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Aumatell J, Schwartzmann I, Bravo-Balado A, Subiela JD, Farré A, Moncada E, Martínez MJ, Palou J, Breda A, Ponce de León Roca J. Natural history of renal angiomyolipoma in a high-volume center: our experience during more than 15 years of follow up. Int Urol Nephrol 2024; 56:1551-1557. [PMID: 38085409 DOI: 10.1007/s11255-023-03839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/03/2023] [Indexed: 04/09/2024]
Abstract
OBJECTIVES To describe the natural history of AML, the clinical results and the need for treatment during long-term follow-up of renal AML. METHODS Retrospective study of patients diagnosed with AML by computed tomography or nuclear magnetic resonance between 2001 and 2019, with at least two follow-up images. Clinical and imaging variables, need for intervention, complications and follow-up time were recorded. Statistical analysis was performed using SPSS 22.0. RESULTS 111 patients and 145 AML were included. The median follow-up was 6.17 years (range 0.7-18.1, IQR 11.8-12.2). The median tumor size at diagnosis was 13 mm (IQR 7.5-30), with 24 (16.4%) being ≥ 4 cm. Most presented as an incidental finding (85.5%); in 3 (2.1%) cases, the presentation was as a spontaneous retroperitoneal hematoma. The main indication for intervention was size ≥ 4 cm in 50%. Eighteen (12%) patients received a first intervention, being urgent in 3. Embolization was performed in 15 cases and partial nephrectomy in 3. The need for reintervention was recorded in five: two underwent partial nephrectomy and two total nephrectomy; one patient required a new urgent embolization. Of the non-operated patients, 43% decreased in size or did not change, while 57% increased, with the median annual growth being 0.13 mm (IQR - 0.11 to 0.73). There were no differences in the median growth in tumors measuring ≥ 4 cm (0.16 mm) at diagnosis vs. < 4 cm (0.13 mm) (p = 0.9). CONCLUSIONS The findings of this study suggest that AML typically demonstrate a slow-progressing clinical course during long-term follow-up. Moreover, our observations, which cast doubt on tumor size as a reliable predictor of adverse clinical outcomes, advocate for a less intensive monitoring strategy in both monitoring frequency and choice of imaging modality.
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Affiliation(s)
- Júlia Aumatell
- Urology Department, Hospital Universitario Rey Juan Carlos, Universidad Rey Juan Carlos, Móstoles, Madrid, Spain.
| | - Iván Schwartzmann
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Alejandra Bravo-Balado
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - José Daniel Subiela
- Urology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - Alba Farré
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Enver Moncada
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - María José Martínez
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
- Radiology Department, Fundació Puigvert, Universidad Autónoma de Barcelona, Surgery Department, Barcelona, Spain
| | - Joan Palou
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Alberto Breda
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Javier Ponce de León Roca
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
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Singh A, Shah HJ, Dabiri BE, Landman W. Renal Collision Tumor: A Case of Small Cell Lung Cancer Metastasis to Renal Angiomyolipoma. Clin Nucl Med 2024; 49:e202-e205. [PMID: 38389212 DOI: 10.1097/rlu.0000000000005136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
ABSTRACT A 68-year-old woman presented with chest pain and shortness of breath. Imaging revealed a left hilar mass biopsy-proven as small cell cancer. Concurrently, a macroscopic fat-containing renal lesion consistent with an angiomyolipoma was observed. Systemic therapy achieved stability in the lungs and bones, and palliative radiation targeted the left hilum. However, progressive lung disease and brain metastases necessitated stereotactic radiosurgery for brain lesions. Notably, the renal angiomyolipoma exhibited increased soft tissue component and new focal uptake on FDG PET/CT. Biopsy confirmed metastatic small cell lung cancer within the renal lesion. This case highlights a rare occurrence of a renal collision tumor involving small cell cancer and angiomyolipoma.
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Affiliation(s)
- Aparna Singh
- From the Brigham and Women's Hospital, Boston, MA
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Tao B, Zhang H, Zhang G, Liu H, Meng L, Zhu X, Ji X, Jia G, Qi A, Wang C. Management of Nontraumatic Spontaneous Renal Hemorrhage (Wünderlich Syndrome) through Robotic-Assisted Laparoscopic Nephrectomy: A Case Series. Am J Case Rep 2024; 25:e942826. [PMID: 38659203 PMCID: PMC11060495 DOI: 10.12659/ajcr.942826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/14/2024] [Accepted: 02/28/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Wünderlich syndrome (WS) is a rare diagnosis of nontraumatic spontaneous renal hemorrhage into the subcapsular, perirenal, or pararenal spaces. Prompt and effective intervention is necessary for an accurate pathological diagnosis and preservation of life. In the current literature, open surgery is the primary option when conservative treatment fails, but there can be serious trauma and corresponding consequences. Herein, we present 3 cases of Wünderlich syndrome managed by robot-assisted laparoscopic nephrectomy via a retroperitoneal approach. CASE REPORT Patient 1 was a 44-year-old woman with right flank pain for 6 h. Patient 2 was a 53-year-old woman with a history of diabetes who had pain in her right flank pain and nausea for 1 day. Patient 3 was a 45-year-old man with left flank pain for 1 day. All cases of WS were confirmed by CT. All 3 patients were treated with retroperitoneal robot-assisted nephrectomy after conservative treatment failed. Pathological examination confirmed that patient 1 had angiomyolipoma, and patients 2 and 3 had renal clear cell carcinoma. At the 9-month follow-up, renal function was good and no evidence of recurrence or metastasis has been detected. CONCLUSIONS These cases have highlighted the importance of the clinical history and imaging findings in the diagnosis of Wünderlich syndrome, and show that rapid management can be achieved using robot-assisted laparoscopic nephrectomy. However, it is crucial to have a skilled surgical team and adequate preoperative preparation.
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Xing L, Yilun Y, Ji Z, Wei C. Rare Case of Renal Epithelioid Angiomyolipoma With Tumor Thrombus Into the IVC and Right Atrium. Circ Cardiovasc Imaging 2024; 17:e016083. [PMID: 38288625 DOI: 10.1161/circimaging.123.016083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Luo Xing
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital (L.X., Z.J., C.W.), Third Military Medical University (Army Medical University), Chongqing, China
| | - Yi Yilun
- College of Basic Medical Sciences (Y.Y.L), Third Military Medical University (Army Medical University), Chongqing, China
| | - Zheng Ji
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital (L.X., Z.J., C.W.), Third Military Medical University (Army Medical University), Chongqing, China
| | - Chen Wei
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital (L.X., Z.J., C.W.), Third Military Medical University (Army Medical University), Chongqing, China
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Sharma S, Gupta R, Bhalla V, Aggarwal P, Gulati M. Utility of Chemical Shift Imaging and Diffusion-weighted Images/Apparent Diffusion Coefficient Maps as a Tool for Evaluation of Solid Renal Tumors. J Assoc Physicians India 2024; 72:18-23. [PMID: 38736111 DOI: 10.59556/japi.72.0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
OBJECTIVES To study the utility of chemical shift imaging (CSI) and diffusion-weighted images (DWI)/apparent diffusion coefficient (ADC) maps for the evaluation of solid renal tumors. METHODS Magnetic resonance imaging (MRI) has an equivalent application as computerized tomography (CT) in the characterization of renal masses. It offers a radiation-free imaging technique and has a better soft tissue contrast than CT. Also, MRI is favored in patients with chronic kidney disease. MRI is useful when findings on CT are equivocal. The role of DWI in characterizing solid renal lesions as malignant is encouraging, and DWI can be particularly useful when gadolinium is contraindicated. CSI is useful in differentiating angiomyolipoma (AML) from clear cell (cc) renal cell carcinoma (RCC). We did a cross-sectional study on 24 patients with solid renal masses. MRI of the upper abdomen (from the dome of the diaphragm to the iliac crest) will be done on an MRI machine in our department (1.5T, ACHIEVA, Phillips medical system) using the torso coil. RESULT There was no significant association seen in terms of ADC values and histological subtypes (χ2 = 11.222, p = 0.082). In our study, 50% (one out of two) of AML showed a signal drop, whereas 40% of cases (6 out of 15) of ccRCC and 66% (two out of three) of papillary RCC showed a signal drop. CONCLUSION In this article, we concluded CSI, although a useful tool to look for microscopic fat, can't be used as a reliable marker to rule in cc-carcinoma as both AML and papillary cell carcinoma have microscopic fat. Further, no histological classification can be done on the basis of DWI/ADC images.
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Affiliation(s)
- Sahil Sharma
- Senior Resident, Department of Radiodiagnosis, PGI Chandigarh, Chandigarh, India, Corresponding Author
| | - Rekha Gupta
- Associate Professor, Department of Radiodiagnosis, Government Medical College & Hospital, Chandigarh, India
| | - Vidur Bhalla
- Professor, Department of Radiodiagnosis, Government Medical College & Hospital, Chandigarh, India
| | - Phiza Aggarwal
- Assistant Professor, Department of Radiodiagnosis, Government Medical College & Hospital, Chandigarh, India
| | - Mudita Gulati
- Senior Resident, Department of Radiodiagnosis, PGI Chandigarh, Chandigarh, India
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Yang X, Yu X, Zhang S, Zhang Z. Angiomyolipoma with epithelial cysts misdiagnosed as cystic renal carcinoma: A case report. Asian J Surg 2024; 47:1571-1573. [PMID: 38087691 DOI: 10.1016/j.asjsur.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/01/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Xi Yang
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, Liaoning Province, China.
| | - Xinrui Yu
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, Liaoning Province, China.
| | - Siran Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, Liaoning Province, China.
| | - Zhuo Zhang
- Department of Radiation Oncology, the Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, Liaoning Province, China.
