Malignant Renal Tumors

S. Wichien

Renal Masses Classified by Pathologic Features

Renal Masses Classified by Radiographic Appearance

Renal pseudotumors -hypertrophied column of Bertin -renal dysmorphism -unusually shaped kidney DMSA, dimercaptosuccinic acid -inc density pseudotumor -dec density cyst/solid tumor RMB, renal mass biopsy

Renal CT scan

After administration of the contrast Unenhanced CT scan shows agent, CT scan shows HU > 20 solid, right posterior renal mass

( highly suggestive of RCC )

Renal scan

A, CT scan after administration of contrast material shows isodense hilar mass in solitary right kidney. B, Right renal arteriography shows no neovascularity. C, Glucoheptonate isotope renal scan shows increased density of mass indicative of hypertrophied column of Bertin.

MRI with gadolinium

A large enhancing mass in the lateral anterior right kidney that is partially exophytic and extends to the central sinus

C/P : nephrogenic systemic fibrosis (NSF) in renal insuff pt

Renal mass biopsy

Patients who are potential candidates for a wide variety of treatment options ranging from observation to surgical Tx.
More traditional indications for renal mass biopsy include suspicion of renal abscess or when RCC must be differentiated from metastatic malignant disease or renal lymphoma.

Bosniak Classification

Bosniak class II renal cysts A, CT scan shows right renal cyst with thin internal septation. B, CT scan in another patient shows relatively thin, curvilinear calcification in the septa of the wall of right renal cyst.

Bosniak class II hyperdense cyst A, Unenhanced CT scan shows small, smooth-walled, highdensity left renal cyst. B, CT scan after administration of contrast material shows no enhancement of the cyst

Bosniak class III cysts A, CT scan shows complex right renal cyst with thick and irregular septa and inhomogeneous Character

B, CT scan shows somewhat thick-walled, complex left renal cyst also exhibiting irregular calcification and moderate heterogeneity

Bosniak class IV cysts A, CT scan shows complex left renal cystic lesion with thick, enhancing walls.
B, CT scan shows complex right cystic lesion with enhancing nodular areas and inhomogeneity. Both lesions proved to be renal cell carcinoma

Radiologic and Pathologic Correlates for Renal Masses

Solid renal mass

The diagnosis of most of these lesions can be established on the basis of the clinical presentation and the characteristic radiographic features, occasionally combined with endourologic studies or needle biopsy of the mass.
However, it is not possible to reliably distinguish RCC from benign renal neoplasms, including oncocytoma and fatpoor AML, with current diagnostic techniques
Ten to 20 percent of small, solid, CT-enhancing renal masses with features suggestive of RCC prove to be benign after surgical excision

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