The small renal mass: detection, characterization, and management

Zagoria, Ronald J.; Dyer, Raymond B.

doi:10.1007/s002619900336

Cited by 40 publications

(4 citation statements)

References 34 publications

(58 reference statements)

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“…The diagnosis in the present case was based on the presence of typical morphology and immunophenotype (S100 CT scanning, with and without the administration of contrast material, is necessary to take full advantage of the contrast enhancement characteristics of highly vascular renal parenchymal tumours. In general, any renal mass that enhances with intravenous administration of contrast material on CT scanning by more than 15 HU should be considered an RCC until proven otherwise (7). In this patient, a contrast-enhanced CT revealed a heterogeneously enhanced mass (more than 20 HU; Fig.…”

Section: Discussionmentioning

confidence: 99%

Sporadic renal haemangioblastoma: Case report and review of the literature

et al. 2012

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Abstract. Haemangioblastoma is a benign tumour which generally occurs in a relatively restricted area of the central nervous system. Renal haemangioblastoma are extremely rare. We report a rare case of renal haemangioblastoma occurring in a 61-year-old male with a solid mass, which was detected during a routine examination. The patient was asymptomatic and abdominal computed tomography (CT) revealed a solid mass in the right kidney. No definitive preoperative diagnosis could be established. Surgical resection of the tumour revealed sporadic renal haemangioblastoma by pathological examination. The patient was followed up at 1 year without any problems. We also present a supplementary review of previously published cases and literature. IntroductionHaemangioblastoma is a slowly growing, highly vascular solid mass of uncertain histogenesis, also known as capillary haemangioblastoma (1). It typically occurs within the central nervous system (CNS), predominantly in the cerebellum (2). Renal haemangioblastoma is an extremely uncommon disease with a poorly established diagnosis due to a lack of descriptions of typical symptoms. To the best of our knowledge, there are 6 cases reported previously (Table I) (3,4). In the present study, we report the case of a patient with haemangioblastoma involving the kidney, which may be mistaken for other renal tumours, in particular renal cell carcinoma (RCC). The study was approved by the ethics committee of Peking University Shenzhen Hospital, Shenzhen, China. Written informed patient consent was obtained from the patient. Case reportA 61-year-old male, who was found to have a right renal tumour during a routine examination, was admitted to our department for further examination on April 20, 2011. The patient was asymptomatic with a normal appetite, no abdominal pain and no weight changes. The patient had no urinary, respiratory or cardiovascular symptoms, no constitutional symptoms and had not previously undergone surgery. His family history was unremarkable. Physical examination revealed a well-developed and well-nourished male. The patient was afebrile and had a pulse of 66 beats per min, temperature 36.7˚C, blood pressure 120/60 mmHg and respiration 20 per min. The chest was clear to percussion and auscultation and no masses were palpable on abdominal examination.Laboratory examination revealed that haemoglobin was 12.3 g/dl, white blood cell count was 7.21x10 9 /l, with 61.4% granulocytes. Glucose was 5.88 mmol/l, blood urea nitrogen was 8.25 mmol/l and serum creatinine was 82.2 µmol/l. Liver function tests and serum electrolytes were within normal limits. Urinalysis was unremarkable. Chest X-ray was normal. A non-contrast computed tomography (CT) scan of the kidneys revealed a 6.5x6.2-cm round hypodense mass [48.2-54.2 Hounsfield units (HU)] in the upper pole of the right kidney ( Fig. 1A and B). A contrast-enhanced CT revealed a heterogeneously enhanced mass with a non-enhanced hypodense region in the centre (Fig. 1C and D).A right radical nephrectomy was performed on Apri...