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Wang G, Tang H, Xu S, Zhu H, Peng Y, Wang C. Gastrointestinal: Primary pancreatic epithelioid angiomyolipoma. J Gastroenterol Hepatol 2024; 39:416. [PMID: 37940773 DOI: 10.1111/jgh.16390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023]
Affiliation(s)
- G Wang
- Department of Biliary and Pancreatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - H Tang
- Department of Biliary and Pancreatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - S Xu
- Department of Biliary and Pancreatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - H Zhu
- Department of Biliary and Pancreatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Y Peng
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - C Wang
- Department of Biliary and Pancreatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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Dipinto P, Canale V, Minelli R, Capuano MA, Catalano O, Di Pierro GB, Anceschi U, Perdonà S, Tufano A. Qualitative and quantitative characteristics of CEUS for renal cell carcinoma and angiomyolipoma: a narrative review. J Ultrasound 2024; 27:13-20. [PMID: 38238503 PMCID: PMC10908740 DOI: 10.1007/s40477-023-00852-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/23/2023] [Indexed: 03/03/2024] Open
Abstract
Incidental findings of renal masses are increasing. However, a substantial portion of surgically treated renal masses turn out to be benign on histopathological examination. Thus, there is a clear need for improved pre-surgical assessment to minimize unnecessary invasive procedures. The challenge intensifies when distinguishing between renal cell carcinoma (RCC) and angiomyolipoma (AML) in renal lesions smaller than 4 cm with minimal adipose tissue. In such cases, contrast-enhanced ultrasound (CEUS) has emerged as a valuable diagnostic tool, by utilizing both qualitative and quantitative parameters. Quantitative measures offer objectivity, reliability, and reproducibility compared to qualitative parameters, enabling the characterization of RCC subtypes and differentiation from AML. Qualitative features as enhancement pattern, degree, and peak were less helpful in distinguishing triphasic minimal fat AML (TAML) from epithelioid AML (EAML), with the pseudocapsule sign potentially being the only distinguishing qualitative feature. The pseudocapsule sign was more frequently observed in ccRCCs (38.0%) than in AMLs (15.6%). Moreover, it was detected in 40.0% of EAMLs and 34.5% of ccRCCs but not in TAMLs due to similar growth patterns between EAMLs and low-grade ccRCCs. Quantitative measures such as the time-to-peak (TTP) ratio can further enhance diagnostic accuracy and also TOC ratio should be considered, as it was higher in clear cell RCCs (ccRCCs) and in EAMLs compared to TAMLs, indicating behavior similar to ccRCCs. However, CEUS remains an operator-dependent exam.
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Affiliation(s)
- Piervito Dipinto
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162, Rome, Italy
| | - Vittorio Canale
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162, Rome, Italy.
| | - Rocco Minelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, CB, Italy
| | - Marco Alex Capuano
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, CB, Italy
| | - Orlando Catalano
- Radiology Unit, Varelli Diagnostic Institute, 80126, Naples, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144, Rome, Italy
| | | | - Antonio Tufano
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162, Rome, Italy
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Ding JA, Li PC, Yang J, Ni CF. Spontaneous massive hemorrhage caused by giant renal angiomyolipoma in a patient with tuberous sclerosis complex. Asian J Surg 2024; 47:1626-1627. [PMID: 38145913 DOI: 10.1016/j.asjsur.2023.12.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023] Open
Affiliation(s)
- Jia-An Ding
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Pei-Cheng Li
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Jian Yang
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Cai-Fang Ni
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
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Basri NI, Dasrilsyah RA. Spontaneous rupture of renal angiomyolipoma in pregnancy mimicking preterm labour. BMJ Case Rep 2024; 17:e258979. [PMID: 38320830 PMCID: PMC10860011 DOI: 10.1136/bcr-2023-258979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Ruptured renal angiomyolipoma in pregnancy is uncommon. Pregnant women may present with nonspecific symptoms such as flank or abdominal pain, contraction pain and haematuria. A thorough assessment is needed to reach the correct diagnosis. Management varies between conservative measures, radiological intervention or surgery depending on the patient's haemodynamic status and foetal condition. We present a case of a woman in her 30s, gravida 5 para 3+1 at 28 weeks of gestation, who presented with pain. The pain worsened, and she went into hypovolaemic shock. An exploratory laparotomy and emergency caesarean section were done. Retroperitoneal haematoma was found intraoperatively, but the source of bleeding was difficult to determine. An abdominal CT angiogram subsequently revealed an ongoing bleeding from a ruptured angiomyolipoma. An emergency nephrectomy was performed, and the bleeding was secured.
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Affiliation(s)
- Nurul I Basri
- Obstetrics and Gynaecology Department, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rima A Dasrilsyah
- Obstetrics and Gynaecology Department, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Li J, Huang X, Wang L, Wang X, Li Y, Liu X, Ye N, Yang S, Nie F. Role of Contrast-Enhanced Ultrasound With the Enhancement Pattern and Qualitative Analysis for Differentiating Hypovascular Solid Renal Lesions. Ultrasound Med Biol 2024; 50:295-303. [PMID: 37996360 DOI: 10.1016/j.ultrasmedbio.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/29/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE The aim of the work described here was to explore the clinical value of contrast-enhanced ultrasound (CEUS) with the enhancement pattern and qualitative analysis in distinguishing different types of hypovascular solid renal lesions. METHODS A total of 140 patients with 140 renal tumors (all diagnosed by pathology), which manifested hypo-enhancement on CEUS, were included in this study. We compared conventional ultrasound (US) and CEUS features in five common hypovascular renal tumors, including renal angiomyolipoma (RAML), clear cell renal cell carcinoma (ccRCC), renal pelvic urothelial carcinoma (RPUC), papillary renal cell carcinoma (pRCC) and chromophobe renal cell carcinoma (chRCC). The diagnostic value of conventional US and qualitative parameters of CEUS for differentiating hypovascular solid renal lesions were evaluated. RESULTS The mean age of patients with a benign renal lesion was younger than that of patients with a malignant renal lesion (p < 0.05). Echogenicity and qualitative parameters such as wash-out, perfusion defects and perilesional rim-like enhancement (PRE) in the two groups differed significantly (all p values <0.05). Benign renal lesions exhibited mainly slow wash-out, whereas malignant renal lesions exhibited predominantly fast wash-out on CEUS (p < 0.05). There were significant differences in echogenicity, such as between RAML and ccRCC, between RAML and RPUC and between RAML and pRCC (all p values <0.05). The rates of appearance of perfusion defect in ccRCC (48%, 13/27) and pRCC (53%, 10/19) were significantly higher than the rate in RAML (14%, 6/43) (p < 0.05). The rates of appearance of PRE in ccRCC (15%, 4/27), pRCC (26%, 5/19) and chRCC (24%,4/17) were significantly higher than the rate in RAML (9%, 4/43) (p < 0.05). CONCLUSION CEUS with the enhancement pattern and qualitative analysis may be helpful in distinguishing malignant from benign hypovascular renal lesions.
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Affiliation(s)
- Jing Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Xiao Huang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Lan Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Xiaofeng Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Yan Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Xuehui Liu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Na Ye
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Shaoqing Yang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China.
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Liao Z, Li J, Zhao Y, Wang Z, Wang X, Qiu D, Zhang Y. The association between computed tomography attenuation value of renal angiomyolipoma associated with tuberous sclerosis complex and response to everolimus. World J Urol 2024; 42:10. [PMID: 38183428 DOI: 10.1007/s00345-023-04708-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/30/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The response to everolimus in patients with renal angiomyolipoma associated with tuberous sclerosis complex (TSC-RAML) varies among individuals. This study aims to identify potential factors associated with the response to everolimus. METHOD We retrospectively examined data encompassing age, gender, tumor size, computed tomography attenuation value (CT value), CT enhancement, and tumor reduction rate in patients with TSC-RAML undergoing everolimus in two previously registered clinical trials. RESULT A total of 33 participants (29.33 ± 6.63 years old, 20 females) were included. The correlation analysis conducted separately for tumors located in the left and right kidneys revealed significant negative correlations (P < 0.05) between tumor reduction rate and age, as well as tumor size. While significant positive correlations (P < 0.05) were observed between tumor reduction rate and unenhanced CT value as well as CT enhancement. Nonetheless, based on multiple linear regression analysis, unenhanced CT value emerged as the sole-independent predictor of tumor reduction rate among age, gender, tumor size, unenhanced CT value and CT enhancement for both left (coefficient = 0.00319, P < 0.0001) and right kidneys (coefficient = 0.00315, P = 0.0104). Notable reductions were observed in unenhanced CT value (- 3.81 vs - 24.70HU, P < 0.0001) and CT enhancement (48.16 vs 33.56HU, P < 0.0001) following a 3-month administration of everolimus. The decline in both unenhanced CT value and tumor size predominantly occurred within the initial 3 months, subsequently maintaining a relatively stable level throughout the treatment. CONCLUSION The unenhanced CT value of TSC-RAML showed an independent correlation with the response to everolimus, suggesting its potential as a predictor of everolimus efficacy in patients with TSC-RAML.
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Affiliation(s)
- Zhangcheng Liao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jiao Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhan Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xu Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dongxu Qiu
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Almazedi B, Stubbs C. Renal angiomyolipoma: from imaging to intervention. Clin Radiol 2024; 79:25-32. [PMID: 37925365 DOI: 10.1016/j.crad.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/24/2023] [Accepted: 09/29/2023] [Indexed: 11/06/2023]
Abstract
A high volume of cross-sectional imaging has created a window of opportunity for radiologists to identify renal angiomyolipomas (AMLs). The purpose of this review is to help the reader recognise the spectrum of renal AML appearances using different imaging methods and to gain an understanding of the classic and atypical features for appropriate lesion characterisation. Risk factors for AML growth and rupture will be highlighted. An overview of the imaging features of acute AML rupture will be provided, principally relating to computed tomography (CT) assessment. A series of cases will be presented, including a case of peripartum renal AML rupture during Caesarean section leading to diagnostic dilemma. The indications for intervention and available treatment options will be considered: medical therapy, surgery, and interventional radiology (IR) techniques including their pros and cons. Emergency interventional radiology management with selective transarterial embolisation will be presented and analysed in relation to technique, angiographic appearances (pre and post embolisation) and associated complications.
