Pathology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China
| | - Yan Fu
- Department of Radiology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, 410008, Changsha, Hunan, People's Republic of China
| | - Liping Zhu
- Department of Radiology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, 410008, Changsha, Hunan, People's Republic of China
| | - Hongling Yin
- Department of Pathology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China
| | - Longfei Liu
- Department of Urology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China
| | - Zhiming Zhu
- Department of Radiology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China
| | - Gaofeng Zhou
- Department of Radiology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China
| | - Ang Yan
- Department of Radiology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China.,Department of Medical Equipment, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China
| | - Guangwu Lei
- Department of Radiology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China
| | - Changyong Chen
- Department of Radiology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China
| | - Peipei Pang
- GE Healthcare, Hangzhou, 310000, People's Republic of China
| | - Xiaoping Yi
- Department of Radiology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China. .,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, 410008, Changsha, Hunan, People's Republic of China. .,Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, Hunan, People's Republic of China.
| | - Yehong Kuang
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, Hunan, People's Republic of China. .,National Clinical Research Center for Geriatric Disorders, Changsha, Hunan, People's Republic of China. .,Hunan Engineering Research Center of Skin Health and Disease, Changsha, Hunan, People's Republic of China. .,Department of Dermatology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, People's Republic of China.
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, USA
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Luo C, Liu Z, Gao M, Hu Q, He X, Xi Y, Cai F, Zhang R, Zeng X, Xiao N. Renal epithelioid angiomyolipoma: computed tomography manifestation and radiologic-pathologic correlation depending on different epithelioid component percentages. Abdom Radiol (NY) 2022; 47:310-319. [PMID: 34664098 DOI: 10.1007/s00261-021-03313-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Renal epithelioid angiomyolipoma (EAML) is a rare and potentially malignant mesenchymal lesion mainly composed of epithelioid cells. Although some case reports or small case series have been published, the computed tomography (CT) manifestations and radiologic-pathologic correlation depending on different epithelioid component percentages have not been studied before. OBJECTIVE To investigate the CT manifestation and radiologic-pathologic correlation between renal EAML and angiomyolipoma (AML) with epithelioid component. METHODS The clinicopathologic and imaging data of 53 patients with an original diagnosis of EAML or AML with epithelioid component were retrospectively collected from three hospitals. All tissue specimens were re-sectioned and re-observed under the microscope. Samples were divided into an EAML group (≥ 80% epithelioid component, n = 25) and AML with epithelioid component group (5% ≤ epithelioid component < 80%, n = 28). Two radiologists reviewed the images in consensus, describing and comparing the CT manifestation, including the long diameter of the tumor, morphology, presence of necrosis or cystic change, hemorrhage, fat, calcification, enlarged blood vessels, and dynamic enhancement pattern according to the Hounsfield unit value of each CT phase between the two groups. The radiologic-pathologic correlation depending on the different percentages of epithelioid component were studied. RESULTS The long diameter of the tumor, presence of necrosis or cystic change, fat, enhancement pattern, and tumor-to-cortex enhancement ratio of the cortical phase between the two groups were significantly different (z = - 2.932, P = 0.003; χ2 = 18.020, P < 0.001; χ2 = 16.377, P < 0.001; P = 0.020; and T = - 3.944, P < 0.001, respectively). In multivariate logistic regression analysis, the significant predictive factors of EAML included the presence of necrosis or cystic change [odds ratio (OR) 11.864, P = 0.001] and absence of fat (OR 0.095, P = 0.003). Correlation analysis found that the presence of necrosis or cystic change (r = 0.679, P < 0.001) and fat (r = - 0.603, P < 0.001) were both moderately related to the epithelioid component percentage. The combined model based on the presence of necrosis or cystic change and absence of fat yielded the best diagnostic performance in discriminating EAML and AML with epithelioid component with the highest area under the curve (0.887). CONCLUSION EAML has characteristic CT signs; these characteristic CT signs are closely related to the epithelioid component percentage. The presence of necrosis or cystic change and the absence of fat were independent predictors of EAML.
