MRI Features of Renal Oncocytoma and Chromophobe Renal Cell Carcinoma

Rosenkrantz, Andrew B.; Hindman, Nicole; Fitzgerald, Erin F.; Niver, Benjamin E.; Melamed, Jonathan; Babb, James S.

doi:10.2214/ajr.10.4718

Cited by 207 publications

(132 citation statements)

References 34 publications

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“…Cystic changes can be observed within a solid tumor, and central necrosis might be absent, even in very large chromophobe carcinomas (50). Signal loss on out of phase images due to microscopic fat has been reported (51). It is interesting that oncocytomas and chromophobe RCC share similar ontogenic and histologic features (on hematoxylin-eosin-stained slides) and some imaging findings.…”

Section: Chromophobe Rccmentioning

confidence: 98%

“…It is interesting that oncocytomas and chromophobe RCC share similar ontogenic and histologic features (on hematoxylin-eosin-stained slides) and some imaging findings. Oncocytomas develop from type B intercalated cells of the cortical collecting duct and are indistinguishable from chromophobe RCC on imaging studies, sharing features such as central scar and spoke wheel pattern of enhancement (51) .…”

Section: Chromophobe Rccmentioning

confidence: 99%

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Subtypes of renal cell carcinoma: MRI and pathological features

Gürel¹,

Narra²,

Elsayes³

et al. 2013

Diagn Interv Radiol

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Renal cell carcinoma (RCC) is the most common malignant tumor involving the kidney. Determining the subtypes of renal cell carcinoma is among the major goals of preoperative radiological work-up. Among all modalities, magnetic resonance imaging (MRI) has several advantages, such as inherent soft tissue contrast, detection of lipid and blood products, and excellent sensitivity to detect small amounts of intravenous contrast, which facilitate the discrimination of subtypes of RCC. In this article, we review MRI and pathological features used for determining the main histologic subtypes of RCC, including clear cell, papillary, collecting duct, chromophobe, multilocular cystic, and unclassified RCC. Renal cell carcinoma (RCC) is the most common malignant epithelial tumor of the kidney, accounting for 85%-90% of all solid renal tumors in adults and comprising 1%-3% of all malignant visceral neoplasms (1). Approximately 40% of patients with RCC eventually die from progression of this disease, making it the most lethal urologic malignancy (2). Today, most RCC instances are incidental masses identified on imaging studies performed for nonurological reasons.Percutaneous biopsy is a minimally invasive method, and its accuracy for identifying renal tumors ranges from 70% to 90% (3, 4). However, widespread use of percutaneous biopsy remains controversial due to the potential complications of biopsy, the possibility of sampling errors, the dependence on an adequate biopsy sample for analysis, and concerns about how the biopsy information might alter the treatment plan (5). Therefore, histopathological characterization of renal masses with magnetic resonance imaging (MRI) compared with percutaneous biopsy becomes more advantageous.Determining subtypes of RCC has significant prognostic and theraupeutic implications for patients who are poor surgical candidates, for patients who have a metastatic disease, for surgical planning in patients who are surgical candidates, and for immunotherapy and use of the tyrosine kinase inhibitors "sunitinib" and "sorafenib" for clear cell RCC and "temsirolimus" for papillary RCC (6-9).The need for a different approach to the management of RCC among classical surgical procedures has arisen. Nephron-preserving surgical methods, cryoablation, radiofrequency ablation, targeted molecular therapy or follow-up, and MRI are believed to surpass other modalities both in the diagnosis of RCC and determination of its subtypes (10,11).In this article, we review MRI findings and pathological features used for determining the main histologic subtypes of RCC, including clear cell carcinoma, papillary, collecting duct, chromophobe, multilocular cystic, and unclassified RCC. The role of MRI in renal imagingThere are three indispensable components of renal MRI: breathhold imaging, three-dimensional (3D) gradient echo pulse sequence, and fat detection techniques.Breathhold imaging is one of the essential techniques in renal mass MRI protocols. Suspended expiration eliminates respiratory motion artifacts an...

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Section: Chromophobe Rccmentioning

confidence: 98%

Section: Chromophobe Rccmentioning

confidence: 99%

Subtypes of renal cell carcinoma: MRI and pathological features

Gürel¹,

Narra²,

Elsayes³

et al. 2013

Diagn Interv Radiol

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“…Traditional MR imaging features of oncocytoma may be indistinguishable from those of chromophobe RCC (42). However, Zhang et al (39) reported avid enhancement in oncocytomas on contrast-enhanced CT scans but did not find a significant difference between these and clear cell RCCs.…”

Section: Genitourinary Imagingmentioning

confidence: 98%

Arterial Spin-labeling MR Imaging of Renal Masses: Correlation with Histopathologic Findings