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Affiliation(s)
- B Almazedi
- Department of Radiology, York Teaching Hospital, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
| | - C Stubbs
- Department of Radiology, York Teaching Hospital, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
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14
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Şal O, Göksoy B, Al Hajeh A, Ercan LD, Büyük M, Serin KR. Surgical management of liver angiomyolipoma: eighteen years of experience from a single-reference center. HPB (Oxford) 2024; 26:156-159. [PMID: 37852918 DOI: 10.1016/j.hpb.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/08/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Oğuzhan Şal
- HPB Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Beslen Göksoy
- HPB Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Anas Al Hajeh
- HPB Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Leman Damla Ercan
- Department of Emergency Surgery and Trauma, Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Melek Büyük
- Department of Pathology, Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Kürşat Rahmi Serin
- HPB Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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15
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Alves MG, André S, Nogueira F. Prevascular mediastinal angyomiolipoma. A case report. Pulmonology 2024; 30:93-95. [PMID: 37684105 DOI: 10.1016/j.pulmoe.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 09/10/2023] Open
Affiliation(s)
- M G Alves
- Serviço de Pneumologia, Centro Hospitalar de Lisboa Ocidental, EPE, Lisboa, Portugal.
| | - S André
- Serviço de Pneumologia, Centro Hospitalar de Lisboa Ocidental, EPE, Lisboa, Portugal
| | - F Nogueira
- Serviço de Pneumologia, Centro Hospitalar de Lisboa Ocidental, EPE, Lisboa, Portugal
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Yao H, Tian L, Liu X, Li S, Chen Y, Cao J, Zhang Z, Chen Z, Feng Z, Xu Q, Zhu J, Wang Y, Guo Y, Chen W, Li C, Li P, Wang H, Luo J. Development and external validation of the multichannel deep learning model based on unenhanced CT for differentiating fat-poor angiomyolipoma from renal cell carcinoma: a two-center retrospective study. J Cancer Res Clin Oncol 2023; 149:15827-15838. [PMID: 37672075 PMCID: PMC10620299 DOI: 10.1007/s00432-023-05339-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE There are undetectable levels of fat in fat-poor angiomyolipoma. Thus, it is often misdiagnosed as renal cell carcinoma. We aimed to develop and evaluate a multichannel deep learning model for differentiating fat-poor angiomyolipoma (fp-AML) from renal cell carcinoma (RCC). METHODS This two-center retrospective study included 320 patients from the First Affiliated Hospital of Sun Yat-Sen University (FAHSYSU) and 132 patients from the Sun Yat-Sen University Cancer Center (SYSUCC). Data from patients at FAHSYSU were divided into a development dataset (n = 267) and a hold-out dataset (n = 53). The development dataset was used to obtain the optimal combination of CT modality and input channel. The hold-out dataset and SYSUCC dataset were used for independent internal and external validation, respectively. RESULTS In the development phase, models trained on unenhanced CT images performed significantly better than those trained on enhanced CT images based on the fivefold cross-validation. The best patient-level performance, with an average area under the receiver operating characteristic curve (AUC) of 0.951 ± 0.026 (mean ± SD), was achieved using the "unenhanced CT and 7-channel" model, which was finally selected as the optimal model. In the independent internal and external validation, AUCs of 0.966 (95% CI 0.919-1.000) and 0.898 (95% CI 0.824-0.972), respectively, were obtained using the optimal model. In addition, the performance of this model was better on large tumors (≥ 40 mm) in both internal and external validation. CONCLUSION The promising results suggest that our multichannel deep learning classifier based on unenhanced whole-tumor CT images is a highly useful tool for differentiating fp-AML from RCC.
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Affiliation(s)
- Haohua Yao
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Li Tian
- Department of Medical Imaging, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xi Liu
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shurong Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuhang Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiazheng Cao
- Department of Urology, Jiangmen Central Hospital, Jiangmen, China
| | - Zhiling Zhang
- Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhenhua Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zihao Feng
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Quanhui Xu
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiangquan Zhu
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yinghan Wang
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Caixia Li
- School of Mathematics and Computational Science, Sun Yat-Sen University, Guangzhou, China
| | - Peixing Li
- School of Mathematics and Computational Science, Sun Yat-Sen University, Guangzhou, China
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Junhang Luo
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Bai D, Liang Y, Liu W, Liu Y, Wang Z. A case report of anterior mediastinal angiomyolipoma that invaded the left thoracic cavity. Medicine (Baltimore) 2023; 102:e35786. [PMID: 37904415 PMCID: PMC10615488 DOI: 10.1097/md.0000000000035786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/04/2023] [Indexed: 11/01/2023] Open
Abstract
RATIONALE Angiomyolipoma is a mesenchymal tumor composed of blood vessels, smooth muscle, and mature adipose tissue. It is most commonly found in the kidney, and is rare outside the kidney, especially in the mediastinum. Only about 12 cases have been reported worldwide so far. PATIENT CONCERNS We report a young female patient who had been found with a left thoracic mass for 19 years. In the past 19 years, the patient had no chest pain, dyspnea and other symptoms, but this time she visited the doctor because of cough, and there were no other clinical signs. DIAGNOSES The patient underwent computed tomography plain scan and enhanced scan after admission with imaging manifestations of a mixed density mass in the left chest cavity, calcification and fat density in the inside, and tortuous blood vessels after enhancement. Combined with imaging, the diagnosis was teratoma, not excluding hamartoma. INTERVENTIONS The patient underwent a central open thoracic giant mass resection. OUTCOMES The postoperative pathology confirmed that it was angiomyolipoma originating from anterior mediastinum invasion of the left chest cavity, and no clear recurrence was seen after 1 year of postoperative follow-up. LESSONS Angiomyolipomas in the mediastinum are rare, especially those that invade the thorax. This article describes the clinical, imaging and pathological features of the patient in detail, which improves the understanding of the disease of clinical and imaging doctors, and provides a basis for the differential diagnosis of mediastinal lesions.
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Affiliation(s)
- Dong Bai
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Yuanzi Liang
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Wenting Liu
- Department of Pathology, Aerospace Center Hospital, Beijing, China
| | - Yanhan Liu
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Zhiqun Wang
- Department of Radiology, Aerospace Center Hospital, Beijing, China
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19
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Han Z, Xue X, Wang J, Lu D. Tuberous sclerosis complex associated lymphangioleiomyomatosis. QJM 2023; 116:873-874. [PMID: 37286375 PMCID: PMC10593382 DOI: 10.1093/qjmed/hcad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Indexed: 06/09/2023] Open
Affiliation(s)
- Z Han
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - X Xue
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - J Wang
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - D Lu
- Department of Respiratory, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
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20
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McQueen S, Combes A, Benz D. Renal angiomyolipoma: Beyond size criteria for predicting rupture. J Med Imaging Radiat Oncol 2023; 67:619-624. [PMID: 37596942 DOI: 10.1111/1754-9485.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/25/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Renal angiomyolipomas (AMLs) are vascular tumours that while histologically benign, carry a risk of rupture and potentially life-threatening haemorrhage. Selective arterial embolisation (SAE) has been demonstrated as effective treatment; however, given most tumours are asymptomatic, the challenge facing the radiologist is selection of which AML should undergo treatment. This study considers presence and size of intratumoural aneurysm, to advance the readers treatment decision-making beyond historical size criteria. METHODS Retrospective cohort analysis of all SAE-treated AML at a quaternary-level institution in the last 10 years was completed independently by two radiologists. Computerised tomography (CT) and angiographic imaging were reviewed to evaluate tumour size, presence of intratumoural aneurysm and aneurysm size. Univariant and multivariant statistical analyses were used to identify predictors of spontaneous rupture and haemorrhage. RESULTS Twenty-seven renal AML underwent SAE. Five tumours had presented with haemorrhage. Twenty-two were asymptomatic or without CT/angiographic detectable haemorrhage. There was no statistically significant size difference between ruptured (mean 7.8 cm, range 6.1-12.0 cm) and unruptured AML (7.5 cm, 3.3-21.7 cm) in the study population. Eighty percent of ruptured AML and 27% of unruptured AML contained at least one intratumoural aneurysm (P-value < 0.05). Mean aneurysm size in ruptured AMLs was 5.4 mm, versus 4.6 mm among unruptured AML (P-value > 0.05). CONCLUSION The presence of intratumoural aneurysm is a useful predictor for AMLs that are at risk of spontaneous rupture and haemorrhage. Intratumoural aneurysm should therefore be considered when selecting patients to undergo SAE.
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Affiliation(s)
- Simon McQueen
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Alexander Combes
- Department of Urology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - David Benz
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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21
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Isharwal S, Tandon YK. Active surveillance for large renal angiomyolipoma. Am J Med Sci 2023; 366:e51-e52. [PMID: 37156460 DOI: 10.1016/j.amjms.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/17/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Sumit Isharwal
- Department of Urology, University of Virginia, Charlottesville, VA 22908-0422, USA.
