1
|
Sharma K, Agarwala S, Kandasamy D, Jana M, Sharma R, Dhua A, Jain V, Bhatnagar V. Role of Diffusion Weighted MRI (DW-MR) in Detection of Satellite Lesions Not Detected with Multiphase CT Scans in Hepatoblastoma and Its Implications for Management. Indian J Pediatr 2022; 89:968-974. [PMID: 34997528 DOI: 10.1007/s12098-021-04016-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/18/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MR) in hepatoblastoma as compared to multiphase contrast enhanced computed tomography (CECT) scans for detection of satellite lesions. METHODS In this prospective study on new cases of hepatoblastoma, multiphase CECT scans and DW-MR were performed before initiation of chemotherapy. Results of interpretation were compared for detection of satellite lesions. PRETEXT grouping and risk categorization was done according to SIOPEL based on CECT scan. RESULTS Nine boys and 1 girl with hepatoblastoma, with median age of 11.5 mo were included. All patients were stratified as high-risk group with 2 (20%) in PRETEXT II and 8 (80%) in PRETEXT III. In 2 of 10 (20%) patients, additional satellite lesions were detected on DW-MR, which upgraded their stage. One of the two patients had one satellite lesion identified on CECT, while additional seven satellite lesions were identified on DW-MR imaging. For the other patient, CECT showed no satellite lesion while DW-MR detected six satellite lesions. CONCLUSION MRI has become the gold standard investigation for evaluation of hepatoblastoma. DW-MR, which is a contrast free technique, is a better tool for assessment of satellite lesions which are usually missed on CECT. This would help in proper staging, planning of management and prognostication.
Collapse
Affiliation(s)
- Kanika Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.,Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | | | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Dhua
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vishesh Jain
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Veereshwar Bhatnagar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.,Department of Pediatric Surgery, Sharda University, School of Medical Sciences & Research, Greater Noida, Uttar Pradesh, India
| |
Collapse
|
2
|
Lu Q, Ji C, Zhao X, Fu Y, Guo S, Liu G, Zhang S, Li X, Gan W, Guo H. Histopathologic analysis of tumor bed and peritumoral pseudocapsule after in vitro tumor enucleation on radical nephrectomy specimen for clinical T1b renal cell carcinoma. Urol Oncol 2017; 35:603.e15-603.e20. [PMID: 28619631 DOI: 10.1016/j.urolonc.2017.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 05/07/2017] [Accepted: 05/20/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE This study was designed to assess the feasibility and histopathologic safety of tumor enucleation for renal cell carcinoma, through histopathologic analysis of the tumor bed and peritumoral pseudocapsule (PC) after in vitro tumor enucleation. MATERIALS AND METHODS We studied 176 radical nephrectomy specimens for clinical T1b renal cell carcinoma in our institution, from January 2013-February 2016. Immediately after the kidney was excised, the tumor of radical specimen was enucleated in vitro. The tumor bed parenchyma of 15mm beyond the PC was examined to investigate the possible presence of tumor invasion or satellite lesions. The PC invasion was also evaluated. RESULTS The average tumor size was 5.7±0.7cm. The histopathologic evaluation revealed that 68.2% of tumors were clear cell renal cell carcinoma (RCC). The pathological staging showed that 92.6% of tumors were pT1b, 2.8% were pT2, and 4.5% were pT3a. For clinical T1b RCC, tumor infiltration on tumor bed was detected in 6 cases (3.4%), and satellite lesion was detected in 3 (1.7%). In the group of grade 1 to 2, 4 (2.3%) were found with residual tumor, and 5 (2.8%) in the group of grade 3 to 4 (P = 0.133). Papillary RCC had the highest rate of residual tumors (8.8%). A statistically significant association of peritumoral PC invasion with tumor size and pathologic grade was observed. Median follow-up was 23 months (range: 6-43) with a recurrence rate of 6.3% (11 of 176) and a cancer-specific mortality rate of 2.8% (5 of 176). CONCLUSIONS For clinical T1b renal cell carcinoma, the risks of tumor infiltration or satellite lesions on enucleation tumor bed or both are relatively low. Peritumoral PC invasion is associated with tumor size and pathologic stage. Tumor enucleation is a histopathologically safe technique for patients undergoing partial nephrectomy.
Collapse
Affiliation(s)
- Qun Lu
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People׳s Republic of China
| | - Changwei Ji
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People׳s Republic of China
| | - Xiaozhi Zhao
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People׳s Republic of China
| | - Yao Fu
- Department of Pathology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People׳s Republic of China
| | - Suhan Guo
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, People׳s Republic of China
| | - Guangxiang Liu
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People׳s Republic of China
| | - Shiwei Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People׳s Republic of China
| | - Xiaogong Li
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People׳s Republic of China
| | - Weidong Gan
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People׳s Republic of China
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People׳s Republic of China.
| |
Collapse
|