et al. 2012

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Purpose:To assess the value of arterial spin-labeling (ASL) perfusion magnetic resonance (MR) imaging in the characterization of solid renal masses by using histopathologic findings as the standard of reference. Materials and Methods:This prospective study was compliant with HIPAA and approved by the institutional review board. Informed consent was obtained from all patients before imaging. Fortytwo consecutive patients suspected of having renal masses underwent ASL MR imaging before their routine 1.5-T clinical MR examination. Mean and peak tumor perfusion levels were obtained by one radiologist, who was blinded to the final histologic diagnosis, by using region of interest analysis. Perfusion values were correlated with histopathologic findings by using analysis of variance. A linear correlation model was used to evaluate the relationship between tumor size and perfusion in clear cell renal cell carcinoma (RCC). P , .05 was considered indicative of a statistically significant difference. Results:Histopathologic findings were available in 34 patients (28 men, six women; mean age 6 standard deviation, 60.4 years 6 11.7). The mean perfusion of papillary RCC (27.0 mL/min/100 g 6 15.1) was lower than that of clear cell RCC (171.6 mL/min/100 g 6 61.2, P = .001), chromophobe RCC (152.9 mL/min/100 g 6 80.7, P = .04), unclassified RCC (208.0 mL/min/100 g 6 41.1, P = .001), and oncocytoma (373.9 mL/min/100 g 6 99.2, P , .001). The mean and peak perfusion levels of oncocytoma (373.9 mL/ min/100 g 6 99.2 and 512.3 mL/min/100 g 6 146.0, respectively) were higher than those of papillary RCC (27.0 mL/min/100 g 6 15.1 and 78.2 mL/min/100 g 6 39.7, P , .001 for both), chromophobe RCC (152.9 mL/min/100 g 6 80.7 and 260.9 mL/min/100 g 6 61.9; P , .001 and P = .02, respectively), and unclassified RCC (208.0 mL/ min/100 g 6 41.1 and 273.3 mL/min/100 g 6 83.4; P = .01 and P = .03, respectively). The mean tumor perfusion of oncocytoma was higher than that of clear cell RCC (P , .001). Conclusion:ASL MR imaging enables distinction among different histopathologic diagnoses in renal masses on the basis of their perfusion level. Oncocytomas demonstrate higher perfusion levels than RCCs, and papillary RCCs exhibit lower perfusion levels than other RCC subtypes.q RSNA, 2012

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“…The presence of a central scar was defined as a central stellate area of T2 hyperintensity with lack of enhancement during the nephrographic phase with or without enhancement during subsequent phases [20]. Nonenhancing areas (assessed for only solid tumors) were defined as hypoattenuating, nonenhancing areas which were not sharply demarcated and lacked apparent walls.…”

Section: Assessment Of Imaging Features On Both Ct and Mrimentioning

confidence: 99%

Early-stage clear cell tubulopapillary renal cell carcinoma: imaging features and distinction from clear cell and papillary subtypes

et al. 2016

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Purpose: Clear cell tubulopapillary renal cell carcinoma (CCTPRCC) is a recently described, low grade subtype of renal cancer. We determined if imaging features could be used to distinguish early-stage CCTPRCC from stage-matched clear cell RCC (ccRCC) and papillary RCC (pRCC). Subjects and Methods:This IRB-approved retrospective study included 54 stage-Ia patients with pathologically-confirmed CCTPRCC (n=18), ccRCC (n=18), and pRCC (n=18). CT (n=48) and MRI (n=27) exams were reviewed and imaging features compared. Continuous variables were evaluated using ANOVA and Tukey's multiple comparison tests. Categorical variables were compared using Chi square test or Fisher's exact test.Results: Compared to pRCC, CCTPRCC had a lower mean attenuation value on unenhanced CT (p<0.017), was more often hyperintense on T2-weighted images (p<0.0001), showed an illdefined margin (p=0.003), and demonstrated nonenhancing areas (p=0.0003). The presence of all three of these statistically significant features (hypoattenuation [unenhanced attenuation < 25HU], ill-defined margin, nonenhancing areas) yielded an area under the Receiver Operator Curve (ROC) of 0.92 (95% CI: 0.83-0.99) for differentiating CCTPRCC from pRCC. There were no significant differences in the imaging features of CCTPRCC and ccRCC. Conclusions:Early stage clear cell tubulopapillary renal cell carcinoma can be distinguished from papillary RCC based on low attenuation on unenhanced CT, high intensity on T2-weighted images, an ill-defined margin, and presence of nonenhancing areas, but cannot be distinguished from clear cell RCC. Author ManuscriptClick here to view linked References 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 CCTPRCC is now considered the fourth most common variant of RCC, behind ccRCC (70%), pRCC (16.6%), and chromophobe carcinoma (5.9%), with an incidence of 4.1% [1][2][3][4][5][6].CCTPRCC was reported initially in patients with end-stage renal disease, however, the majority of subsequent cases are now known to occur sporadically [1][2][3][5][6][7][8][9]. The average age at presentation is 60 and there is no sex predilection [1,2,8,9].There is limited literature on the biologic behavior of CCTPRCC, however, prior reports suggest that these neoplasms behave indolently, and carry a favorable prognosis [1][2][3][4][7][8][9][10]. To our knowledge, metastases have not been reported [1][2][3][4][7][8][9][10][11]. Therefore, the prospective differentiation of CCTPRCC from the more common subtypes such as clear cell RCC (ccRCC) and papillary RCC (pRCC) at an early stage may be useful for counseling patients on prognosis and treatment plans. For example, an active surveillance approach may be considered in a patient with CCTPRCC [12].To our knowledge, no prior study has attempted to differentiate CCTPRCC from other renal cell tumor subtypes ...

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MRI Features of Renal Oncocytoma and Chromophobe Renal Cell Carcinoma

Abstract: We have presented the largest series to date of the MRI features of both renal oncocytoma and chromophobe RCC. These related entities exhibited similar findings, and no MRI features were reliable in distinguishing between them.

Cited by 207 publications

References 34 publications

Subtypes of renal cell carcinoma: MRI and pathological features

Subtypes of renal cell carcinoma: MRI and pathological features

Arterial Spin-labeling MR Imaging of Renal Masses: Correlation with Histopathologic Findings

Early-stage clear cell tubulopapillary renal cell carcinoma: imaging features and distinction from clear cell and papillary subtypes

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