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Park S, Kim MJ, Han K, Park JH, Han DH, Park YN, Kim J, Rhee H. Differentiation between hepatic angiomyolipoma and hepatocellular carcinoma in individuals who are not at-risk for hepatocellular carcinoma. Eur J Radiol 2023; 166:110957. [PMID: 37451136 DOI: 10.1016/j.ejrad.2023.110957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To develop a practical methodfor differentiating hepatocellular carcinoma (HCC) from angiomyolipoma (AML) in individuals who are not at-risk for HCC. METHOD We retrospectively enrolled consecutive patients who underwent gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) and pathological confirmation between January 2008 and April 2022. Patients who underwent prior treatment, those with multiple lesions, or those at-risk for HCC were excluded. The training cohort included patients with pathological confirmation between 2008 and 2019, whereas the validation cohort included the remaining cases. Independent reviews of the MRI were performed by two reviewers. Using the clinical and MRI findings, we developed AML-HCC score using Firth's logistic regression in the training cohort, and the diagnostic performance was validated in the validation cohort. RESULTS Of the 206 patients, 156 were assigned to the training cohort (25 and 131 patients with AML and HCC, respectively) and 50 were assigned to the validation cohort (4 and 46 patients with AML and HCC, respectively). The AML-HCC score was defined as the sum of female (score 1), early draining vein (score 2), T2 homogeneity (score 1), necrosis or severe ischaemia (score -2), and HBP hyperintensity to spleen (score -1). When the AML-HCC score was ≥1, the sensitivity and specificity were 80% and 95% for the training cohort and 100% and 80% for the validation cohort, respectively. CONCLUSIONS We developed and validated an AML-HCC score to differentiate between AML and HCC in individuals who are not at-risk for HCC, and our model demonstrated good diagnostic performance.
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Affiliation(s)
- Sungtae Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
| | - Jae Hyon Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dai Hoon Han
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Nyun Park
- Department of Pathology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaehyo Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyungjin Rhee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea.
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23
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Chen AF, McGahan JP, Wilson MD, Larson MC, Vij A, Kwong A. Are There Ultrasound Features to Distinguish Small (<3 cm) Peripheral Renal Angiomyolipomas From Renal Cell Carcinomas? J Ultrasound Med 2023; 42:2083-2094. [PMID: 36988571 DOI: 10.1002/jum.16229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/22/2023] [Accepted: 03/19/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Small echogenic renal masses are usually angiomyolipomas (AMLs), but some renal cell carcinomas (RCCs) can be echogenic and confused with an AML. OBJECTIVES This is a study to evaluate any distinguishing demographic and sonographic features of small (<3 cm) peripheral AMLs versus peripheral RCCs. METHODS This is a HIPAA-compliant retrospective review of the demographics and ultrasound features of peripheral renal AMLs compared with a group of peripheral RCCs. All AMLs had confirmation of macroscopic fat as noted on thin-cut CT or fat-saturation MRI sequence images. All RCCs were pathologically proven. Statistical analysis was used to compare findings in the two groups. RESULTS There were a total of 52 patients with 56 AMLs, compared with 42 patients with 42 RCCs. There were 42 females in the AML group versus 10 females in the RCC group (P < .0001). The AML diameters (15.7 mm × 12.0 mm) were statistically significantly smaller (Plargest = .0085, Psmallest < .001) than the diameters of the RCCs (19.9 mm × 18.5 mm). Ultrasound features found to be statistically different between the two groups were the ratio of the largest dimension to the smallest dimension (P < .001), a lobulated versus smooth margin of the AML (26 vs 30) compared with the RCC group (3 vs 39) (P = .0012), and an "unusual" versus a round shape (P < .001) of the AML group (45 vs 11) compared with the RCC group (9 vs 33). In the multivariable model, the patient sex, margin, and mass shape were predictive of AML, with an area under the receiver operating characteristic curve of 0.92. CONCLUSION For a small (<3 cm) peripheral echogenic mass in a female patient, a lobulated lesion with an unusual shape is highly predictive of being an AML.
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Affiliation(s)
- Anthony F Chen
- Department of Radiology, University of California, Davis School of Medicine, Sacramento, California, USA
| | - John P McGahan
- Department of Radiology, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Machelle D Wilson
- Department of Public Health Sciences, Division of Biostatistics, UC Davis, Sacramento, California, USA
| | - Michael C Larson
- Department of Radiology, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Arjun Vij
- Department of Radiology, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Austin Kwong
- Department of Radiology, University of California, Davis School of Medicine, Sacramento, California, USA
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24
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Sokooshi H, Zhang X, Kuwatsuru Y, Okada S, Kato H, Kuwatsuru R. Serum lactate dehydrogenase concentration after transcatheter renal artery embolization correlates with reduction in renal angiomyolipoma volume. Acta Radiol 2023; 64:2479-2484. [PMID: 37246404 DOI: 10.1177/02841851231177391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The extent of renal angiomyolipoma (AML) volume reduction after renal transcatheter arterial embolization (TAE) varies between patients, with no predictive measure available. PURPOSE To determine whether the serum lactate dehydrogenase (LDH) concentration shortly after TAE correlates with the extent of tumor shrinkage. MATERIAL AND METHODS In a cohort of 36 patients undergoing prophylactic renal TAE for unruptured renal AML, we retrospectively acquired data from patient medical records, including serum LDH before and within 7 days after TAE and the tumor volume before and 12-36 months after TAE. The relationship between the serum level of LDH and reduction in tumor volume was evaluated using Spearman correlation analysis. RESULTS The median LDH concentration was significantly higher after TAE than before (909.0 U/L vs. 186.5 U/L). This early post-TAE serum LDH level and LDH index (post-TAE LDH / pre-TAE LDH) correlated significantly and positively with the absolute decrease in tumor volume (both P < 0.0001). We observed no significant correlation between the relative tumor volume reduction and serum LDH level or LDH index. CONCLUSION Serum LDH elevation occurs shortly after TAE and correlates with the extent of absolute decrease in AML volume at 12-36 months after TAE. Further large-scale studies are warranted to confirm the predictive role of post-TAE serum LDH level and LDH index in tumor shrinkage in patients with unruptured renal AML.
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Affiliation(s)
- Hideaki Sokooshi
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Xixi Zhang
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yoshiki Kuwatsuru
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Shingo Okada
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hitomi Kato
- Department of Radiology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
- Department of Radiology, School of Medicine, Juntendo University, Tokyo, Japan
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25
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Zhuang J, Wu Q, Yang X, Cai L, Li K, Hua H, Bao M, Yu R, Liu P, Li P, Cao Q, Lu Q. Renal Lipoma-Like Angiomyolipoma of Tumour Thrombus Extending to the Confluence of Inferior Vena Cava with Right Atrium: A Rare Case Report and Literature Review. Urol Int 2023; 107:742-746. [PMID: 36889288 DOI: 10.1159/000529412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/22/2023] [Indexed: 03/10/2023]
Abstract
Angiomyolipoma (AML) complicated with tumour thrombus extending to the confluence of inferior vena cava (IVC) with right atrium is rarely observed. We report a female AML patient admitted to our centre on January 21, 2020, with complication of tumour thrombus extending to the confluence of IVC with right atrium and had no sign of difficult breathing. She underwent whole-abdominal enhanced CT for abdominal pain and was diagnosed with a possible renal AML with tumour thrombus. Open radical nephrectomy and thrombectomy of vena cava were performed. Intraoperative transoesophageal echocardiography indicated that the tumour thrombus has reached the confluence of IVC with right atrium. The operation took 255 min with an intraoperative haemorrhage of 800mL. The patient was discharged 7 days after surgery. Pathology revealed lipoma-like AML. Immunohistochemistry showed vimentin (+), EMA (-), HMB45 (+), S-100 (-), SMA (+), TFE-3 (-), melan A (+). After 2 years of follow-up, we found that the patient showed full recovery and had no recurrence. Therefore, lipoma-like AML should also be followed closely for recurrence and metastasis. When AML involves IVC tumour thrombus, open thrombectomy and radical nephrectomy are safe and effective methods.
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MESH Headings
- Humans
- Female
- Vena Cava, Inferior/diagnostic imaging
- Vena Cava, Inferior/surgery
- Vena Cava, Inferior/pathology
- Carcinoma, Renal Cell/surgery
- Angiomyolipoma/complications
- Angiomyolipoma/diagnostic imaging
- Angiomyolipoma/surgery
- Kidney Neoplasms/complications
- Kidney Neoplasms/diagnostic imaging
- Kidney Neoplasms/surgery
- Thrombosis/diagnostic imaging
- Thrombosis/surgery
- Thrombosis/complications
- Venous Thrombosis/diagnostic imaging
- Venous Thrombosis/etiology
- Venous Thrombosis/surgery
- Thrombectomy/adverse effects
- Nephrectomy/methods
- Lipoma/complications
- Lipoma/diagnostic imaging
- Lipoma/surgery
- Heart Atria
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/surgery
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Affiliation(s)
- Juntao Zhuang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qikai Wu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao Yang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingkai Cai
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Li
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongjin Hua
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meiling Bao
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruixi Yu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Peikun Liu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengchao Li
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Cao
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Keskin Z, Keskin S. Shear wave elastography in the characterization of renal cell carcinoma and angiomyolipoma. Acta Radiol 2023; 64:1272-1279. [PMID: 35938612 DOI: 10.1177/02841851221118473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Detection and characterization of renal lesions are common in daily clinical practice. PURPOSE To investigate the effectiveness of shear wave elastography (SWE), a novel radiological examination technique, in the characterization of renal masses. MATERIAL AND METHODS The study included a total of 68 patients (33 men, 35 women; mean age = 57.71 ± 12.08 years; age range = 19-83 years) who underwent SWE. SWE measurements were obtained at depths of 2-8 cm from the probe surface in two different positions from an analysis window of approximately 0.5 × 1.0 cm on ultrasound. The cutoff SWE was calculated for the differentiation of renal cell carcinoma (RCC) and angiomyolipoma (AML) by receiver operating characteristic (ROC) analysis. When the result was statistically significant, the sensitivity, specificity, accuracy, and positive and negative predictive values of the test were calculated. RESULTS Mass-to-parenchyma SWE ratios of RCCs were significantly higher than those of AMLs (P = 0.003). In ROC curve analysis, the SWE cutoff was 1.215 m/s to differentiate RCCs from AMLs. The area under the ROC curve was calculated as 0.74 (95% CI = 0.610-0.871, sensitivity = 70.7%, specificity = 70.6%, positive predictive value = 87.8%, negative predictive value = 44.4%). CONCLUSION The SWE technique is increasingly used and may be useful in distinguishing RCC and AML lesions, and especially clear cell and non-clear cell RCCs.