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Abstract
With the ever increasing trend of using cross-section imaging in today's era, incidental detection of small solid renal masses has dramatically multiplied. Coincidentally, the number of asymptomatic benign lesions being detected has also increased. The role of radiologists is not only to identify these lesions, but also go a one step further and accurately characterize various renal masses. Earlier detection of small renal cell carcinomas means identifying at the initial stage which has an impact on prognosis, patient management and healthcare costs. In this review article we share our experience with the typical and atypical solid renal masses encountered in adults in routine daily practice.
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Affiliation(s)
- Mahesh Kumar Mittal
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Binit Sureka
- Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
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8
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Benincasa A, Pinto A, Lamberti F, Fristachi R, Della Pepa C, Benincasa G. A rare case of spontaneous rupture of epithelioid angiomyolipoma. Urol Case Rep 2021; 38:101645. [PMID: 33850730 PMCID: PMC8024590 DOI: 10.1016/j.eucr.2021.101645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
A male patient, 40 years of age, arrived at our Institute with diffuse abdominal tenderness, right flank pain, hematuria and early stage of hemorrhagic shock with anemia and initial hypotension. The immediate clinical history revealed no significant previous trauma, only subsequently was reported inconstant pain in the right flank for 4–5 days with pallor and asthenia, signs and symptoms that the patient had not investigated. Abdominal CT scan with angiographic evaluation was performed showing right kidney mass and perirenal fluid collection by blood component. Immediate nephrectomy was performed and histopathological and further immunohistochemical study, revealed the epithelioid variant of angiomyolipoma.
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Affiliation(s)
- Alfonso Benincasa
- Department of Urology, San Luca Hospital, Via Francesco Cammarota 1, 84078, Vallo della Lucania, Italy
| | - Angelo Pinto
- Department of Urology, San Luca Hospital, Via Francesco Cammarota 1, 84078, Vallo della Lucania, Italy
| | - Francesco Lamberti
- Department of Urology, San Luca Hospital, Via Francesco Cammarota 1, 84078, Vallo della Lucania, Italy
| | - Raffaele Fristachi
- Department of Pathology, San Luca Hospital, Via Francesco Cammarota 1, 84078, Vallo della Lucania, Italy
| | - Chiara Della Pepa
- Department of Oncology, San Luca Hospital, Via Francesco Cammarota 1, 84078, Vallo della Lucania, Italy
| | - Giuseppe Benincasa
- Department of Urology, San Luca Hospital, Via Francesco Cammarota 1, 84078, Vallo della Lucania, Italy
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9
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Tatsuya S, Hirotaka A, Yuki A, Akiko T, Masahiro H, Shigeo O, Shuji M, Ryuichi M, Mototsugu O, Masahiro J. Radiologic features of mixed epithelial and stromal tumors of the kidney: Hyperattenuating on unenhanced computed tomography and T2-hypointensity on magnetic resonance imaging. Radiol Case Rep 2021; 16:858-862. [PMID: 33552340 PMCID: PMC7850961 DOI: 10.1016/j.radcr.2021.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/30/2022] Open
Abstract
In the 2016 World Health Organization renal tumor classification, the mixed epithelial and stromal tumor family was introduced as a new entity. This family encompasses a spectrum of tumors, ranging from predominantly cystic tumors (adult cystic nephromas) to tumors that are variably solid (mixed epithelial and stromal tumors). The majority of previous studies incorporating “mixed epithelial and stromal tumor” in the titles were actually reports of imaging findings of adult cystic nephroma. Thus, the solid component of mixed epithelial and stromal tumors has not been well evaluated. In this study, we present 2 cases of mixed epithelial and stromal tumors, as defined by the 2016 World Health Organization classification, showing a predominantly solid component. The characteristic findings of the solid component of these tumors were T2-hypointensity on magnetic resonance imaging and hyperattenuation on unenhanced computed tomography. Angiomyolipoma with epithelial cysts and epithelioid angiomyolipoma should be considered in the differential diagnosis of mixed epithelial and stromal tumors.
