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Imaging of Kidney Cancer

Ali Guermazi (eds.)

Resumen/Descripción – provisto por la editorial

No disponible.

Palabras clave – provistas por la editorial

Imaging / Radiology; Diagnostic Radiology; Oncology; Urology; Radiotherapy

Disponibilidad
Institución detectada Año de publicación Navegá Descargá Solicitá
No detectada 2006 SpringerLink

Información

Tipo de recurso:

libros

ISBN impreso

978-3-540-21129-7

ISBN electrónico

978-3-540-30003-8

Editor responsable

Springer Nature

País de edición

Reino Unido

Fecha de publicación

Información sobre derechos de publicación

© Springer-Verlag Berlin Heidelberg 2006

Tabla de contenidos

Collecting Duct Carcinoma

Seong Kuk Yoon; Seo Hee Rha

Collecting duct carcinoma is an aggressive subtype of RCC derived from the renal medulla. The tumor occurs in a wide age range, predominately in men. The usual histologic pattern is that of a tubular or tubulopapillary carcinoma with a desmoplastic stroma. Imaging features suggestive of this diagnosis include a medullary origin and an infiltrative growth pattern. This type of cancer is associated with an extremely poor prognosis. At presentation CDC is metastatic to regional lymph nodes. The characteristic location, typical histologic and radiologic appearance, and reportedly poor prognosis differentiate CDC from the more common RCC. Death usually occurs within 2 years. Various treatments have been proposed but with disappointing results, including radiation therapy, immunotherapy and some combinations of chemotherapy.

Pp. 171-185

Renal Sinus Neoplasms

Sung Eun Rha; Jae Young Byun

A broad pathologic spectrum of tumors can occur in the renal sinus. The diagnosis and exact preoperative staging of renal sinus tumors relies on a multimodality imaging approach that includes excretory urography, US, CT, MR imaging, and angiography. Ultrasound is an excellent noninvasive technique to confirm whether such a mass is cystic or solid. If US findings suggest a solid mass, CT or MR imaging is used as a problem-solving technique and for evaluation of the staging or to determine the extent of the lesion. In general, the coronal plane of cross-sectional imaging is the most useful for the evaluation of renal sinus lesions, because it provides a comprehensive view of complicated renal sinus pathology. Familiarity with the imaging features and differential diagnoses of various renal sinus tumors will facilitate prompt, accurate diagnosis and treatment.

Pp. 187-201

Small Renal Neoplasms

Nancy S. Curry

Radiologists frequently encounter small renal masses in daily practice. Most are small benign cysts which are difficult to characterize because of their size. With modern cross-sectional imaging techniques, however, it is possible to distinguish most of these from true renal neoplasms. The small renal neoplasms that contain fat or reside within the collecting system of the kidney are easily identified and managed appropriately. The remainder of enhancing, small solid renal masses continue to be a challenge. Since their histologic make-up and biologic behavior cannot be accurately predicted by imaging, a choice of nephron-sparing surgical or percutaneous ablation techniques vs “watchful waiting” are rational options for management. The appropriate course of action depends heavily on individual patient factors.

Pp. 203-218

Unusual Kidney Cancers

Kyeong Ah Kim; Cheol Min Park

There are various unusual manifestations of RCCs. Sometimes they mimic other benign or malignant renal tumors or inflammation. Familiarity with these radiologic features of unusual RCCs can help ensure correct diagnosis and proper management.

Pp. 219-238

Hereditary Renal Cancer

Toshiyuki Miyazaki; Mutsumasa Takahashi

Over the past 5 years there have been dramatic developments in the understanding of hereditary renal cancers. von Hippel-Lindau disease is now understood to be associated with clear cell carcinoma, and other associations have also become known: hereditary papillary renal cancer is associated with type 1 papillary renal cancer, and hereditary leiomyoma renal cell carcinoma with type 2 papillary renal cancer. Birt-Hogg-Dubé syndrome and familial renal oncocytoma are associated with chromophobe carcinoma and oncocytomas, although other histologic tumor types have been found in Birt-Hogg-Dubé syndrome. Medullary carcinoma of kidney is associated with the sickle cell trait.

Although the genes associated with these tumors have been discovered, the exact mechanisms by which they cause renal cancer remain to be elucidated. It is quite likely that other genes also are involved in this process. Using VHL disease as an example, research is now underway on using mutant pVHL or excess HIF for diagnostic and therapeutic purposes. Understanding the mechanisms that lead to cancer may open new avenues of opportunity for drug development. This improved knowledge of the biogenetic pathways used to form tumors will affect the development of new therapeutic techniques for treating both hereditary and nonhereditary forms of renal cancer.

