Radiological features of papillary renal cell carcinoma.

Transcription

1 Radiological features of papillary renal cell carcinoma. Poster No.: C-1530 Congress: ECR 2015 Type: Educational Exhibit Authors: T. Serna Castro, C. Parrilla Muñoz, J. P. Ruiz Gutierrez, S. Sánchez Rodríguez, G. Silla Búrdalo; Valencia/ES Keywords: DOI: Neoplasia, Diagnostic procedure, Ultrasound, MR, CT, Abdomen /ecr2015/C-1530 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 9

2 Learning objectives Identify findings that characterize papillary renal cell carcinoma in ultrasound, CT and MRI. Background Papillary renal cell carcinoma is a type of cancer that forms inside the lining of the kidney's tubules. About 5-10% of primary renal carcinomas are papillary carcinoma. Patients present in the third to eighth decades of life. Like the rest of renal tumors is usually an incidental finding, it is more frequent in men than in women. Most are unilateral (type 1) but can occur in a multifocal or bilateral (type 2), this finding is more prevalent than in other subtypes. It is divided into two subtypes: type 1, sporadic, which appears between the fifth and eighth decades of life, with large, low vascularization and pleomorphism, and type 2, inherited, more aggressive small, listed in the fourth decade of life, more vascularized and marked pleomorphism. If the tumor is large it can also show cystic degeneration, necrosis, calcification, bleeding changes and exceptional-mind, macroscopic fat cholesterol-laden macrophages. Findings and procedure details In the Hospital Clínico Universitario de Valencia it was done a retrospective review of cases in patients with papillary renal cell carcinoma diagnosis, confirmed by pathology between 2010 y Were identified the radiological features of this type of kidney tumor in US, CT and MRI. Although ultrasound is very frequently requested to assess the renal tract, it is not as sensitive or specific as CT or MRI, In ultrasound papillary renal cell carcinoma is a solid tumor, that may appear hypo-, iso-, or hyperechoic relative to the surrounding renal parenchymase, heterogeneous, with little vascularization. CT is frequently used to both diagnose and stage renal cell carcinomas. CT shows as a solid renal tumor of low attenuation and edges, the smaller ones tend to be homogeneous, and more heterogeneous size pockets of central necrosis. Contrastenhanced CT the tumor has little enhancement compared to the clear renal cell carcinoma, given its lower vascularization. Calcifications may be seen. MRI is not only excellent at imaging the kidneys and locally staging tumours, but is also able to suggest the likely histology, on the grounds of T2 differences. In RM renal papillary carcinoma frequently have low signal intensity on T1- and T2 Both-weighted images (clear cell renal carcinoma have a high signal intensity on T2), can present cystic areas, Page 2 of 9

3 haemorrhage and in contrast-enhanced MR imaging enhancement is less intense than in clear cell renal carcinoma. However, these imaging findings continue to be suggestive but not specific for the diagnosis of papillary renal cell carcinoma. Images for this section: Fig. 1: Papillary renal cell carcinoma in a 62-years-old man. Ultrasound shows a solid, hypoechoic and heterogeneous renal mass. Page 3 of 9

4 Fig. 2: Papillary renal cell carcinoma in a 68-years-old man. Unenhanced (A), corticomedullary phase (B y D), and excretory phase (C) CT scans shows a lowattenuation solid tumor in the left kidney with minimal heterogeneous enhancement, and retroperitoneal lymphadenopathy. The heterogeneous appearance of the tumor is due to necrosis. Page 4 of 9

5 Fig. 3: Nonenhancing papillary renal cell carcinoma in a 52-years-old man. Unenhanced (A), early phase (B), and corticomedullary phase (C, D) CT scans shows a lowattenuation solid tumor in the lower pole of the right kidney without significant enhancement. Page 5 of 9

6 Fig. 4: Papillary renal cell carcinoma in a 57-years-old man. T1 (left) T2 (right) MRI scans shows a low signal intensity on both T1- and T2- weighted images solid tumor in the right kidney. Page 6 of 9

7 Fig. 5: Papillary renal cell carcinoma in a 53-years-old man. T1 (top left) T1 + gadolinium, arterial phase (top right), venous phase (bottom left) and late phase (bottom right) MRI scans shows a low signal intensity on T1 weighted image solid tumor in the right kidney and minimal heterogeneous enhancement on late phase. Page 7 of 9

8 Conclusion The radiological findings like poor enhancement after contrast administration, that characterize the papillary renal cell carcinoma, could suggest this diagnosis, however the gold standar test continues to be the histopathological study. Personal information References 1.Raghunandan Vikram, MBBS, MRCP, FRCR, Chaan S. Ng, Pheroze Tamboli, Nizar M. Tannir, Eric Jonasch, Surena F. Matin, Christopher G. Wood, and Carl M. Sandler. Papillary Renal Cell Carcinoma: Radiologic-Pathologic Correlation and Spectrum of Disease. Mayo-junio Vol 29, issue F. Bazan, M. Busto. Radiología del carcinoma renal Radiología, Volume 56, Issue 1, Pages J M Garin, I Marco, A Salva, F Serrano, J M Bondia, and M Pacheco. CT and MRI in fat-containing papillary renal cell carcinoma. The British Journal of Radiology. Volume 80, Issue Ugalde A., López J.I. Papillary renal cell carcinoma spectrum. Actas Urológicas Españolas v.32 n.8 Madrid sep William R. Sukov, Christine M. Lohse, Bradley C. Leibovich, R. Houston Thompson, John C. Cheville. Clinical and Pathological Features Associated With Prognosis in Patients With Papillary Renal Cell Carcinoma. The journal of urology. January 2012 Volume 187, Issue 1, Pages Börje Ljungberg, Nigel C. Cowan, Damian C. Hanbury, Milan Hora, Markus A. Kuczyk, Axel S. Merseburger, Jean-Jacques Patard, Peter F.A. Mulders, Ioanel C. Sinescu. EAU Guidelines on Renal Cell Carcinoma: The 2010 Update. European Urology, Volume 58, Issue 3, Pages Nathan D. Egbert, Elaine M. Caoili, Richard H. Cohan, Matthew S. Davenport, Isaac R. Francis, L. Priya Kunju and James H. Ellis. Differentiation of Papillary Renal Cell Carcinoma Subtypes on CT and MRI. August 2013, Volume 201, Number 2. Page 8 of 9

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