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Affiliation(s)
- Suzuki Tatsuya
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Akita Hirotaka
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Arita Yuki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Tomiyama Akiko
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hashimoto Masahiro
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Okuda Shigeo
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Mikami Shuji
- Department of Diagnostic Pathology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mizuno Ryuichi
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Oya Mototsugu
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Jinzaki Masahiro
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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10
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Kim B, Seo JW. Multiloculated Cystic Type Renal Epithelioid Angiomyolipoma Mimicking Renal Cell Carcinoma: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1292-1296. [PMID: 36238387 PMCID: PMC9432379 DOI: 10.3348/jksr.2020.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Byungsoo Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jung Wook Seo
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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11
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Hatano T, Egawa S. Renal angiomyolipoma with tuberous sclerosis complex: How it differs from sporadic angiomyolipoma in both management and care. Asian J Surg 2020; 43:967-972. [PMID: 31959574 DOI: 10.1016/j.asjsur.2019.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/14/2019] [Accepted: 12/27/2019] [Indexed: 01/25/2023] Open
Abstract
Renal angiomyolipoma (AML) is the most common benign tumor of the kidney. It consists of blood vessels, smooth muscle and fat components in varying proportions. AML is divided into the sporadic type and tuberous sclerosis complex (TSC)-associated type. TSC-associated AML develops at a younger age and tends to exhibit a much faster growth rate over time than sporadic AML. AMLs are classified as classic AML, fat-poor AML and epithelioid AML. Epithelioid AML, though rare, shows aggressive behavior leading to distant metastasis and mortality. TSC-associated AML is more likely to have an epithelioid component than sporadic AML. Active surveillance is the suggested management for small AML. Clinical intervention is mainly indicated when there is a substantial risk of rupture. Minimally invasive therapies, including partial nephrectomy, transcatheter arterial embolization, and mammalian target of rapamycin (mTOR) inhibitor treatment are employed for patients who require treatment. An updated algorithm for the management of AML is herein described. According to this algorithm, treatment intervention is recommended for TSC-associated AML >3 cm, even in asymptomatic cases. In cases with asymptomatic sporadic AML >4 cm in size or with an intra-tumoral aneurysm of >5 mm, treatment, including transcatheter arterial embolization or partial nephrectomy, is advised. The major complication of AML is intra-tumoral or retroperitoneal hemorrhage due to rupture that may be serious and life threatening. Thus, correct diagnosis, proper observation, and appropriate treatment are very important in the management of renal AML.
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Affiliation(s)
- Takashi Hatano
- Department of Urology, JR Tokyo General Hospital, Japan.
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Japan
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Park SG, Park BK. New radiologic classification of renal angiomyolipoma: frequently asked questions. Clin Imaging 2019; 55:156-160. [DOI: 10.1016/j.clinimag.2019.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/15/2019] [Accepted: 01/31/2019] [Indexed: 01/20/2023]
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13
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Imaging of Unusual Renal Tumors. Curr Urol Rep 2019; 20:5. [PMID: 30663008 DOI: 10.1007/s11934-019-0867-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW Renal masses are a wide entity and a common finding in clinical practice. Detection of these masses has increased in the last years, yet mortality rates have slightly decreased. RECENT FINDINGS According to the World Health Organization classification, there are 8 types, 51 subtypes, and a lot more subsequent subclassifications of renal tumors. Histopathological analysis should always be assessed for final diagnosis of theses tumors. However, imaging can be an important diagnostic guidance. The most common diagnoses of renal tumor are clear cell carcinoma, papillary renal cell carcinoma, angiomyolipoma, and transitional cell carcinoma. Nonetheless, a considerable variety of particular tumors can arise from the kidney, challenging the expertise of radiologists and urologists on this subject. The awareness of these unusual entities is vital for professionals working at a complex medical facility with greater volume of patients. We hereby present uncommon renal tumors and its pathological and radiological features.
