Value of triphasic MDCT in the differentiation of small renal cell carcinoma and oncocytoma.

INTRODUCTION: Although differentiation between benign and malignant small renal tumors (≤4 cm) is still difficult, it is a demand for decision making and determining the treatment strategy. Our aim is to evaluate the role of multidetector row computed tomography (MDCT) in the differentiation of small renal clear cell carcinoma (RCC) and renal oncocytoma (RO). METHODS: We reviewed triphasic computed tomographic (CT) scans performed in 43 patients diagnosed with RCC (n = 23) and RO (n = 21). After an unenhanced CT phase of the upper abdomen, triple-phase acquisition included a cortico-medullary phase (CMP), a nephrographic phase (NP), and a pyelographic phase (PP), and lesions were evaluated both qualitatively and quantitatively. RESULTS: RCCs were hypervascular in 13 cases and hypovascular in 10 cases, while ROs were hypervascular in nine cases and hypovascular in 12 cases. Mean attenuation values (MAVs) for hypervascular RCCs and hypervascular ROs on unenhanced examination were 34.0 ± 7.1 and 31.3 ± 8.1 HU, respectively. Enhancement in CMP was 173.1 ± 45.2 HU for RCCs and 151.1 ± 36.0 HU for ROs and a gradual wash-out in NP (148.8 ± 34.3 and 137.1 ± 33.9 HU for RCCs and ROs, respectively) and in PP (98.2 ± 36.0 HU for RCCs and 79.4 ± 21.5 HU for ROs) was observed. MAV for hypovascular RCCs and hypovascular ROs on unenhanced examination were 32.4 ± 12.0 and 28.9 ± 8.0 HU, respectively. Both hypovascular RCCs and ROs showed a statistically significant difference in each post contrastographic phase. CONCLUSIONS: Absolute attenuation and the quantitative amount of the enhancement were not strong predictors for RO and RCC differentiation.

Rosai-Dorfman disease with atypical intrascrotal involvement.

We describe two new cases of Rosai-Dorfman disease with intrascrotal involvement. Also known as sinus histiocytosis with massive lymphadenopathy, this is a rare entity, usually presenting with massive bilateral cervical lymphadenopathy. It is associated with extranodal involvement in up to 40% of cases, commonly in the face and neck area. Isolated intrascrotal involvement with no lymphadenopathies is extremely rare, and its definitive diagnosis is histopathological. Although they are the most frequent type, not all intrascrotal lesions are neoplastic; therefore, it is important to know other possible etiologies and their radiogical features that might help in the diagnosis. We also review other cases of intrascrotal involvement reported in the literature, as well as a review clinical features, treatment and prognosis of this entity, and a differential diagnosis of solid intrascrotal lesions.

Resonancia fetal y síndrome de Currarino / Fetal magnetic resonance imaging and Currarino syndrome

El síndrome de Currarino es una agenesia sacra parcial autosómica dominante que implica los cuerpos vertebrales sacros S2 a S5, con preservación de S1. En la forma más severa del síndrome, la agenesia sacra se asocia a masa presacra y malformaciones anorrectales y urogenitales (AU)

Currarino syndrome is an autosomal dominant partial sacral agenesis involving sacral vertebrae S2 to S5, with preservation of the S1 vertebrae. In the most severe form of the syndrome, the sacral agenesis is associated with a presacral mass and anorectal and urogenital malformations (AU)

[Testicular adrenal remnants in cases of congenital adrenal hyperplasia: ultrasonography and MR imaging findings]. / Restos de tejido adrenal testicular en la hiperplasia suprarrenal congénita (HSC): hallazgos en ecografía y resonancia magnética.

OBJECTIVE: To show the characteristic findings of testicular ultrasound and MR imaging in patients with congenital adrenal hyperplasia and testicular adrenal remnants. METHODS/RESULTS: Male patient with congenital adrenal hyperplasia presenting with azoospermia. Testicular ultrasound showed heteroecogenic nodular lesions in both testicles. In view of the past medical history of the patient suspect of adrenal tissue remnants was raised. Testicular MRI findings supported the diagnosis. Regression of the intratesticular masses after glucocorticosteroid treatment confirmed the disease. CONCLUSIONS: The presence of a testicular mass in a patient with congenital adrenal hyperplasia may pose a diagnostic dilemma in relation to perform or not testicular biopsy or orchIectomy to identify it. The combination of imaging diagnostic tests such as testicular ultrasound and MRI, the medical history of congenital adrenal hyperplasia and the regression of the lesions after administration of glucocorticosteroids allow to identify this pathologic entity without performance of other invasive procedures.