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Affiliation(s)
- Zeynep Keskin
- Department of Radiology, 591703Konya City Hospital, Konya, Turkey
| | - Suat Keskin
- Department of Radiology, Karatay School of Medicine, Medicana Hospital, Konya, Turkey
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Zhang L, Sun K, Shi L, Qiu J, Wang X, Wang S. Ultrasound Image-Based Deep Features and Radiomics for the Discrimination of Small Fat-Poor Angiomyolipoma and Small Renal Cell Carcinoma. Ultrasound Med Biol 2023; 49:560-568. [PMID: 36376157 DOI: 10.1016/j.ultrasmedbio.2022.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/20/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
We evaluated the performance of ultrasound image-based deep features and radiomics for differentiating small fat-poor angiomyolipoma (sfp-AML) from small renal cell carcinoma (SRCC). This retrospective study included 194 patients with pathologically proven small renal masses (diameter ≤4 cm; 67 in the sfp-AML group and 127 in the SRCC group). We obtained 206 and 364 images from the sfp-AML and SRCC groups with experienced radiologist identification, respectively. We extracted 4024 deep features from the autoencoder neural network and 1497 radiomics features from the Pyradiomics toolbox; the latter included first-order, shape, high-order, Laplacian of Gaussian and Wavelet features. All subjects were allocated to the training and testing sets with a ratio of 3:1 using stratified sampling. The least absolute shrinkage and selection operator (LASSO) regression model was applied to select the most diagnostic features. Support vector machine (SVM) was adopted as the discriminative classifier. An optimal feature subset including 45 deep and 7 radiomics features was screened by the LASSO model. The SVM classifier achieved good performance in discriminating between sfp-AMLs and SRCCs, with areas under the curve (AUCs) of 0.96 and 0.85 in the training and testing sets, respectively. The classifier built using deep and radiomics features can accurately differentiate sfp-AMLs from SRCCs on ultrasound imaging.
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Affiliation(s)
- Li Zhang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Kui Sun
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Liting Shi
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Jianfeng Qiu
- Medical Science and Technology Innovation Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shumin Wang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China.
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Jin L, Chun HJ, Oh JS, Choi BG, Lee HG, Kim IJ. Selective arterial embolization of renal angiomyolipoma: comparing ethanol-lipiodol emulsion and polyvinyl alcohol particles as embolic agents. Diagn Interv Radiol 2023; 29:170-174. [PMID: 36960593 PMCID: PMC10679591 DOI: 10.5152/dir.2022.21625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/18/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE To examine the effectiveness and safety of two embolic agents, an ethanol-lipiodol emulsion and polyvinyl alcohol (PVA) particles, for selective arterial embolization (SAE) of renal angiomyolipoma (AML). METHODS Retrospectively, we reviewed the medical records and imaging data of renal AML patients who received SAE in our hospitals between July 2007 and January 2018. Among those eligible for analysis were patients with complete medical information, preoperative and postoperative contrast-enhanced computed tomography scans, and follow-up data. An ethanol-lipiodol emulsion was used to embolize 15 AMLs, and PVA particles were used to embolize 16 AMLs. We compared the tumor responses and adverse events between the two embolization-agent groups. RESULTS After embolization, no significant differences were observed in the shrinkage rates: 34.2% ± 3.4% for the ethanol-lipiodol emulsion group and 26.3% ± 3.0% for the PVA particles group (P = 0.090). Minor post-embolization complications were also similar between the groups, and there were no severe adverse events. The length of hospital stay after SAE was 2.5 ± 0.5 days for the ethanol-lipiodol emulsion group and 1.9 ± 0.5 days for the PVA particles group and was not significantly different (P = 0.425). CONCLUSION The results showed that SAE with ethanol-lipiodol emulsion or PVA particles was safe and efficient in decreasing tumor size and controlling renal AML hemorrhage.
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Affiliation(s)
- Long Jin
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
- Department of Medicine Radiology, Graduate School of Medical Science, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Jong Chun
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
| | - Jung Suk Oh
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
| | - Byung Gil Choi
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
| | - Hae Giu Lee
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
| | - Il Jung Kim
- Department of Radiology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do, Republic of Korea
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29
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Liu H, Xiao E. Renal angiomyolipoma with inferior vena cava and right atrial embolism: A case report and literature review. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2022; 47:1763-1768. [PMID: 36748389 PMCID: PMC10930266 DOI: 10.11817/j.issn.1672-7347.2022.220044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Indexed: 02/08/2023]
Abstract
Renal angiomyolipoma (AML) with renal vein, inferior vena cava (IVC), and right atrial embolism is a rare solid tumor, whose etiology and pathogenesis are still unclear. Moreover, it is often misdiagnosed. One patient with renal AML complicated with renal vein, IVC, and right atrial embolism was admitted to the Second Xiangya Hospital of Central South University, who was a 35-year-old female, without any previous medical history, presented with right low back pain for more than 3 years. Computed tomography (CT) scan showed irregular lobulated fatty density mass in the right kidney, renal vein, IVC, and right atrium. The contrast-enhanced scan showed no enhancement of fat components at each phase and mild enhancement of solid components. Radical resection of the right kidney and removal of tumor thrombus were performed, and there was no recurrence 1 year after the operation. It is rare for renal AML to grow along the renal vein, IVC, and extend to the right atrium. Imaging examination is extremely important, and the CT findings of this case are characteristic, but the diagnosis eventually depends on pathological and immunohistochemical examinations.
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Affiliation(s)
- Huan Liu
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Enhua Xiao
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410011, China.
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30
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Ayoub K, Rakab A, Shibani M, Bohsas H, Alibrahim H, Swed S, Rais MA, Sawaf B, Mahli N. An asymptomatic giant extra-renal retroperitoneal angiomyolipoma: Case report. Medicine (Baltimore) 2022; 101:e31869. [PMID: 36626540 PMCID: PMC9750637 DOI: 10.1097/md.0000000000031869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Angiomyolipoma is a benign mesenchymal tumor that consists of adipose tissue, muscle cells and blood vessel. Renal angiomyolipomas represent almost one percent of all renal tumors. PATIENT CONCERNS We reported a case of a 42-year-old woman complaining of mild abdominal pain with no other symptoms and no remarkable medical history. DIAGNOSIS Clinical examination was inconclusive and revealed a large, smooth, non-tender, and immovable mass in the right abdomen. Ultrasound examination confirmed the existence of a large, homogeneous, hyperechoic tissue mass. Abdominal multi-slice computed tomography (CT) scans also confirmed the presence of a well-rounded mass in the right abdomen. The histopathology tests confirmed the diagnosis of a large retroperitoneal mass. INTERVENTIONS The patient underwent a traditional laparotomy without complications to remove the tumor. OUTCOMES The open surgery was the best option, and the patient's condition improved due to the following-up. LESSONS Retroperitoneal extra-renal angiomyolipomas are extremely rare, and in this case, we document a case of retroperitoneal angiomyolipoma manifested with only mild abdominal pain in Syrian women.
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Affiliation(s)
- Kusay Ayoub
- Department of Surgery, Aleppo University Hospital, Aleppo, Syria
| | - Amine Rakab
- Medicine, Weill Cornell Medical College, Qatar
| | - Mosa Shibani
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | | | | | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
- * Correspondence: Sarya Swed, Faculty of Medicine, Aleppo University, Aleppo, Syria (e-mail: )
| | | | - Bisher Sawaf
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Nihad Mahli
- Department of surgery, Aleppo University Hospital, Aleppo, Syria
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31
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Ahmadov J, Çay F, Eldem G, Akdoğan B, Bilen CY, Aki FT, Çil BE, Ergen A, Peynircioğlu B. Endovascular management of renal angiomyolipomas: Do coils have a benefit in terms of clinical success rates? Diagn Interv Radiol 2022; 28:597-602. [PMID: 36550760 PMCID: PMC9885714 DOI: 10.5152/dir.2022.201044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE This study evaluated single center results of endovascular treatment in renal angiomyolipoma (AML) to determine whether there is clinical relevance of adding proximal coil embolization to distal particle embolization in terms of safety, efficacy and retreatment rates. METHODS A retrospective analysis was performed to evaluate patients undergoing transarterial embolization for renal AMLs from January 2007 to October 2020. Parameters regarding patient and tumor characteristics, embolization technique, treatment outcome and complications were recorded. Patients were divided into two groups as A (only particle group) and B (particle + coil group) based on the type of embolic agent used for treatment. Comparative analysis was performed between the two groups in terms of tumor size reduction, retreatment and complication rates. RESULT Forty-two patients (37 (88.1%) female, 5 (11.9%) male) harboring 48 AMLs were included in the study. The mean age was 43.46 (range 20 to 78). The technical success rate was 95.8% (46 of 48 procedures). The mean size reduction was 1.94±1 cm (p < 0.001) after treatments however, no significant difference was seen between groups in terms of tumor size reduction. Retreatment rates were 3.1% (1 of 32 cases) in group A and 14.3% (2 of 14 cases) in group B (p = 0.21). No significant difference was found between groups in terms of bleeding and complication rates during the perioperative period. Mean follow-up duration was 26.48±25.71 (range from 2 to 102) months. CONCLUSION In this study, no clear supplementary benefit was observed in terms of safety, and efficacy with the adjunction of coils to distal particle embolization in the management of AMLs.