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Cong X, Zhang J, Xu X, Zhang M, Chen Y. Renal epithelioid angiomyolipoma: magnetic resonance imaging characteristics. Abdom Radiol (NY) 2018. [PMID: 29525877 DOI: 10.1007/s00261-018-1548-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of the study was to analyze MR imaging features of renal epithelioid angiomyolipoma (EAML). METHODS This study included 17 patients with histopathologically confirmed renal EAML who underwent renal MRI scanning before radical or partial nephrectomy. MR images were retrospectively reviewed and correlated with pathological findings. RESULT Fifteen lesions (88.2%) appeared as round or oval. The tumor-kidney interface was round in 14 lesions (82.4%). Fifteen tumors (88.2%) presented mainly isointensity on T1WI, and eleven tumors (64.7%) presented mainly hypointensity on T2WI. Twelve lesions (70.6%) showed restricted diffusion on DWI, and the mean ADC value was 1.23 ± 0.28 × 10-3mm2/s. Minimal fat component was identified as loss of signal intensity on opposed-phase MR images in 6 cases (35.3%). Sixteen lesions (100%) demonstrated inhomogeneous enhancement, and 7 of 16 masses (43.8%) showed reticular enhancement. Rapid wash-in and wash-out enhancement was seen in 13 masses (81.3%). In the corticomedullary phase, the mass showed markedly enhancement in 14 cases (87.5%). The irregular vessels and hemorrhage were detected in 4 cases (23.5%) and 7 cases (41.2%), respectively. One patient (5.9%) had a lymph node involvement at initial diagnosis, and showed distant metastasis after operation. In the immunohistochemical analysis, 15 tumors (88.2%) were positive for melanocytic marker (HMB45 or Melan-A), and all cases (100%) were negative for epithelial-associated markers (CK or AE1/AE3). CONCLUSION The presence of hypointensity on T2WI, restricted diffusion on DWI, round tumor-kidney interface, reticular, and marked enhancement (rapid wash-in and wash-out) should further raise suspicion for renal EAML. The diagnosis may be confirmed by pathological analysis.
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Affiliation(s)
- Xinying Cong
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- China Rehabilitation Research Center, Beijing, 100068, China
| | - Jin Zhang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiaojuan Xu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Miaomiao Zhang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yan Chen
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Malignant renal epithelioid angiomyolipoma with TFE3 gene amplification mimicking renal carcinoma. Clin Nephrol Case Stud 2018; 6:11-15. [PMID: 29951351 PMCID: PMC5972752 DOI: 10.5414/cncs109443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/30/2018] [Indexed: 11/24/2022] Open
Abstract
Malignant renal epithelioid angiomyolipoma (EAML) is an extremely rare disease with a poor prognosis, and currently there are no uniform criteria for its biological behavior. Here, we present a case of malignant renal EAML with TFE3 gene amplification in a 53-year-old woman. Four months after surgery, unenhanced computed tomography scans showed recurrence as well as metastasis in the abdomen and lung. The patient succumbed to rapid neoplastic progression of the disease 6 months later.
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Thiravit S, Teerasamit W, Thiravit P. The different faces of renal angiomyolipomas on radiologic imaging: a pictorial review. Br J Radiol 2018; 91:20170533. [PMID: 29327940 DOI: 10.1259/bjr.20170533] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Renal angiomyolipoma (AML) is an uncommon renal tumour, generally composed of mature adipose tissue, dysmorphic blood vessels and smooth muscle. Identification of intratumoral fat on unenhanced CT images is the most reliable finding for establishing the diagnosis of renal AML. However, AMLs sometimes exhibit atypical findings, including cystic as well as solid forms; some of these variants overlap with the appearance of other renal tumours. A rare type of AML, the epithelioid type, possesses malignant potential. The aim of this pictorial review is to gather the different imaging features of AMLs including the classic and fat-poor types, AMLs with epithelial cysts, epithelioid AML, AML associated with tuberous sclerosis, haemorrhagic AML and large AMLs mimicking retroperitoneal liposarcomas. The diagnostic clues that help to distinguish AMLs from other renal tumours are also described in the review.