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Section: Discussionmentioning

confidence: 99%

Sporadic renal haemangioblastoma: Case report and review of the literature

et al. 2012

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“…Currently, the recommendation for indeterminate small renal masses is follow-up imaging studies [4] because it is thought that most of these lesions are cysts, and that even if the lesions are malignant, there is little risk of advancement of tumor stage [24]. However, it is also known that small renal malignancies can metastasize if left untreated [25], and earlier treatment may improve prognosis [26], since the tumor stage at the start of treatment is the most important prognostic factor for primary renal malignancy [27].…”

Section: Discussionmentioning

confidence: 99%

The characterization of small hypoattenuating renal masses on contrast-enhanced CT

et al. 2009

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Purpose To determine if small hypoattenuating renal masses can be characterized as simple cysts or renal cell carcinomas on contrast-enhanced computed tomography (CT). Materials and methods We retrospectively identified 20 small (≤1.5 cm) hypoattenuating renal masses seen on contrast enhanced CT, consisting of 14 simple cysts and six renal cell carcinomas. Three independent readers recorded subjective visual impression (five-point scale from 1=definitely fluid to 5=definitely solid), CT attenuation, border (well circumscribed or ill defined), and shape (ovoid or irregular) for each lesion. Results The overall area under the receiver operator characteristic curves for subjective visual impression, CT attenuation, border, and shape were 0.97, 0.82, 0.59, and 0.55, respectively. Using dichotomized ratings (1–2=cyst and 3–5=carcinoma), subjective impression had a sensitivity and specificity of 100% and 79–100%, respectively, for the diagnosis of renal cell carcinoma. Using a threshold of 50 Hounsfield Units (HU) or more, CT attenuation had a sensitivity and specificity of 100% and 43–64%, respectively. Conclusion Small hypoattenuating renal masses can be characterized with reasonable accuracy by subjective impression and CT attenuation; lesions that appear solid on visual inspection or have an attenuation value of 50 HU or more are likely to be renal cell carcinoma. © 2009 Elsevier Inc. All rights reserved.

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“…Furthermore, the discovery of an incidental renal mass of >5 cm, if not clearly characterized as malignant by radiological features, might also require biopsy. However, it could be argued that for lesions of <1 cm in diameter the overwhelming majority are simple cysts, unless the patient is predisposed to developing RCC [31] . However, for observation of renal tumours, a safe threshold size of <3 cm has been suggested, below which the metastatic potential of observed lesions is low [32] .…”

Section: Arguments In Favour Of Biopsy For Incidental Renal Tumoursmentioning

confidence: 99%

The role of biopsy in incidental renal tumours

Al-Marhoon

2011

Arab Journal of Urology

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PurposeHistorically, the biopsy of renal masses was not advocated, and to date there remains some controversy on the role of biopsy for renal masses in making treatment decisions. With the widespread use of imaging methods, the incidental diagnosis of renal masses has increased, necessitating renal biopsies to better plan the management of these tumours. Here I review previous reports to define the role of biopsy in incidental renal tumours.MethodsData were obtained from English-language studies listed in PubMed on the use of renal biopsy for evaluating incidental solid small renal tumours.ResultsThe biopsy of small renal tumours is increasingly accepted due to: the increase in the incidence of small renal tumours; the finding that a significant number of these tumours are benign; the availability of new management options, such as ablative therapy and surveillance strategies; that imaging alone is unable to predict the biological behaviour of these tumours; and advances in the pathological evaluation of the biopsies. The biopsy procedure has an acceptable complication rate but is not free of limitations. The current recommendations for the use of renal biopsy in small renal tumours are: to help in differentiating benign from malignant renal tumours; before or during ablative therapies and during the follow-up after ablative therapies, for defining treatment success or failure; and to exclude nonrenal cell primary tumours (metastasis and lymphoma) or benign conditions (abscess), which may not require surgery.ConclusionsThe biopsy of small renal tumours is a safe and accurate procedure, and can help in the planning of definitive patient management.

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The small renal mass: detection, characterization, and management

Cited by 40 publications

References 34 publications

Sporadic renal haemangioblastoma: Case report and review of the literature

Sporadic renal haemangioblastoma: Case report and review of the literature

The characterization of small hypoattenuating renal masses on contrast-enhanced CT

The role of biopsy in incidental renal tumours

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