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Affiliation(s)
- Javid Ahmadov
- Department of Radiology, Hacettepe University Hospital, İstanbul, Turkey
| | - Ferdi Çay
- Department of Radiology, Hacettepe University Hospital, İstanbul, Turkey
| | - Gonca Eldem
- Department of Radiology, Hacettepe University Hospital, İstanbul, Turkey
| | - Bülent Akdoğan
- Department of Urolog, Hacettepe University Hospital, İstanbul, Turkey
| | - Cenk Yücel Bilen
- Department of Urolog, Hacettepe University Hospital, İstanbul, Turkey
| | - Fazıl Tuncay Aki
- Department of Urolog, Hacettepe University Hospital, İstanbul, Turkey
| | - Barbaros Erhan Çil
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ali Ergen
- Department of Urolog, Hacettepe University Hospital, İstanbul, Turkey
| | - Bora Peynircioğlu
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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32
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Ji J, Zhang Y, Yang C. Hepatic caudate epithelioid angiomyolipoma mimics hydatid cyst. Asian J Surg 2022; 46:1700-1701. [PMID: 36270941 DOI: 10.1016/j.asjsur.2022.09.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Junchong Ji
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yu Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China; Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province & Organ Transplantation Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Chong Yang
- Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province & Organ Transplantation Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China.
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Kwong A, Mitchell A, Wang D, McGahan JP. Etiology of Small Echogenic Renal Masses. J Ultrasound Med 2022; 41:2567-2575. [PMID: 35043978 DOI: 10.1002/jum.15946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/09/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES There has been controversy on how frequently small echogenic masses are angiomyolipomas (AMLs) versus renal cell carcinoma (RCC) and how best to manage these echogenic masses. We performed this study to determine the etiologies of echogenic renal masses and compare them with prior publications to reach possible management decisions. METHODS This is a retrospective chart review of all consecutive renal ultrasound examinations performed at our institution between January 2015 and December 2016, with an ultrasound report finding containing the wording "echogenic" and "mass." This yielded 6462 total examinations. A total of 107 echogenic lesions met inclusion and exclusion criteria with correlative computed tomography, pathology, or long-term (>5 years) follow-up ultrasound. These lesions were stratified into those that were ≤2 cm and those that were >2 cm. RESULTS Almost all masses were benign, with the majority (79/107) being AMLs (73.8%); 64 of the 79 (81%) of the AMLs were in female patients. Two of the 107 masses were RCCs, and 1 mass was an oncocytic neoplasm. There were 77 of the masses that were ≤2 cm and these masses were benign except for one lesion of an oncocytic neoplasm. There were 30 of the 107 masses >2 cm, with 2 of the 30 (6.7%) being RCCs. CONCLUSIONS Incidental echogenic renal masses are most commonly AMLs. However, some masses may be RCCs. In comparing our results with the prior literature, we feel that small echogenic renal masses ≤1 cm usually require no further evaluation, while masses greater than that size require other imaging.
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Affiliation(s)
- Austin Kwong
- Department of Radiology, UC Davis Health SOM, Sacramento, California, USA
| | - Ana Mitchell
- Department of Radiology, UC Davis Health SOM, Sacramento, California, USA
| | - Danielle Wang
- Department of Radiology, UC Davis Health SOM, Sacramento, California, USA
| | - John P McGahan
- Department of Radiology, UC Davis Health SOM, Sacramento, California, USA
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Sapadin AJ, Girzadas D, Chhabra D, Ahmed T. Ruptured angiomyolipoma, a novel entity for emergency physicians in the differential diagnosis of haemorrhagic shock in a female patient of reproductive age. BMJ Case Rep 2022; 15:15/8/e248626. [PMID: 35944938 PMCID: PMC9367167 DOI: 10.1136/bcr-2021-248626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A woman in her 30s presented to the emergency department with acute onset, progressively worsening left-sided abdominal pain after exercise. She was found to be hypotensive and diaphoretic, with free intraperitoneal fluid detected on bedside point-of-care ultrasound. Resuscitation was initiated, a presumptive diagnosis of ruptured ectopic pregnancy was made, and obstetrics and gynaecology were consulted. Point-of-care urine pregnancy testing, however, was negative, and subsequent CT angiography of the patient’s abdomen revealed an angiomyolipoma (AML) with active haemorrhage. Ultimately, embolisation was performed in the interventional radiology suite, with improvement of patient haemodynamics. Ruptured AML is a rare, life-threatening condition that needs to be included in the differential diagnosis of haemorrhagic shock in female patients of reproductive age presenting to the emergency department.
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Affiliation(s)
- Abby Jo Sapadin
- Emergency Department, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Daniel Girzadas
- Emergency Department, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Darshika Chhabra
- Nephrology, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Tasneem Ahmed
- Emergency Department, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
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35
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Matsumoto S, Arita Y, Yoshida S, Fukushima H, Kimura K, Yamada I, Tanaka H, Yagi F, Yokoyama M, Matsuoka Y, Oya M, Tateishi U, Jinzaki M, Fujii Y. Utility of radiomics features of diffusion-weighted magnetic resonance imaging for differentiation of fat-poor angiomyolipoma from clear cell renal cell carcinoma: model development and external validation. Abdom Radiol (NY) 2022; 47:2178-2186. [PMID: 35426498 DOI: 10.1007/s00261-022-03486-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the utility of radiomics features of diffusion-weighted magnetic resonance imaging (DW-MRI) to differentiate fat-poor angiomyolipoma (fpAML) from clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS This multi-institutional study included two cohorts with pathologically confirmed renal tumors: 65 patients with ccRCC and 18 with fpAML in the model development cohort, and 17 with ccRCC and 13 with fpAML in the external validation cohort. All patients underwent magnetic resonance imaging (MRI) including DW-MRI. Radiomics analysis was used to extract 39 imaging features from the apparent diffusion coefficient (ADC) map. The radiomics features were analyzed with unsupervised hierarchical cluster analysis. A random forest (RF) model was used to identify radiomics features important for differentiating fpAML from ccRCC in the development cohort. The diagnostic performance of the RF model was evaluated in the development and validation cohorts. RESULTS The cases in the developmental cohort were classified into three groups with different frequencies of fpAML by cluster analysis of radiomics features. RF analysis of the development cohort showed that the mean ADC value was important for differentiating fpAML from ccRCC, as well as higher-texture features including gray-level run length matrix (GLRLM)_long-run low gray-level enhancement (LRLGE), and GLRLM_low gray-level run emphasis (LGRE). The area under the curve values of the development [0.90, 95% confidence interval (CI) 0.80-1.00] and validation cohorts (0.87, 95% CI 0.74-1.00) were similar (P = 0.91). CONCLUSION The radiomics features of ADC maps are useful for differentiating fpAML from ccRCC.
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Affiliation(s)
- Shunya Matsumoto
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Yuki Arita
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Hiroshi Fukushima
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Koichiro Kimura
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ichiro Yamada
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Fumiko Yagi
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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Cao H, Fang L, Chen L, Zhan J, Diao X, Liu Y, Lu C, Zhang Z, Chen Y. The Value of Contrast-Enhanced Ultrasound in Diagnosing Small Renal Cell Carcinoma Subtypes and Angiomyolipoma. J Ultrasound Med 2022; 41:1415-1423. [PMID: 34499770 DOI: 10.1002/jum.15824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To retrospectively explore the value of contrast-enhanced ultrasound (CEUS) in differentiating small renal cell carcinomas (RCCs) from angiomyolipomas (AMLs), and distinguishing between clear cell RCC (ccRCC), papillary RCC (pRCC), and chromophobe RCC (chRCC). METHODS A total of 151 patients with small renal masses (110 ccRCCs, 12 pRCCs, 9 chRCCs, and 20 AMLs) were enrolled between August 2016 and October 2019. RESULTS There were significant differences in terms of enhancement intensity (EI), enhancement homogeneity, perilesional rim-like enhancement (PRE), wash in, and wash out (WO) between RCC and AML (P = .000, .011, .000, .001, .000, respectively). Although there was no significant difference in EI between pRCC and chRCC (P = .272), EI of ccRCC was higher than that of pRCC (P = .000) and chRCC (P = .010). Multivariate regression analysis showed PRE and fast WO were related to RCC (OR = 18.189, 15.141, respectively). Although there were no significant differences in the sensitivity and area under the curve (AUC) between PRE and fast WO (95.0% vs. 95.0%, P = 1.000 and .880 vs. 0.799, P = .123, respectively), the specificity of PRE in predicting RCC was higher than that of fast WO (80.92% vs. 64.89%, P = .011). The sensitivity, specificity, and AUC of the two characteristics combination for differentiating RCC from AML were 95.0%, 90.8%, and 0.920, respectively, and that of EI for differentiating between ccRCC, pRCC, and chRCC were 81.0%, 78.2%, and 0.796, respectively. CONCLUSIONS CEUS has value in differentiating small RCCs from AMLs and distinguishing ccRCC, a subtype associated with a greater likelihood of malignant behavior from pRCC and chRCC.
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Affiliation(s)
- Hongli Cao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Xuehong Diao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yingchun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Chen Lu
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
- Department of Pathology, Huadong Hospital, Fudan University, Shanghai, China
| | - Zhengwang Zhang
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
- Department of Urology, Huadong Hospital, Fudan University, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
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Abstract
ABSTRACT Angiomyolipoma is a common benign tumor in the kidney. Previous publication reported that renal angiomyolipoma had very low to low uptake of 18F-FDG. We report a case of pathologically proven angiomyolipoma in the left kidney with intense 18F-FDG and 18F-ALF-NOTA-FAPI uptake.