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Affiliation(s)
- Shanigarn Thiravit
- 1 Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Wanwarang Teerasamit
- 1 Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Phakphoom Thiravit
- 1 Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
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Feng Z, Rong P, Cao P, Zhou Q, Zhu W, Yan Z, Liu Q, Wang W. Machine learning-based quantitative texture analysis of CT images of small renal masses: Differentiation of angiomyolipoma without visible fat from renal cell carcinoma. Eur Radiol 2017; 28:1625-1633. [PMID: 29134348 DOI: 10.1007/s00330-017-5118-z] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 09/23/2017] [Accepted: 10/03/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the diagnostic performance of machine-learning based quantitative texture analysis of CT images to differentiate small (≤ 4 cm) angiomyolipoma without visible fat (AMLwvf) from renal cell carcinoma (RCC). METHODS This single-institutional retrospective study included 58 patients with pathologically proven small renal mass (17 in AMLwvf and 41 in RCC groups). Texture features were extracted from the largest possible tumorous regions of interest (ROIs) by manual segmentation in preoperative three-phase CT images. Interobserver reliability and the Mann-Whitney U test were applied to select features preliminarily. Then support vector machine with recursive feature elimination (SVM-RFE) and synthetic minority oversampling technique (SMOTE) were adopted to establish discriminative classifiers, and the performance of classifiers was assessed. RESULTS Of the 42 extracted features, 16 candidate features showed significant intergroup differences (P < 0.05) and had good interobserver agreement. An optimal feature subset including 11 features was further selected by the SVM-RFE method. The SVM-RFE+SMOTE classifier achieved the best performance in discriminating between small AMLwvf and RCC, with the highest accuracy, sensitivity, specificity and AUC of 93.9 %, 87.8 %, 100 % and 0.955, respectively. CONCLUSION Machine learning analysis of CT texture features can facilitate the accurate differentiation of small AMLwvf from RCC. KEY POINTS • Although conventional CT is useful for diagnosis of SRMs, it has limitations. • Machine-learning based CT texture analysis facilitate differentiation of small AMLwvf from RCC. • The highest accuracy of SVM-RFE+SMOTE classifier reached 93.9 %. • Texture analysis combined with machine-learning methods might spare unnecessary surgery for AMLwvf.
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Affiliation(s)
- Zhichao Feng
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Pengfei Rong
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Peng Cao
- GE Healthcare, Shanghai, 210000, China
| | - Qingyu Zhou
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Wenwei Zhu
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Zhimin Yan
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Qianyun Liu
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Wei Wang
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China.
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Zhong Y, Shen Y, Pan J, Wang Y, An Y, Guo A, Ma L, Ye H, Wang H. Renal epithelioid angiomyolipoma: MRI findings. Radiol Med 2017; 122:814-821. [DOI: 10.1007/s11547-017-0788-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/29/2017] [Indexed: 11/28/2022]
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19
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Jinzaki M, Silverman SG, Akita H, Mikami S, Oya M. Diagnosis of Renal Angiomyolipomas: Classic, Fat-Poor, and Epithelioid Types. Semin Ultrasound CT MR 2016; 38:37-46. [PMID: 28237279 DOI: 10.1053/j.sult.2016.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
With the increasing discovery of small renal masses with cross-sectional imaging, there has been the concomitant rise in their treatment. With the intent of early curative surgery for a presumed renal cell carcinoma, many renal masses are being resected at surgery without a confirmed diagnosis. Many of them are benign, and some are angiomyolipomas. The diagnosis of renal angiomyolipoma using imaging is, therefore, is as important as ever. Although most, if not all angiomyolipomas with abundant fat are diagnosed readily, some have too little fat to be detected with imaging. This article reviews the current classification, imaging pitfalls, and diagnosis of angiomyolipoma with an emphasis on the fat-poor types. Proper imaging technique, a thorough search for fat, and the appropriate use of percutanoeus biopsy are all needed to eliminate the unnecessary treatment of these benign neoplasms.
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Affiliation(s)
- Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
| | | | - Hirotaka Akita
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shuji Mikami
- Department of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Gaur S, Turkbey B, Choyke P. Hereditary Renal Tumor Syndromes: Update on Diagnosis and Management. Semin Ultrasound CT MR 2016; 38:59-71. [PMID: 28237281 DOI: 10.1053/j.sult.2016.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hereditary renal cancers account for approximately 5%-8% of all renal tumors. Over the past 2 decades, a number of syndromes have been identified that predispose patients to early renal cancer development, representing all the major histologic types of tumor pathology. In this article, we describe the current knowledge concerning the cell type, known mechanism of tumor development, other manifestations of the syndrome, imaging findings, genetic screening, and imaging surveillance recommendations for each of the major syndromes associated with hereditary renal cancers.
