ABSTRACT
Objective: To evaluate the value of multi slice computed tomography (CT) in differential diagnosis of renal clear cell carcinoma and renal papillary carcinoma. Methods: The CT images of 47patients with renal cell carcinoma (RCC) were reviewed. The RCC patients were divided into 2 groups pathologically, including 37 cases of clear cell RCC and 10 cases of papillary RCC. Plain scan and three phase (corticomedullary, nephrographic and excretory phases) CT were performed in all patients. Age and sex of patients, tumor size, enhancement degree and pattern (homogeneous, heterogeneous and predominantly peripheral), the presence of calcification or cystic degeneration (necrotic or hemorrhagic areas within the tumor) and tumor spreading (including perinephric change, venous invasion and lymphadenopathy) were compared between the 2 subtypes. Results: The degrees of enhancement were significantly different between the 2 subtypes in the corticomedullary, parenchymal and excretory phases (P<0.05). Necrosis and cystic degeneration were more evident in the clear cell RCC than in papillary RCC regardless of tumor size (P<0.05). A hypervascular pattern (higher tumor enhancement after contrast material injection due to higher vascularity) was noted in 21.6% of clear cell RCC cases and in 10% of papillary RCC (P<0.05). Half of the clear cell RCC and 2.7% of papillary RCC patients showed homogeneous enhancement (P<0.05). Calcification was evident in 21.6% of clear cell RCC patients and 20% of papillary RCC patients. Conclusion: The degree of enhancement is the most valuable parameter for differentiation of clear cell RCC and papillary RCC. The presence of cystic degeneration, hemorrhage, vascularity and enhancement patterns can also contribute to the differentiation of the 2 subtypes.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the role of multiphasic spiral computed tomography (SCT) in the differential diagnosis of small renal cell carcinoma.</p><p><b>METHODS</b>The data of 100 patients with small renal cell carcinoma (< or = 3.0 cm) proved by pathology were retrospectively reviewed in order to analyze the features of SCT during plain, corticomedullary and excretory phases. There were 83 males and 17 females, with a mean age of 54. 3 years ranging from 9 to 81 years.</p><p><b>RESULTS</b>There were 38 tumor masses in the left kidney and 62 in the right one. They were 1.0-3.0 cm (mean, 2.5 cm) in the greatest dimension. According to the 2004 WHO histological classification criteria for the tumors of the kidney. Seventy-six patients had clear cell renal cell carcinoma, 4 multilocular clear cell renal cell carcinomas, 9 papillary renal cell carcinoma, 4 chromophobe renal cell carcinomas and 7 unclassified renal cell carcinomas. Clear cell renal cell carcinoma exhibited rich blood supply and inhomogeneous density due to hemorrhage, necrosis or cystic degeneration. Multilocular clear cell renal cell carcinoma presented as a multilocular cystic mass with thin wall and septa, instead of an expansile nodule. Papillary renal cell carcinoma showed inhomogeneous density and hypovascular distribution. Chromophobe renal cell carcinoma was relatively homogeneous and hypovascular. Compared with clear cell renal cell carcinoma, unclassified renal cell carcinoma showed inhomogeneous density and hypervascular distribution with more invading growth features than the other subtypes.</p><p><b>CONCLUSION</b>Commonly encountered subtypes of the small renal cell carcinoma exhibit their own specific features in multiphasic spiral CT, which may be helpful in differential diagnosis, but each subtype should be differentiated from the renal oncocytoma, cystic nephroma, complex renal cyst, renal angiomyolipoma with minimal fat and renal infiltrating urothelial carcinoma.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Carcinoma, Papillary , Diagnostic Imaging , Carcinoma, Renal Cell , Diagnostic Imaging , Diagnosis, Differential , Kidney Neoplasms , Diagnostic Imaging , Prognosis , Retrospective Studies , Tomography, Spiral Computed , MethodsABSTRACT
Objective To analyze the CT features of renal cell carcinoma,so as to improve the diagnostic accuracy of renal cell carcinoma.Methods Three hundred cases of renal cell carcinoma proved by pathology were examined by means of CT.There were 214 male and 86 female in this group.Their age ranged from 9 to 81 years,with a mean of 53.7 years.Their CT features were retrospectively reviewed. Results The masses were 1.5—16.0 cm(mean,4.8 cm)in greatest dimension,125 masses on left kidney and 175 masses on right kidney.According to WHO histological classification of tumours of the kidney in 2004,there were 238 cases of clear cell renal cell carcinoma,6 cases of multilocular clear cell renal cell carcinomas,23 cases of papillary renal cell carcinoma,14 cases of chromophobe renal cell carcinoma and 19 cases of renal cell carcinoma,unclassified.The above subtype of renal cell carcinoma demonstrated characteristic features.Clear cell renal cell carcinoma exhibited inhomogenous(due to hemorrhage,necrosis or cystic degeneration)and hypervaseular.Multilocular clear cell renal cell carcinoma presented as a multilocular cystic mass lacking an,expansile nodule,and with regular thin cyst wall and septa.Papillary renal cell carcinoma exhibited inhomogenous and hypovascular.Chromophobe renal cell carcinoma was relatively homogenous and hypovascular.Renal cell carcinoma,unclassified showed inhomogenous and hypervascular,and was more invading growth compared to clear cell renal cell carcinoma. Conclusion Common subtype of renal cell carcinoma demonstrated characteristic features in CT and it is helpful for differentiation.