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Affiliation(s)
- Yue-Hong Guo
- From the Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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38
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Rajarajen AP, Shaji A, Sethi J, Devana SK. Renal angiomyolipoma presenting as acute abdomen in a previously undiagnosed patient of tuberous sclerosis. BMJ Case Rep 2022; 15:e248328. [PMID: 35131804 PMCID: PMC8823086 DOI: 10.1136/bcr-2021-248328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Alan Shaji
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmine Sethi
- Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Zhang Y, Zhao XT, Wang ML, Han LJ, Mao L, Li XL, Liang CH, Liu ZY. [Value of radiomics model based on dynamic contrast-enhanced magnetic resonance imaging in differentiation fat-poor angiomyolipoma from alpha-fetoprotein-negative hepatocellular carcinoma in the background of non-cirrhotic liver]. Zhonghua Yi Xue Za Zhi 2022; 102:196-200. [PMID: 35042288 DOI: 10.3760/cma.j.cn112137-20211110-02495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To explore the value of radiomics model based on dynamic contrast-enhanced magnetic resonance imaging (MRI) in differentiation fat-poor angiomyolipoma (fp-AML) from alpha-fetoprotein-negative hepatocellular carcinoma (n-HCC) in the background of non-cirrhotic liver. Methods: The complete data of 121 patients from Guangdong Provincial People's Hospital, Zhongshan Hospital Affiliated to Fudan University and Sun Yat-sen University Cancer Center with hepatic fp-AML and n-HCC confirmed by pathology from October 2010 to July 2020 were retrospectively analyzed. Among them, 75 were males and 46 were females, aged from 23 to 80 (55±12) years. A total of 93 patients from Zhongshan Hospital Affiliated to Fudan University were divided into the training cohort (n=75) and internal test cohort (n=18) according to entry time, and the patients of other 2 hospitals were divided into external test cohort (n=28). The radiomics features were extracted from the preoperative triple-phase contrast-enhanced images. The feature selection algorithm based on Joint Mutual Information Maximisation (JMIM) was used to extract the optimal feature subset, and support vector machine (SVM) was used to build the radiomics model. The diagnostic performance of radiomics model was evaluated using the receiver operating characteristic (ROC) curve, and was compared with that of two radiologists. Results: In the internal cohort, the area under the curve (AUC) for the differential diagnosis between fp-AML and n-HCC of the radiomics model was 0.819 (with an accuracy of 72.2%), outperforming than radiologist 1 with 10 years of diagnostic experience (AUC=0.542, P=0.029) and radiologist 2 with 2 years of diagnostic experience (AUC=0.375, P=0.004). In the external cohort, the AUC of the radiomics model was 0.772 (with and accuracy of 71.4%), which was comparable to that of radiologist 1 (AUC=0.661, P=0.442) and better than that of radiologist 2 (AUC=0.400, P=0.008). Conclusion: The radiomics model based on dynamic contrast-enhanced MRI is of high accuracy for preoperatively differentiating hepatic fp-AML from n-HCC in the noncirrhotic liver.
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Affiliation(s)
- Y Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - X T Zhao
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - M L Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - L J Han
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - L Mao
- AI Lab, Deepwise Healthcare, Beijing 100080, China
| | - X L Li
- AI Lab, Deepwise Healthcare, Beijing 100080, China
| | - C H Liang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Z Y Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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40
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Tuma J, Dudeck O. [CME-Sonography 104: Angiomyolipomas]. Praxis (Bern 1994) 2022; 111:123-129. [PMID: 35232258 DOI: 10.1024/1661-8157/a003857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CME-Sonography 104: Angiomyolipomas Abstract. Angiomyolipomas are the most common benign kidney tumors. Approximately 80 % are spontaneously occurring tumors, the majority <1.0 cm (approximately 54 %). These tumors do not grow and are harmless. Tumors between 1.0 and 2.5 cm (approx. 44 %) also very rarely grow and remain harmless. Larger tumors are rarely found (about 2 %). These must be carefully monitored, as tumors >4.0 cm can spontaneously manifest dangerous bleeding. Apart from spontaneous occurrence, there are also angiomyolipomas in the context of the tuberous sclerosis complex (TCS). Such tumors are often larger and combined with renal cysts and renal cell carcinomas. Measuring the of echo intensity is important for diagnosis.
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Affiliation(s)
- Jan Tuma
- Ultrasound Learning Center (ULC) der European Federation of Ultrasound in Medicine and Biology (EFSUMB), Klinik Hirslanden, Zürich
| | - Oliver Dudeck
- Zentrum für Mikrotherapie, Klinik Hirslanden, Zürich
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41
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Israrahmed A, Gupta A, Gupta A, Yadav RR. Supraclavicular extra-renal angiomyolipoma: a challenging diagnosis. BMJ Case Rep 2021; 14:e247358. [PMID: 34848433 PMCID: PMC8634210 DOI: 10.1136/bcr-2021-247358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Amrin Israrahmed
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aviral Gupta
- Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Archna Gupta
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajanikant R Yadav
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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42
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Chong GY, Chedid MT, Potretzke TA, Chebib FT. Massive renal angiomyolipomas in tuberous sclerosis complex. Kidney Int 2021; 100:1354. [PMID: 34802568 DOI: 10.1016/j.kint.2021.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Grace Y Chong
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Maroun T Chedid
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Fouad T Chebib
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
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El Aoufir O, Zerda I, Slaoui A, El Khamlichi A, Iben Attya A, Jiddane M, Fikri M. Haemorrhagic renal angiomyolipoma embolization. J Med Vasc 2021; 46:254-257. [PMID: 34862021 DOI: 10.1016/j.jdmv.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/02/2021] [Indexed: 06/13/2023]
Affiliation(s)
- O El Aoufir
- Department of Radiology, Vascular Radiology Unit, Specialties Hospital, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
| | - I Zerda
- Department of Urology B, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
| | - A Slaoui
- Department of Urology B, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
| | - A El Khamlichi
- Department of Radiology, Vascular Radiology Unit, Specialties Hospital, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
| | - A Iben Attya
- Department of Urology B, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
| | - M Jiddane
- Department of Radiology, Vascular Radiology Unit, Specialties Hospital, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
| | - M Fikri
- Department of Radiology, Vascular Radiology Unit, Specialties Hospital, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
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44
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Ahsan M, Choudhury S, Razi RM, Verma DK. Bilateral Renal Angiomyolipoma with Hidden Tuberous Sclerosis Complex: A Case Report. Mymensingh Med J 2021; 30:850-854. [PMID: 34226479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Angiomyolipomas (AML) are benign tumor of kidney also referred as renal hamartoma composed of varying amounts of mature adipose tissue, smooth muscle, and blood vessels. It is seen in two distinct clinical forms, a sporadic (isolated) form and 55-80% seen in association with Tuberous sclerosis complex (TSC). If the lesion grows to a large size, a series of clinical manifestations and serious complications may occur. Here we present a case of 26 years lady who presented in the Department Radiology & Imaging of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with chief complaints of bilateral loin pain and occasional hematuria for 2 months. Ultrasound abdomen and contrast enhanced computed tomography shows bilateral renal angiomyolipoma (left>right). In order to look for tuberous sclerosis features, we followed her with plain computed tomography of head which shows subependymal calcifications.
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Affiliation(s)
- M Ahsan
- Dr Mainul Ahsan, Associate Professor, Department of Radiology & Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail:
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45
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Salvador R, Sebastià M, Cárdenas G, Páez-Carpio A, Paño B, Solé M, Nicolau C. CT differentiation of fat-poor angiomyolipomas from papillary renal cell carcinomas: development of a predictive model. Abdom Radiol (NY) 2021; 46:3280-3287. [PMID: 33674961 DOI: 10.1007/s00261-021-02988-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify specific contrast-enhanced CT (CECT) findings and develop a predictive model with logistic regression to differentiate fat-poor angiomyolipomas (fpAML) from papillary renal cell carcinomas (pRCC). METHODS This is a single-institution retrospective study that assess CT features of histologically proven 67 pRCC and 13 fpAML. CECT variables were studied by means of univariate logistic regression. Variables included patients' demographics, tumor attenuation (unenhanced and at arterial, venous and excretory post-contrast phases), type of enhancement, morphological features (axial long and short diameters, long-short axis ratio (LSR) and tumor to kidney angle interface) and presence of visible calcifications or vessels. Those variables with a p ≤ 0.05 underwent standard stepwise logistic regression to find predictive combinations of clinical variables. Best models were evaluated by AUROC curves and were subjected to Leave-one-out cross validation to assess their robustness. RESULTS Odds ratio (OR) between pRCC and fpAML was statistically significant for patient's gender, tumor attenuation in arterial, venous and excretory phases, tumor's long diameter, short diameter, LSR, type of enhancement, presence of intratumoral vessels and tumor-kidney angle interface. The best predictive model resulted in an area under the curve (AUC) of 0.971 and included gender, tumor-kidney angle interface and venous attenuation with the following equation: Log(p/1 - p) = - 2.834 + 4.052 * gender + - 0.066 * AngleInterface + 0.074 * VenousphaseHU. CONCLUSIONS The combination of patients' gender, tumor to kidney angle interface and venous enhancement helps to distinguish fpAML from pRCC.
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Affiliation(s)
- R Salvador
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain.
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain.
| | - M Sebastià
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - G Cárdenas
- Department of Radiology, Hospital Clínico de la Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Región Metropolitana, Chile
| | - A Páez-Carpio
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - B Paño
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - M Solé
- Department of Pathology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - C Nicolau
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain
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46
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Wang D, Liu M, Li Y, Xie M. Right renal angiomyolipoma with intracardiac extension and pulmonary embolism. J Clin Ultrasound 2021; 49:516-519. [PMID: 33325037 DOI: 10.1002/jcu.22968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/04/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Angiomyolipoma is the most common benign mesenchymal neoplasm of the kidney. Despite its benign nature, it may, in rare instances, invade the inferior vena cava and right cardiac chambers. A tumor thrombus in the pulmonary artery is an extremely rare but potentially fatal complication. We report a rare case of 53-year-old woman showing a right renal angiomyolipoma with intracardiac extension and pulmonary embolism. The patient underwent open radical right nephrectomy and thrombectomy of the inferior vena cava and pulmonary artery. Our case highlights that close attention to these complications is important to determine the surgical plan.