[MRI for the diagnosis of Leydig cell testicular tumors]. / Resonancia magnética (RM) en el diagnóstico de tumor testicular de células de Leydig.

OBJECTIVE: To determine the diagnostic usefulness of MRI in the diagnosis of Leydig cell testicular tumor. METHODS/RESULTS: Male patient consulting for infertility. Testicular ultrasound and MRI were performed. Testicular MRI showed a hypointense lesion in T2 powered sequences with intense, homogeneous enhance after contrast administration. CONCLUSIONS: MRI is considered an excellent diagnostic test for the management of patients with testicular diseases of difficult diagnosis on ultrasound, contributing to define the lesion, a Leydig cell testicular tumor in this case.

Restos de tejido adrenal testicular en la hiperplasia suprarrenal congénita (HSC): hallazgos en ecografía y en resonancia magnética / Testicular adrenal remnants in cases of congenital adrenal hyperplasia: ultrasonography and MR imaging findings

Objetivo: Mostrar los hallazgos característicos en ecografía y Resonancia Magnética (RM) testicular de los restos de tejido adrenal testicular en la Hiperplasia Suprarrenal Congénita (HSC). Método/resultado: Varón con HSC que acude a la consulta de urología por azoospermia. Se le realiza ecografía testicular observando lesiones nodulares heterogéneas en ambos testículos. Por los antecedentes del paciente se sospecha restos de tejido adrenal. Los hallazgos en RM testicular apoyan el diagnóstico. La regresión de las masas intratesticulares tras el tratamiento con glucocorticoides confirma dicha patología. Conclusiones: La presencia de una masa testicular en un paciente con HSC puede plantear un dilema diagnóstico en cuanto a realizar una biopsia testicular ó una orquiectomía para identificar dicha lesión. Con las técnicas diagnósticas por imagen como la ecografía y la RM testicular, los antecedentes clínicos de HSC y la regresión de las lesiones tras administrar glucocorticoides, se identifica este tipo de patología sin realizar otros procedimientos de carácter invasivo (AU)

Objective: To show the characteristic findings of testicular ultrasound and MR imaging in patients with congenital adrenal hyperplasia and testicular adrenal remnants. Methods/results: Male patient with congenital adrenal hyperplasia presenting with azoospermia. Testicular ultrasound showed heteroecogenic nodular lesions in both testicles. In view of the past medical history of the patient suspect of adrenal tissue remnants was raised. Testicular MRI findings supported the diagnosis. Regression of the intratesticular masses after glucocorticosteroid treatment confirmed the disease. Conclusions: The presence of a testicular mass in a patient with congenital adrenal hyperplasia may pose a diagnostic dilemma in relation to perform or not testicular biopsy or orchyectomy to identify it. The combination of imaging diagnostic tests such as testicular ultrasound and MRI, the medical history of congenital adrenal hyperplasia and the regression of the lesions after administration of glucocorticosteroids allow to identify this pathologic entity without performance of other invasive procedures (AU)

Resonancia magnetica (RM) en el diagnóstico de un tumor testicular de células de Leydig / MRI for the diagnosis of Leydig cell testicular tumors

OBJETIVOS: Determinar la utilidad diagnóstica de la RM en el tumor testicular de las células de Leydig. METODOS /RESULTADOS: Varón que acude por estudio de infertilidad. Se le realiza ecografía y RM testicular. En la RM testicular la lesión es hipointensa en las secuencias potenciadas en T2 y con realce intenso y homogéneo tras la administración de contraste. CONCLUSIONES: La RM se considera un excelente método diagnóstico en el manejo de pacientes con patología testicular de difícil diagnóstico ecográfico, contribuyendo a filiar la lesión, en este caso un tumor testicular de células de Leydig (AU)

OBJECTIVE: To determine the diagnostic usefulness of MRI in the diagnosis of Leydig cell testicular tumor. METHODS/RESULTS: Male patient consulting for infertility. Testicular ultrasound and MRI were performed. Testicular MRI showed a hypointense lesion in T2 powered sequences with intense, homogeneous enhance after contrast administration. CONCLUSIONS: MRI is considered an excellent diagnostic test for the management of patients with testicular diseases of difficult diagnosis on ultrasound, contributing to define the lesion, a Leydig cell testicular tumor in this case