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CT and MRI Appearances and

Radiologic Staging of Pediatric


Renal Cell Carcinoma
Journal Reading
Kepanitraan Klinik Ilmu Radiologi

oleh
Nurin Pascarini Jusaim
1102012205

Pembimbing
Kombes Pol. dr. A. Munir, Sp. Rad
Introduction
01
Background and Aim
02
TABLE OF 03 Materials

CONTENTS 04 Methods

Results
05
Conclusion
06
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I N T R O D U C T I O N
Primary renal malignancies in patients
younger than 20 years of age
2% 1%

5%

Wilms Tumor

Renal Cell Carcinoma


(RCC)
Clear cell carsinoma

Rhabdoid tumor

92%

Despite its relative infrequency compared to Wilms tumor,


RCC is a noteworthy childhood tumor with an incidence
that may be increasing especially in children with certain
genetic disorders
BACKGROUND
There are few data available regarding
the CT and MRI appearances of RCC in
children and adolescents

AIM There is little known about the accuracy


of these imaging modalities in the
pretreatment radiologic staging of RCC
in children
To determine the different CT and MRI
appearances of pediatric RCC as well as
evaluate the accuracy of pretreatment
radiologic staging using these imaging
modalities.
University of Michigan Health System
Departments of Pathology and Radiology
electronic medical record systems from Jan.
1, 1995, to Dec. 31, 2010

materials Subject/parent informed consent

Institutional review board approval

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01
Exclusion criterias

METHODS Patiens without either a


pretreatment contrast-enchanted
CT or MRI examination
Any child with multiple solid renal
masses in the same kidney

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02
03
CT / MRI Examination

Reviewed in consensus by
two radiologists
CT Exam
Only axial images were reviewed

Axial CT section width ranged from 0,625 mm to 5 mm

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04
Tumor Staging

Reviewers were asked to


characterize all renal tumors
using the 2010 American Joint
Comitte on Cancer (AJCC)
TNM staging system for RCC
05
Establishing surgicopathological stage
All reports in e-medical
record system for each
pediatric RCC patient were
reviewed by a single author

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American Joint Committee on Cancer (AJCC) 2010 TNM staging system for renal cell carcinoma
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Confirming the histopathological findings
The original hematoxylin and eosin stained slides
from each case were reviewed by a single pathologist

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results
History of Renal Cell Carcinoma
8 children 1 boy 1 girl (16 year-old)
had metachronous with tuberous sclerosis was
had a solitary renal tumor
bilateral renal tumors excluded from imaging review due
to the presence of bilateral
multicentric RCC (Fig. 1)
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Only contrast-enhanced CT
8 tumors

Radiology Only contrast-enhanced MRI


1 tumors

Staging
both CT and MRI
1 tumors

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Mean pediatric RCC maximum diameter was
6.2 cm (range 1.512.6 cm)

Nine (90%) tumors demonstrated


heterogeneous postcontrast enhancement

One (10%) tumors demonstrated


homogenous postcontrast enhancement

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Left stage 3 renal cell carcinoma in an 11-year-old girl
Five (50%) tumors had internal or adjacent hemorrhage

Right stage 4 renal cell carcinoma in a 17-year-old girl

Four (40%) tumors had calsification/ossification (arrow)

Three (30%) tumors had intralesional or adjacent neovascularity (headarrow)

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Left stage 3 renal cell carcinoma
Right stage 4 renal cell carcinoma Right stage 3 renal cell carcinoma in a 7-year-old girl with
in a 17-year-old girl in a 9-year-old boy a history of right Wilms tumor

A single child had evidence of distant There is an enlarged pathological A bulky, heterogeneous left para-aortic
abdominal metastatic disease lymph node located posterior to the lymph node (arrowheads)
IVC (arrow)
A small predominantly hyperintense,
hemorrhagic mass (arrow)

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Radiologic vs surgicopathologic TNM staging of pediatric renal cell carcinoma

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Discussion

01 02 03
While pediatric RCC is commonly Pediatric RCC has a widely variable Imaging overestimated the
initially recognized by sonog- raphy, radiologic appearance. While tumors are appropriate T stage. The results
subsequent imaging with either most commonly solitary, multifocal, suggest inaccurate T staging most
bilateral and metachronous disease may
contrast-enhanced CT or MRI is often often occurs when an incorrect
be detected. The tumors in our study
deemed necessary to define exact determination is made regarding
were quite variable in size, ranging from
local extent of the neoplasm, identify whether a tumor has breached the
1.5 to 12.6 cm, and most demonstrated a
the presence of lymph node heterogeneous postcontrast
renal capsule to involve perinephric
metastasis and detect distant enhancement pattern. Intrale- sional or fat
metastatic disease perilesional hemorrhage was quite
common
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RCC is an uncommon primary renal malignancy in

conclusion
children and adolescents

RCC characteristics : large, heterogeneously enhancing masses


that often contain internal calcification/ossification, one-half have
evidence of either intralesional or adjacent hemorrhage

Radiologic overall TNM staging of pediatric RCC is


usually concordant with final surgicopathologic staging

Hope: next study was designed to evaluate the sensitivity and


specificity of CT and MRI in the staging of pediatric RCC, will
establish the true accuracy of radiologic staging.

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