Genitourinary Malignancies in Transplant or Dialysis Patients: The Frequency of Two Newly Described 2016 World Health Organization Histopathologic Types.

BACKGROUND: The aim of this study was to revise the histopathologic types of neoplasias in the genitourinary tract and determine the frequency of 2 new entities included in the 2016 book of World Health Organization classification of renal tumors. It is not established so far whether these 2 recently described tumors are the most frequent in association with end-stage kidney disease. METHODS: In a retrospective analysis, we revised the histopathologic type of 37 genitourinary tumors from 21 patients in dialysis and/or submitted to renal transplantation from 2003 to 2016 aiming to find the frequency of acquired cystic disease-associated renal cell carcinoma and clear cell papillary (tubulopapillary) renal cell carcinoma. RESULTS: From the total of 37 tumors, 34 were from native end-stage kidneys, 1 from the pelvis of the transplant kidney, and 2 from the urinary bladder. The frequencies from native kidneys were: papillary carcinoma, 13/34 (38.2%); papillary adenoma, 9/34 (26.5%); acquired cystic disease-associated renal cell carcinoma, 4/34 (11.8%); oncocytoma, 3/34 (8.8%); conventional clear cell renal cell carcinoma, 3/34 (8.8%); and clear cell papillary (tubulopapillary) renal cell carcinoma, 2/34 (5.34%). The pelvis and urinary bladder tumors were high-grade urothelial carcinomas. The patients with urinary bladder tumors had been treated for polyomavirus infection. CONCLUSIONS: The frequencies of acquired cystic disease-associated renal cell carcinoma and clear cell papillary renal cell carcinoma were 11.8% and 5.9%, respectively. However, the spectrum of adenoma/carcinoma papillary tumors composed the majority, 64.7%, of tumors.

White matter development in adolescence: a DTI study.

Adolescence is a unique period of physical and cognitive development that includes concurrent pubertal changes and sex-based vulnerabilities. While diffusion tensor imaging (DTI) studies show white matter maturation throughout the lifespan, the state of white matter integrity specific to adolescence is not well understood as are the contributions of puberty and sex. We performed whole-brain DTI studies of 114 children, adolescents, and adults to identify age-related changes in white matter integrity that characterize adolescence. A distinct set of regions across the brain were found to have decreasing radial diffusivity across age groups. Region of interest analyses revealed that maturation was attained by adolescence in broadly distributed association and projection fibers, including those supporting cortical and brain stem integration that may underlie known enhancements in reaction time during this period. Maturation after adolescence included association and projection tracts, including prefrontal-striatal connections, known to support top-down executive control of behavior and interhemispheric connectivity. Maturation proceeded in parallel with pubertal changes to the postpubertal stage, suggesting hormonal influences on white matter development. Females showed earlier maturation of white matter integrity compared with males. Together, these findings suggest that white matter connectivity supporting executive control of behavior is still immature in adolescence.

Autotransplantation and stent implantation for bilateral renal artery fibromuscular dysplasia.

A 36-yr-old male was found to have renovascular hypertension due to an occluded right renal artery and 70% stenosis in the left renal artery, caused by fibromuscular dysplasia. The right kidney was supplied by collateral blood flow, and secreted more renin than the left kidney. Two differential therapeutic approaches were taken: autotransplantation for the right kidney and percutaneous transluminal renal angioplasty followed by stent implantation for the left. The renovascular hypertension was treated with these therapies, preserving renal function in this patient.

Percutaneous transluminal renal angioplasty of arterial divarication: application of kissing balloon technique.

We present a patient with renal artery stenoses due to fibromuscular dysplasia involving the point of arterial bifurcation that we could successfully dilate with percutaneous transluminal angioplasty. We used the kissing balloon technique to prevent possible complications of percutaneous transluminal renal angioplasty (PTRA), including occlusion of the other branch while dilating one branch. The kissing balloon technique worked well for PTRA of the arterial bifurcation.

Multiple fractionated and single-dose irradiation of bone marrow. Evaluation by MR and correlation with histopathological findings.

PURPOSE: To evaluate the MR appearance of bone marrow during and after multiple fractionated and single-dose irradiation using SE sequences, with histopathological correlation. MATERIAL AND METHODS: The left hind limbs of Wistar rats were irradiated with doses of either 2 Gy x 10 fractions or 20 Gy as a single dose. MR images of the femora were taken on days 0, 1, 3, 5, 7, 10, 15, 20, 25, 30, 40, 50, 60, 90, 120, 150 and 180. T1-, proton-density- and T2-weighted images were obtained with SE sequences. The rats were sacrificed on days 3, 12, 40 and 180 for histological study. RESULTS: No significant change in the T1 relaxation time was observed in the fractionated group during the first 15 days after irradiation. T2 did not change during the initial 7 days. There were significant differences in T1 and T2 between nonirradiated and fractionated, and between fractionated and single-dose irradiated marrows (p < 0.01). Sinusoidal dilatation, decrease in cellularity, and hemorrhage were observed on day 3. Fat increased on/after day 12. The fractionated group showed mild changes compared to the single-dose irradiated group. CONCLUSION: The T1 and T2 relaxation times of bone marrow receiving multiple fractionated irradiation did not change significantly on SE sequences during the early phase. However, dilatation of sinusoids, hemorrhage, decrease in cellularity, and increase in fat content were observed. Single-dose irradiation resulted in marked and early changes in T1 and T2 of the bone marrow.

Lipiodolized gelatin sponge: a simple method to make gelatin sponge radiopaque.

