Distinguishing Infiltrative Transitional Cell Carcinoma From Other Infiltrative Lesions of the Kidneys on Multidetector Computed Tomography
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Abstract
Background: The infiltrative renal growth pattern is either characteristic of certain prototype transitional cell carcinomas (TCCs) or other mimickers. Specific computed tomography (CT) features may be used to differentiate TCCs from other overlap findings. Accurate early diagnosis is important to improve treatment outcome and prevent morbidity and mortality from delayed specific treatment.
Objective: To determine the multidetector computed tomography (MDCT) features that discriminate infiltrative TCCs from other infiltrative renal lesions.
Methods: A retrospective review was performed on patients with infiltrative, proven renal lesions on CT from January 2008 to July 2014. Individual CT sequences were analyzed for lesion number, location, size, and density on unenhanced and nephrographic phase scans. Final diagnoses were confirmed by histopathology or clinical or imaging follow-up after treatment. The CT findings of intrarenal TCCs and mimics were compared by using logistic regression analysis.
Results: In 73 patients, there were 18 (24.6%) TCCs, 2 (2.7%) renal cell carcinomas (RCCs), 11 (15.1%) lymphomas, 15 (20.5%) renal parenchymal metastases, 17 (23.3%) infections, and 10 (13.7%) other diagnosis. Compared to non-TCCs, intrarenal TCCs were more likely to be solitary lesion, lack intralesional calcification, less avidly enhance in nephrographic phase and infiltrate pelvicalyceal and perinephric tissue (P < .05).
Conclusions: Five MDCT features including solitary lesion, absence of calcification and poor absolute, relative enhancement, pelvicalyceal system involvement, and perinephric tissue invasion were significantly associated with intrarenal and infiltrative TCCs.
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References
Pickhardt PJ, Lonergan GJ, Davis CJ Jr, Kashitani N, Wagner BJ. From the archives of the AFIP. Infiltrative renal lesions: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics. 2000;20(1):215-243. doi:10.1148/radiographics.20.1.g00ja08215.
Hecht EM, Hindman N, Huang WC, Rosenkrantz AB, Melamed J. Extensive infiltrating renal cell carcinoma with minimal distortion of the renal anatomy mimicking benign renal vein thrombosis. Am J Kidney Dis. 2010;55(5):967-971. doi:10.1053/j.ajkd.2009.09.030.
Ambos MA, Bosniak MA, Madayag MA, Lefleur RS. Infiltrating neoplasms of the kidney. AJR Am J Roentgenol. 1977;129(5):859-864. doi:10.2214/ajr.129.5.859.
Silverman SG, Mortele KJ, Tuncali K, Jinzaki M, Cibas ES. Hyperattenuating renal masses: etiologies, pathogenesis, and imaging evaluation. Radiographics. 2007;27(4):1131-1143. doi:10.1148/rg.274065147.
Bosniak MA. The small (less than or equal to 3.0 cm) renal parenchymal tumor: detection, diagnosis, and controversies. Radiology. 1991;179(2):307-317. doi:10.1148/radiology.179.2.2014269.
Israel GM, Bosniak MA. How I do it: evaluating renal masses. Radiology. 2005;236(2):441-450. doi:10.1148/radiol.2362040218.
Kim JK, Kim TK, Ahn HJ, Kim CS, Kim KR, Cho KS. Differentiation of subtypes of renal cell carcinoma on helical CT scans. AJR Am J Roentgenol. 2002;178(6):1499-1506. doi:10.2214/ajr.178.6.1781499.
Zhang J, Lefkowitz RA, Ishill NM, et al. Solid renal cortical tumors: differentiation with CT. Radiology. 2007;244(2):494-504. doi:10.1148/radiol.2442060927.
Raza SA, Sohaib SA, Sahdev A, et al. Centrally infiltrating renal masses on CT: differentiating intrarenal transitional cell carcinoma from centrally located renal cell carcinoma. AJR Am J Roentgenol. 2012;198(4):846-853. doi:10.2214/AJR.11.7376.
Davenport MS, Neville AM, Ellis JH, Cohan RH, Chaudhry HS, Leder RA. Diagnosis of renal angiomyolipoma with Hounsfield unit thresholds: effect of size of region of interest and nephrographic phase imaging. Radiology. 2011;260(1):158-165. doi:10.1148/radiol.11102476.
Prando A, Prando P, Prando D. Urothelial cancer of the renal pelvicaliceal system: unusual imaging manifestations. Radiographics. 2010;30(6):1553-1566. doi:10.1148/rg.306105501.
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276-282.
Hartman DS, Davidson AJ, Davis Jr CJ, Goldman SM. Infiltrative renal lesions: CT-sonographic-pathologic correlation. AJR Am J Roentgenol. 1988;150(5):1061-1064. doi:10.2214/ajr.150.5.1061.
Bree RL, Schultz SR, Hayes R. Large infiltrating renal transitional cell carcinomas: CT and ultrasound features. J Comput Assist Tomogr. 1990;14(3):381-385.
Phatak SV, Kolwadkar PK. Renal and ureteral transitional cell carcinoma: a case report. Indian J Radiol Imaging. 2006;16(4):907-909. doi:10.4103/0971-3026.32381.
Leder RA, Dunnick NR. Transitional cell carcinoma of the pelvicalices and ureter. AJR Am J Roentgenol. 1990;155(4):713-722. doi:10.2214/ajr.155.4.2119098.
Yousem DM, Gatewood OM, Goldman SM, Marshall FF. Synchronous and metachronous transitional cell carcinoma of the urinary tract: prevalence, incidence, and radiographic detection. Radiology. 1988;167(3):613-618. doi:10.1148/radiology.167.3.3363119.
Cohan RH, Dunnick NR, Leder RA, Baker ME. Computed tomography of renal lymphoma. J Comput Assist Tomogr. 1990;14(6):933-938.
Richmond J, Sherman RS, Diamond HD, Craver LF. Renal lesions associated with malignant lymphomas. Am J Med. 1962;32:184-207. doi:10.1016/0002-9343(62)90289-9.
Heiken JP, Gold RP, Schnur MJ, King DL, Bashist B, Glazer HS. Computed tomography of renal lymphoma with ultrasound correlation. J Comput Assist Tomogr. 1983;7(2):245-250.
Urban BA, Fishman EK. Renal lymphoma: CT patterns with emphasis on helical CT. Radiographics. 2000;20(1):197-212. doi:10.1148/radiographics.20.1.g00ja09197.
Prkačin I, Naumovski-Mihalić S, Dabo N, Palcić I, Vujanić S, Babić Z. Comparison of CT analyses of primary renal cell carcinoma and of metastatic neoplasms of the kidney. Radiol Oncol. 2001;35(2):105-110.