Detection of fat in a renal cell carcinoma mimicking angiomyolipoma.

Strotzer, M.; Lehner, K.; Becker, Karen

doi:10.1148/radiology.188.2.8327690

Cited by 112 publications

(38 citation statements)

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“…Fat within RCC has been pathologically accounted for by three mechanisms [1][2][3][4][5]. First, RCC can engulf perinephric or renal sinus fat [6].…”

Section: Discussionmentioning

confidence: 99%

Renal cell carcinoma containing macroscopic fat on CT mimics an angiomyolipoma due to bone metaplasia without macroscopic calcification

Richmond

Atri²,

Sherman³

et al. 2010

BJR

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ABSTRACT. We report a case of renal cell carcinoma (RCC) containing foci of macroscopic fat, which were pathologically proven to be areas of osseous metaplasia. The macroscopic fat was not associated with calcification on the pre-operative CT scan. To our knowledge, there are no reported cases of RCC that contain osseous metaplasia without evidence of macroscopic calcification on CT. The finding is significant because standard imaging practice is to classify a renal mass containing intratumoral macroscopic fat that is not associated with calcification, ossification or invasion of perirenal or hilar fat as an angiomyolipoma. Case reportA 61-year-old female patient with a history of multiple metachronous localised breast cancers, which had been treated with surgery, radiotherapy and tamoxifen, was found to have renal and liver masses on imaging performed in an outside institution during the staging of her most recent breast cancer. Further investigations, including biopsy of the liver masses and colonoscopy, revealed that the patient had a colon carcinoma in her cacum with three liver metastases; the renal mass was thought to be another metastasis. The patient underwent chemotherapy, which resulted in the disappearance or significant regression of the liver lesions but no change in the kidney mass. She was referred for possible excision of the cacal primary, the remaining liver disease and the renal mass.A portal venous phase enhanced CT scan was performed. In addition, the renal lesion was evaluated sonographically. The CT scan revealed an encapsulated enhancing exophytic left renal mass that measured 10 cm in maximum dimension. This heterogeneous mass contained at least three small hypoattenuating foci measuring up to 5 mm with attenuation values ranging from 219 to 232 HU, consistent with foci of macroscopic fat. No intratumoral calcium was evident on CT (Figure 1). There was no evidence of renal vein involvement or adenopathy.Sonographically, the mass was predominantly solid and hypoechoic, and multiple echogenic foci corresponding to the fat nodules were visualised (Figure 2).The imaging features of the mass were highly suggestive of an angiomyolipoma (AML); nevertheless, a biopsy was performed because of the small possibility that the fat was within a renal cell carcinoma (RCC). The pathology was consistent with a conventional clear-cell RCC rather than an AML.The patient underwent simultaneous left radical nephrectomy and right hemicolectomy. Pathological examination revealed a pT2 clear cell RCC with Fuhrman nuclear grade 2/4. There was no involvement of the perinephric or hilar fat. Histologically, small foci of metaplastic bone containing fat were visualised (Figure 3).

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“…Fat within RCC has been pathologically accounted for by three mechanisms [1][2][3][4][5]. First, RCC can engulf perinephric or renal sinus fat [6].…”

Section: Discussionmentioning

confidence: 99%

Renal cell carcinoma containing macroscopic fat on CT mimics an angiomyolipoma due to bone metaplasia without macroscopic calcification

Richmond

Atri²,

Sherman³

et al. 2010

BJR

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“…All diagnoses were confirmed by pathology (20 lesions), percutaneous biopsy (two lesions), history (one lesion), or a combination of imaging techniques with follow-up and correlative imaging studies (ultrasonography, magnetic resonance imaging: 14 lesions) [24][25][26]. The size of the lesions was distributed as follows: 16 lesions, including five RCC, measured less than 3 cm; 12 lesions, including six RCC, measured between 3 and 5 cm; and nine lesions, including seven RCC, were more than 5 cm.…”

Section: Methodsmentioning

confidence: 99%

Enhancement patterns of renal masses during multiphase helical CT acquisitions

et al. 1998

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“…The fat in these tumors is macroscopic and exhibits negative attenuation value on CT or as bright signal relative to subcutaneous or retroperitoneal fat tissue on T1-weighted MR images [2,3]. RCC, the most common malignant tumors arising from the kidney, rarely show this macroscopic fat on radiologic examinations, although rare exceptional cases have been reported sporadically [5][6][7][8][9]. With a usage of chemical-shift gradient-echo MR imaging, fat of lesser amount, or microscopic fat, which does not exhibit negative attenuation value on CT or bright signal on T1-weighted MR images, has become detectable.…”

Section: Case Reportmentioning

confidence: 99%

Fat detection in granular-cell renal cell carcinoma using chemical-shift gradient-echo MR imaging: another renal tumor that contains fat

et al. 2000

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Preoperative chemical-shift magnetic resonance images in a 56-year-old man suggested the presence of microscopic fat in the tumor. The surgical specimen showed a granular-cell renal cell carcinoma with papillary architecture, associated with abundant fat-containing foamy histiocytes in the interstitium. The radiologist should include this entity in the differential diagnoses of renal tumors that contain microscopic fat.

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Detection of fat in a renal cell carcinoma mimicking angiomyolipoma.

Cited by 112 publications

References 0 publications

Renal cell carcinoma containing macroscopic fat on CT mimics an angiomyolipoma due to bone metaplasia without macroscopic calcification

Renal cell carcinoma containing macroscopic fat on CT mimics an angiomyolipoma due to bone metaplasia without macroscopic calcification

Enhancement patterns of renal masses during multiphase helical CT acquisitions

Fat detection in granular-cell renal cell carcinoma using chemical-shift gradient-echo MR imaging: another renal tumor that contains fat

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