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Affiliation(s)
- Sonia Gaur
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Baris Turkbey
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Peter Choyke
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD.
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Abstract
Hereditary forms of kidney carcinoma account for 5-8% of all malignant kidney neoplasms. The renal tumors are often multiple and bilateral and occur at an earlier age. Each of the hereditary kidney carcinoma syndromes is associated with specific gene mutations as well as a specific histologic type of kidney carcinoma. The presence of associated extrarenal manifestations may suggest a hereditary kidney cancer syndrome. Radiology is most commonly used to screen and manage patients with hereditary kidney cancer syndromes. This manuscript reviews the clinical and imaging findings of well-defined inherited kidney cancer syndromes including von Hippel-Lindau disease, Birt-Hogg-Dubé syndrome, hereditary papillary renal carcinoma syndrome, hereditary leiomyomatosis and RCC syndrome, tuberous sclerosis complex, and Lynch syndrome.
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22
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Sun J, Xing Z, Xing W, Zheng L, Chen J, Fan M, Chen T, Zhang Z. Intratumoral Macroscopic Fat and Hemorrhage Combination Useful in the Differentiation of Benign and Malignant Solid Renal Masses. Medicine (Baltimore) 2016; 95:e2960. [PMID: 26962796 PMCID: PMC4998877 DOI: 10.1097/md.0000000000002960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
To evaluate the value of combining the detection of intratumoral macroscopic fat and hemorrhage in the differentiation of the benign from malignant solid renal masses.Conventional magnetic resonance imaging (MRI), chemical shift (CS)-MRI, and susceptibility-weighted imaging were performed in 152 patients with 152 solid renal masses, including 48 benign and 104 malignant masses all pathologically confirmed. The presence of macroscopic fat detected by CS-MRI and hemorrhage detected by susceptibility-weighted imaging were evaluated in all masses. The rates of macroscopic fat and hemorrhage observed between benign and malignant masses were compared by a χ test. All masses found to contain macroscopic fat with or without hemorrhage were considered to be benign. The remaining masses (without macroscopic fat) found not to contain hemorrhage were considered to be benign. Only those found to contain hemorrhage alone were considered to be malignant. The evaluation indexes for differentiating and forecasting the benign and malignant masses were calculated.Significant differences in the rate of macroscopic fat (observed in 85.42% of benign masses vs. 0% of malignant masses) and hemorrhage (observed in 4.17% of benign masses vs. 95.19% of malignant masses) were measured in the benign and malignant groups (P < 0.005, for both). The 41 masses containing macroscopic fat with or without hemorrhage and 11 masses containing neither macroscopic fat nor hemorrhage were considered to be benign. The 100 masses containing no macroscopic fat and only hemorrhage were considered to be malignant. By combining the results for the macroscopic fat and hemorrhage, the accuracy, sensitivity, and specificity in the differential diagnosis of the benign and malignant masses were 96.05%, 95.19%, and 97.92%, respectively, and the accuracy and error rate of forecasting the benign and malignant masses were 95.39% and 4.61%, respectively.Combining the detection intratumoral macroscopic fat and hemorrhage can be used to differentiate the benign from malignant solid renal masses.