Gelatin sponge particles were rendered radiopaque by soaking them in small amounts of iodized oil (LP-GS). They were evaluated for their usefulness in transarterial embolization (TAE). The LP-GS particles were well visualized fluoroscopically during TAE. The duration of the opacity of LP-GS exceeded 24 hours both in vitro and in vivo. LP-GS are useful, and are an easily obtainable, radiopaque, embolic material.

Changes in contrast enhancement of hepatocellular carcinoma and liver: effect of temporary occlusion of a hepatic vein evaluated with spiral CT.

PURPOSE: To assess the hemodynamics of the liver and of hepatocellular carcinomas (HCCs) with hepatic vein occlusion. MATERIALS AND METHODS: Selected hepatic veins were temporarily occluded with a balloon catheter in 21 patients with 28 nontreated nodular HCCs. Computed tomographic (CT) arteriography was performed without and with temporary occlusion of a hepatic vein that drained the blood from segmental liver parenchyma containing tumor by using a unified spiral CT and angiography system. The degree of enhancement and change in appearance of the HCC in each condition were compared. RESULTS: All HCCs were well-enhanced, almost round masses at CT arteriography. At CT arteriography with hepatic vein occlusion, however, HCCs were changed as follows: (a) the absolute attenuation of the HCC was decreased in 27 (96%) of 28 tumors compared with that at CT arteriography without hepatic vein occlusion, while attenuation of the surrounding liver parenchyma was increased; (b) the size of the highly enhanced area in HCC became smaller in 17 (61%) tumors (of these, two disappeared); and (c) the shape was changed in 12 (43%) tumors. CONCLUSION: Hepatic vein occlusion resulted in reciprocal hemodynamic changes in the liver parenchyma relative to HCCs: Enhancement of the liver increases and that of HCCs decreases.

Adult cystic Wilms' tumor (nephroblastoma): radiologic features with pathologic correlation.

Wilms' tumor is an uncommon disease in adults. Wilms' tumor typically presents as a large complex mass with cystic component and varying degrees of vascularity. The previously reported radiologic findings have reflected this complex appearance. We present a case of cystic Wilms' tumor in an adult patient. The tumor presented as a large, rapidly growing, hypovascular, multicystic mass with minimal solid component which showed as septation on ultrasound, contrast enhanced CT, and MR studies. The preoperative findings were suggestive of multilocular cystic nephroma. We suggest that Wilms' tumor should be included in the differential diagnosis of a patient who presents with a large, rapidly growing, multicystic renal mass.

Evaluation of surgically formed collateral circulation in moyamoya disease with 3D-CT angiography: comparison with MR angiography and X-ray angiography.

Three patients with moyamoya disease who had undergone bypass surgery at which bilateral encephaloduro-arterio-synangiosis (EDAS) anastomoses were created were studied with three-dimensional spiral CT angiography (3D-CTA). In one patient, magnetic resonance angiography (MRA) clearly visualized the bilateral EDAS, and 3D-CTA also visualized these anastomoses in detail with extreme clarity. In the other two patients, MRA did not clearly demonstrate the right EDAS anastomosis, but 3D-CTA visualized both side surgical collaterals clearly. External carotid angiography confirmed these findings. 3D-CTA might have great value in the evaluation of surgical bypass patency and, in following the disease progression.

Effect of temporary occlusion of the hepatic vein on dual blood in the liver: evaluation with spiral CT.

PURPOSE: To evaluate the contribution of hepatic veins to the dual blood supply in the liver under temporary hepatic venous occlusion. MATERIALS AND METHODS: Selected hepatic veins in 23 patients with liver tumors were temporarily occluded with a balloon catheter. Computed tomography (CT) arteriography, CT during arterial portography (CTAP), or both were performed with a spiral technique with and without temporary occlusion of a hepatic vein. RESULTS: After hepatic vein occlusion, a well-demarcated, wedge-shaped area of hypoattenuation was seen at CTAP and/or hyperattenuation was seen at CT arteriography in the following regions: left lobe (left hepatic vein), ventral part of the anterior segment and the medial segment except for the ventromedial part (middle hepatic vein), dorsal part of the anterior segment and the ventral part of the posterior segment (right hepatic vein), and dorsocaudal part of the right lobe (inferior right hepatic veins). CONCLUSION: After hepatic venous occlusion, the portal veins become draining veins and the occluded area is supplied with arterial blood alone.

[Spatial and temporal alteration of the dual supply of the hepatic circulation with transient occlusion of the hepatic veins: spiral volumetric CT during arterial portography and arteriography].

To elucidate the contribution of hepatic veins to the blood flow of liver, CT arterial portography and/or arteriography was performed in eight patients having hepatocellular carcinoma with transient occlusion of the hepatic vein and eight without occlusion. In each patient with occlusion of the hepatic vein, CT showed a well-demarcated fan-shaped area of low density during arterial portography and increased density during arteriography in the corresponding area. Hepatic vein occlusion could result in the pooling of arterial blood in the liver parenchyma. Transient segmental hepatic venous occlusion might improve the results of transcatheter arterial infusion and transcatheter arterial embolization for liver tumors.

[A case of a rare anomaly of the abdominal aorta--magnetic resonance image and angiographic finding].

A case of a rare anomaly of the abdominal aorta was reported. The abdominal aorta was divided into two abnormal vessels and one vessel was celiac artery, and the other was considered to be abdominal aorta. To review literature, this type of anomaly of abdominal aorta is rare. Anatomy of this case had been well demonstrated by MR imaging and angiography. Those findings and the embryological basis of this case were discussed.