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Affiliation(s)
- Dan Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Manwei Liu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Calame P, Tyrode G, Weil Verhoeven D, Félix S, Klompenhouwer AJ, Di Martino V, Delabrousse E, Thévenot T. Clinical characteristics and outcomes of patients with hepatic angiomyolipoma: A literature review. World J Gastroenterol 2021; 27:2299-2311. [PMID: 34040323 PMCID: PMC8130035 DOI: 10.3748/wjg.v27.i19.2299] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/31/2020] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
First reported in 1976, hepatic angiomyolipoma (HAML) is a rare mesenchymal liver tumor occurring mostly in middle-aged women. Diagnosis of the liver mass is often incidental on abdominal imaging due to the frequent absence of specific symptoms. Nearly 10% of HAMLs are associated with tuberous sclerosis complex. HAML contains variable proportions of blood vessels, smooth muscle cells and adipose tissue, which renders radiological diagnosis hazardous. Cells express positivity for HMB-45 and actin, thus these tumors are integrated into the group of perivascular epithelioid cell tumors. Typically, a HAML appears on magnetic resonance imaging (or computed tomography scan) as a hypervascular solid tumor with fatty areas and with washout, and can easily be misdiagnosed as other liver tumors, particularly hepatocellular carcinoma. The therapeutic strategy is not clearly defined, but surgical resection is indicated for symptomatic patients, for tumors showing an aggressive pattern (i.e., changes in size on imaging or high proliferation activity and atypical epithelioid pattern on liver biopsy), for large (> 5 cm) biopsy-proven HAML, and if doubts remain on imaging or histology. Conservative management may be justified in other conditions, since most cases follow a benign clinical course. In summary, the correct diagnosis of HAML is challenging on imaging and relies mainly on pathological findings.
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Affiliation(s)
- Paul Calame
- Department of Radiology, Jean Minjoz University Hospital, Besançon 25030, France
| | - Gaëlle Tyrode
- Department of Hepatology, Jean Minjoz University Hospital, Besançon 25030, France
| | | | - Sophie Félix
- Department of Pathology, Jean Minjoz University Hospital, Besançon 25000, France
| | - Anne Julia Klompenhouwer
- Department of Surgery, Erasmus University Medical Center, Rotterdam PO Box 2040, The Netherlands
| | - Vincent Di Martino
- Department of Hepatology, Jean Minjoz University Hospital, Besançon 25030, France
| | - Eric Delabrousse
- Department of Radiology, Jean Minjoz University Hospital, Besançon 25030, France
| | - Thierry Thévenot
- Department of Hepatology, Jean Minjoz University Hospital, Besançon 25030, France
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48
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Matute Martinez CF, Hamdan A, Sierra David JG, Kolli S. Sporadic, classic-type renal angiomyolipoma with renal vein and inferior vena cava extension: an incidental case. BMJ Case Rep 2021; 14:14/3/e237376. [PMID: 33727284 PMCID: PMC7970235 DOI: 10.1136/bcr-2020-237376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Renal angiomyolipomas (AMLs) were first described in the early 1900s by Gravitz, but it was not until 1951 that they were named renal AML. These kidney tumours are rare, occurring in 0.13%-0.44% of the population. These mesenchymal tumours are composed of smooth muscle-like, adipocyte-like and epithelioid cells. Depending on the predominant cell population, it can be further subclassified into classic, epithelioid and AML with epithelial cyst. A 32-year-old woman presented with mild, intermittent, epigastric and right upper quadrant abdominal pain. Abdominal ultrasound revealed an incidental lesion within the inferior vena cava (IVC). A CT scan showed a lesion within the left renal vein extending into the IVC with 40% narrowing and a fat-containing mass in the lower pole of the left kidney of 15 mm suggesting an AML. Thrombectomy was performed. The specimen resulted positive for classic variant renal AML. Initial diagnosis is centred on imagining studies, based in fatty tissue concentration. The AML expresses melanocytic markers. This helps differentiate from renal cell carcinoma. Although AML is considered a benign condition, there is evidence of malignant transformation. Active surveillance is recommended for lesions <4 cm. Nephron sparing surgery is the procedure of choice. Nephrectomy is recommended if there is a high probability of malignancy. Mammalian target of rapamycin (mTOR) inhibitors have been proposed to be an alternative treatment.
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Affiliation(s)
- Carlos Felipe Matute Martinez
- Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Odessa, Texas, USA
| | - Ahmad Hamdan
- Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Odessa, Texas, USA
| | - Juan Guillermo Sierra David
- Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Odessa, Texas, USA
| | - Swapna Kolli
- Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Odessa, Texas, USA
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Zou MH, Huang Q, Zou Q, Jiang Y, Ju JX, Zhou HC, Jiao J, Zheng RQ. Clinical and Contrast-enhanced Ultrasound Characteristics of Epithelioid and Classic Hepatic Angiomyolipoma: Comparison With Alpha-fetoprotein-negative Hepatocellular Carcinoma. Ultrasound Med Biol 2021; 47:446-453. [PMID: 33353786 DOI: 10.1016/j.ultrasmedbio.2020.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/24/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
Hepatic angiomyolipoma (HAML) comprises epithelioid angiomyolipoma (EAML) and classic hepatic angiomyolipoma (CAML). The imaging appearance of HAML varies widely, and EAML is more easily misdiagnosed as hepatocellular carcinoma (HCC) than as CAML. The clinical and contrast-enhanced ultrasound (CEUS) features of CAML, EAML and HCC with negative alpha-fetoprotein protein expression (HCC[AFP-]) were retrospectively reviewed. The hyper-vascular type was more commonly found in CAML and EAML lesions than in HCC lesions. Most lesions were hyper-enhanced in the arterial phase. CAMLs showed prolonged hyper-enhancement or iso-enhancement during the portal and late phases on CEUS, making them easily distinguishable from HCC(AFP-). Some EAML lesions (41.7%) were hypo-echoic, similar to HCC(AFP-). However, the hypo-enhancement of EAML lesions occurred later than that of HCC(AFP-) lesions. Thus, our findings may be useful in distinguishing among these lesions to improve diagnostic accuracy.
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Affiliation(s)
- Min-Hong Zou
- Department of Ultrasound, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qing Huang
- Department of General Surgery, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, Second Affiliated Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Qiong Zou
- Department of Nuclear Medicine, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ye Jiang
- Department of Pathology, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jin-Xiu Ju
- Department of Ultrasound, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hui-Chao Zhou
- Department of Ultrasound, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ju Jiao
- Department of Nuclear Medicine, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Rong-Qin Zheng
- Department of Ultrasound, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Ogawa Y, Morita S, Takagi T, Yoshida K, Tanabe K, Nagashima Y, Nishina Y, Sakai S. Early dark cortical band sign on CT for differentiating clear cell renal cell carcinoma from fat poor angiomyolipoma and detecting peritumoral pseudocapsule. Eur Radiol 2021; 31:5990-5997. [PMID: 33559699 DOI: 10.1007/s00330-021-07717-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/19/2020] [Accepted: 01/26/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To retrospectively evaluate whether the early dark cortical band (EDCB) on CT can be a predictor to differentiate clear cell renal cell carcinoma (ccRCC) from fat poor angiomyolipoma (Fp-AML) and to detect peritumoral pseudocapsules in ccRCC. METHODS The EDCBs, which are comprised of unenhanced thin lines at the tumor-renal cortex border in the corticomedullary phase, on the CT images of 342 patients who underwent partial nephrectomy were evaluated. Independent predictors among the clinical and CT findings for differentiating ccRCC from Fp-AML were identified using multivariate analyses. The diagnostic performance of the EDCB for diagnosing peritumoral pseudocapsule in ccRCC and differentiating ccRCC from Fp-AML was calculated. RESULTS The EDCB was observed in 157 of 254 (61.8%) ccRCCs, 4 of 31 (12.9%) chromophobe RCCs, 1 of 21 (4.8%) papillary RCCs, 3 of 11 (27.3%) clear cell papillary RCCs, 3 of 8 (37.5%) oncocytomas, and 0 of 17 (0%) Fp-AMLs. There was substantial interobserver agreement for the EDCB (k = 0.719). The EDCB was a significant predictor for differentiating ccRCC from Fp-AML (p < 0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of the EDCB for differentiating ccRCC from Fp-AML were 61.8%, 100%, 100%, and 14.9%, respectively, and those for detecting pseudocapsule in 236 ccRCCs were 62.3%, 68.8%, 96.5%, and 11.7%, respectively. CONCLUSION Although diagnostic accuracy of the EDCB for detecting peritumoral pseudocapsule in RCC is inadequate, it can be a predictor for differentiating ccRCC from Fp-AML with high specificity and PPV. KEY POINTS • The early dark cortical band (EDCB) sign is observed in nearly two-thirds of clear cell renal cell carcinoma (ccRCC) that are treated by partial nephrectomy and have substantial interobserver agreement. • The EDCB is a significant predictor for differentiating ccRCCs from fat poor angiomyolipomas, with a high specificity and positive predictive value. • Diagnostic accuracy of the EDCB for detecting peritumoral pseudocapsule in ccRCC is inadequate, though better than those in the nephrographic and excretory-phase images.
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Affiliation(s)
- Yuko Ogawa
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Satoru Morita
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yu Nishina
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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