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Affiliation(s)
- Jun Sun
- From the Department of Radiology (JS, WX, JC); Department of Urology (ZX, MF); Department of Pathology (TC), Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China; Department of Radiology (LZ, ZZ), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Radiology (LZ), Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China; and Robert H. Lurie Comprehensive Cancer Center (ZZ), Northwestern University Chicago, Chicago, IL
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Murad Gutiérrez V, Aponte Barrios WO, Romero Enciso JA. Angiomiolipoma renal: nuevas perspectivas. Rev Urol 2016. [DOI: 10.1016/j.uroco.2015.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Liu Y, Qu F, Cheng R, Ye Z. CT-imaging features of renal epithelioid angiomyolipoma. World J Surg Oncol 2015; 13:280. [PMID: 26391670 PMCID: PMC4578611 DOI: 10.1186/s12957-015-0700-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/14/2015] [Indexed: 02/01/2023] Open
Abstract
Background The aim of this study was to describe the computed tomography (CT)-imaging features of renal epithelioid angiomyolipomas (E-AMLs) to understand and recognize this new category of renal tumors. Methods Institutional review board approval was obtained for this retrospective study. Clinical data and preoperative CT images of 11 cases of E-AML were retrospectively analyzed. All patients had unenhanced and tri-phase dynamic enhanced CT examination. CT-imaging features including tumor size, existence of fat and calcification, enhancement degree, enhancement pattern, and enhancement heterogeneity were evaluated. Results The patients were ten women and one man. The size of tumor ranged from 1.8 to 10.3 cm. All of them had distinct edges; one had a lobulated appearance, ten had bulging contour of the involved kidney, and four lesions had intratumoral fat. Eight of the E-AMLs demonstrated hyper-attenuation, two as iso-attenuation, and one as hypo-attenuation compared with renal parenchyma on unenhanced CT images. Contrast-enhanced CT features were markedly heterogeneous in eight cases (73 %). The predominant enhancement pattern was rapid wash-in to slow wash-out (91 %). Conclusions The radiological appearance of most E-AMLs has a tendency to be hyper-attenuated on precontrast CT with or without fat component and demonstrates a rapid wash-in to slow wash-out dynamic enhancement pattern.
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Affiliation(s)
- Ying Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, 300060, Tianjin, China.
| | - Fangyuan Qu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, 300060, Tianjin, China.
| | - Runfen Cheng
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, 300060, Tianjin, China.
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Jinzaki M, Silverman SG, Akita H, Nagashima Y, Mikami S, Oya M. Renal angiomyolipoma: a radiological classification and update on recent developments in diagnosis and management. ACTA ACUST UNITED AC 2015; 39:588-604. [PMID: 24504542 PMCID: PMC4040184 DOI: 10.1007/s00261-014-0083-3] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Angiomyolipoma is the most common benign solid renal neoplasm observed in clinical practice. Once thought to be a hamartoma and almost always diagnosed by the imaged-based detection of fat, angiomyolipomas are now known to consist of a heterogeneous group of neoplasms. Although all are considered perivascular epithelioid cell tumors, many display different pathology, imaging features, and clinical behavior. The importance of understanding this group of neoplasms is emphasized by the fact that many types of angiomyolipoma contain little to no fat, and despite being benign, sometimes escape a pre-operative diagnosis. These types of angiomyolipomas can all be considered when encountering a renal mass that is both hyperattenuating relative to renal parenchyma on unenhanced CT and T2-hypointense, features that reflect their predominant smooth muscle component. We review recent developments and provide a radiological classification of angiomyolipomas that helps physicians understand the various types and learn how to both diagnose and manage them.
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Affiliation(s)
- Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan,
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Renal sinus fat invasion and tumoral thrombosis of the inferior vena cava-renal vein: only confined to renal cell carcinoma. Case Rep Radiol 2014; 2014:140365. [PMID: 25506021 PMCID: PMC4251875 DOI: 10.1155/2014/140365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 11/04/2014] [Indexed: 11/20/2022] Open
Abstract
Epithelioid angiomyolipoma (E-AML), accounting for 8% of renal angiomyolipoma, is usually associated with tuberous sclerosis (TS) and demonstrates aggressive behavior. E-AML is macroscopically seen as a large infiltrative necrotic tumor with occasional extension into renal vein and/or inferior vena cava. However, without history of TS, renal sinus and venous invasion E-AML would be a challenging diagnosis, which may lead radiologists to misinterpret it as a renal cell carcinoma (RCC). In this case presentation, we aimed to report cross-sectional imaging findings of two cases diagnosed as E-AML and pathological correlation of these aforementioned masses mimicking RCC.
