ABSTRACT
A 22-year-old black male presented with progressive dyspnea, a nonproductive cough, and new skin lesions. He was severely hypoxic, and had a severe restrictive defect on pulmonary function testing. A 2-cm lytic defect was noted on skull radiographs. A lung biopsy demonstrated pulmonary fibrosis. A biopsy of a skin lesion was consistent with a diagnosis of multifocal eosinophilic granuloma, or disseminated histiocytosis X. The case presents several unusual features of this uncommon disorder.
Subject(s)
Histiocytosis, Langerhans-Cell/diagnosis , Adult , Eosinophilic Granuloma/diagnosis , Humans , Male , Pulmonary Fibrosis/diagnosisABSTRACT
Renal oncocytomas are uncommon, benign tumors that can be treated by local excision or heminephrectomy; their preoperative differentiation from renal cell carcinoma, treated by radical nephrectomy, would be invaluable. A particularly important finding, a central scar--not stressed in previous reports, is frequently demonstrated by CT examination. We evaluated radiographic studies of 18 pathologically confirmed cases of oncocytoma and compared findings with results of CT, sonography, and angiography studies of 18 renal cell carcinoma cases. Oncocytomas can be suggested if a stellate scar is identified within an otherwise homogenous tumor on ultrasound (US) and CT; if the mass appears homogeneous but no scar is present, angiography should be performed. An oncocytoma can be suggested in these cases if a spoke-wheel configuration and homogeneous blush are present. These criteria, which are reliable only if the mass is 3 cm or larger, would have resulted in the correct diagnosis of oncocytoma in 16/18 cases.