Pp. 239-256

Extraosseous Metastases and Local Recurrence

Ali Guermazi; Iman El-Hariry; Yves Miaux

Metastatic lesions from kidney cancer are seen in virtually every organ: the lung; pleura; pancreas; adrenal gland; liver; contralateral kidney; bone; lymph nodes; muscles; etc. These lesions can masquerade as another primary tumor. It is important to distinguish metastatic spread of RCC from primary tumors, as this knowledge is essential for the correct diagnosis and for determining the most effective treatment. Imaging studies are essential, as are histopathological examinations. Whole-body spiral CT is currently the method of choice for evaluating the postsurgical nephrectomy site for the presence of recurrent lesions and for detecting the usual anatomical sites of metastases. Like the primary tumor, metastatic lesions tend to be hypervascular and intravenous contrast administration is very useful. Other radiological modalities may be of interest when exploring particular organs, such as US for the liver and MR imaging for the brain and spine. Knowledge of the mechanisms, risk factors, and clinical timing of recurrent disease in surgically treated renal cancer aids the radiologist in understanding and detecting the patterns of recurrence observed on imaging.

Pp. 257-308

Imaging of Bone Metastases

Heung Sik Kang; Jung Ah Choi

In conclusion, osseous metastases from renal cell carcinoma are characterized by mainly osteolytic lesions in the metaphysis of, most commonly, the spine, pelvic bone, ribs, and proximal long bones with cortical involvement. Solitary lesions with septa are not uncommon. Both CT and MR imaging may help in defining the extent of the lesion and presence of a periosteal soft tissue mass. The presence of “flow-void” sign on MR imaging may suggest the primary origin of a metastatic bone lesion and also suggest its hypervascular nature, which may also be confirmed by angiography. Bone scanning is still used in detection of metastasis and may help in localization.

Although a rare entity, clear cell sarcoma of the kidney in children metastasizes to the bone readily and is characterized by osteolytic lesions, which may be the first manifestation of a clinically occult tumor.

Pp. 309-320

Renal Lymphoma

Sheila Sheth; Elliot K. Fishman

The urinary tract is a common site for extranodal spread of lymphoma, particularly non-Hodgkin lymphoma. Contrast-enhanced CT remains the preferred imaging modality for the detection of renal lymphoma. Magnetic resonance imaging is useful in special circumstances, particularly when the patient cannot tolerate intravenous contrast. Ultrasound has only a limited role except as a guidance modality for percutaneous biopsy.

Pp. 321-335

Lymphoproliferative Neoplasms

Clara G. C. Ooi; Ali Guermazi

Renal involvement in myeloproliferative and lymphoproliferative disorders is generally not routinely imaged, as in most instances they are asymptomatic owing to preserved renal function. Symptoms arise as a result of compression, renal obstruction, infection, or hemorrhage. Ultrasound and CT remain the imaging modalities of choice due to their availability, relatively short scan times, and reduced costs compared with MR imaging. Computed tomography in particular is extremely good at depicting renal, perirenal, and intra-abdominal pathology. However, nuclear medicine imaging, particularly PET, is proving useful in post-treatment monitoring of disease activity. Although there are no specific imaging features that differentiate these entities from other disease processes that can affect the kidney, in general, leukemia and lymphoma are iso- or hypoechoic on US, and iso- or hypodense on CT. Lymphomas are hypovascular, showing minimal or no enhancement after contrast administration on CT. Extramedullary plasmacytomas are hetero-geneous on US, isodense on CT, and demonstrate heterogeneous enhancement.

Pp. 337-349

Pediatric Kidney Cancer

Lisa H. Lowe; Eugenio M. Taboada

Even though the accurate diagnosis of a cystic renal mass is multifactorial, the quality of the examination (CT or MR imaging) is often not emphasized, and yet it is a significant factor in making a correct diagnosis. The techniques for high-quality CT and MR imaging have been reviewed and their role in the characterization of cystic renal masses has been summarized. The Bosniak renal cyst classification has proven helpful in classifying renal cysts into surgical and nonsurgical lesions and its application to MR imaging appears promising. In the future, with further experience using state-of-the-art CT and MR imaging, our ability to diagnose and manage complex cystic renal masses will further advance, leading to improved patient care.

Pp. 351-369