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Ishigami K, Pakalniskis MG, Leite LV, Lee DK, Holanda DG, Rajput M. Characterization of renal cell carcinoma, oncocytoma, and lipid-poor angiomyolipoma by unenhanced, nephrographic, and delayed phase contrast-enhanced computed tomography. Clin Imaging 2014; 39:76-84. [PMID: 25457535 DOI: 10.1016/j.clinimag.2014.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 09/11/2014] [Accepted: 09/19/2014] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to assess the characterization of renal cell carcinoma (RCC) and benign renal tumors by unenhanced, nephrographic, and delayed phase computed tomography (CT). The study group consisted of 129 renal tumors including 79 clear cell RCCs, 17 papillary RCCs, 6 chromophobe RCCs, 21 oncocytoma, and 6 lipid-poor angiomyolipomas (AMLs). CT studies were retrospectively reviewed. Our results suggested that it was possible to discriminate clear cell RCC from papillary RCC, chromophobe RCC, and lipid-poor AML. CT findings of oncocytoma overlapped with both clear cell and non-clear cell RCCs, although oncocytoma more commonly became homogeneous in the delayed phase.
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Affiliation(s)
- Kousei Ishigami
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| | - Marius G Pakalniskis
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Leandro V Leite
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Daniel K Lee
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Danniele G Holanda
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Maheen Rajput
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Jinzaki M, Silverman SG, Akita H, Nagashima Y, Mikami S, Oya M. Renal angiomyolipoma: a radiological classification and update on recent developments in diagnosis and management. ABDOMINAL IMAGING 2014. [PMID: 24504542 DOI: 10.1007/s00261-014-0083-3.pubmedpmid:24504542;pubmedcentralpmcid:pmc4040184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Angiomyolipoma is the most common benign solid renal neoplasm observed in clinical practice. Once thought to be a hamartoma and almost always diagnosed by the imaged-based detection of fat, angiomyolipomas are now known to consist of a heterogeneous group of neoplasms. Although all are considered perivascular epithelioid cell tumors, many display different pathology, imaging features, and clinical behavior. The importance of understanding this group of neoplasms is emphasized by the fact that many types of angiomyolipoma contain little to no fat, and despite being benign, sometimes escape a pre-operative diagnosis. These types of angiomyolipomas can all be considered when encountering a renal mass that is both hyperattenuating relative to renal parenchyma on unenhanced CT and T2-hypointense, features that reflect their predominant smooth muscle component. We review recent developments and provide a radiological classification of angiomyolipomas that helps physicians understand the various types and learn how to both diagnose and manage them.
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Affiliation(s)
- Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan,
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29
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Luo J, Liu B, Wang Y, Li J, Wang P, Chen J, Wang C. Comprehensive clinical and pathological analysis of aggressive renal epithelioid angiomyolipoma: report of three cases. Onco Targets Ther 2014; 7:823-7. [PMID: 24920923 PMCID: PMC4043816 DOI: 10.2147/ott.s61524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Renal angiomyolipoma (AML) is recognized as a benign hamartomatous lesion arising in the kidney with no obvious malignant potential. However, epithelioid AML (EAML), a rare variant of AML, is potentially malignant, with aggressive clinical features. It can occur in patients with or without tuberous sclerosis. Because EAML may mimic renal cell carcinoma in imaging studies, differentiation of this tumor from renal cell carcinoma preoperatively is difficult. At times, the lesions may extend into the renal vein and inferior vena cava or metastasize to other organs such as the lung and liver. To clarify the biological nature of EAML, three specific cases that we encountered in clinical practice are analyzed and reported in detail.
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Affiliation(s)
- Jindan Luo
- Department of Urology, Zhejiang University, Zhejiang, People's Republic of China
| | - Ben Liu
- Department of Urology, Zhejiang University, Zhejiang, People's Republic of China
| | - Yanli Wang
- Department of Pathology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Jun Li
- Department of Pathology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Ping Wang
- Department of Urology, Zhejiang University, Zhejiang, People's Republic of China
| | - Jun Chen
- Department of Urology, Zhejiang University, Zhejiang, People's Republic of China
| | - Chaojun Wang
- Department of Urology, Zhejiang University, Zhejiang, People's Republic of China
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