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Renal cell carcinoma: histological classification and correlation with imaging findings.

Muglia VF, Prando A - Radiol Bras (2015 May-Jun)

Bottom Line: The histological classification of RCCs is of utmost importance, considering the significant prognostic and therapeutic implications of its histological subtypes.The present study is aimed at reviewing the main clinical and imaging findings of histological RCC subtypes.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Postdoctoral Scholar, Associate Professor at Centro de Ciências das Imagens e Física Médica (CCIFM) - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.

ABSTRACT
Renal cell carcinoma (RCC) is the seventh most common histological type of cancer in the Western world and has shown a sustained increase in its prevalence. The histological classification of RCCs is of utmost importance, considering the significant prognostic and therapeutic implications of its histological subtypes. Imaging methods play an outstanding role in the diagnosis, staging and follow-up of RCC. Clear cell, papillary and chromophobe are the most common histological subtypes of RCC, and their preoperative radiological characterization, either followed or not by confirmatory percutaneous biopsy, may be particularly useful in cases of poor surgical condition, metastatic disease, central mass in a solitary kidney, and in patients eligible for molecular targeted therapy. New strategies recently developed for treating renal cancer, such as cryo and radiofrequency ablation, molecularly targeted therapy and active surveillance also require appropriate preoperative characterization of renal masses. Less common histological types, although sharing nonspecific imaging features, may be suspected on the basis of clinical and epidemiological data. The present study is aimed at reviewing the main clinical and imaging findings of histological RCC subtypes.

No MeSH data available.


Related in: MedlinePlus

Clear cell RCC variant. MRI with the chemical shift imaging technique. In phase(A) and out of phase (B) images showing expansile,solid lesion in the right kidney (arrows) presenting with subtle signal loss inthe out of phase sequence, that is difficult to be visualized, characterized onlyby the signal intensity loss índex corresponding to 11% (signal intensityloss index = in phase signal intensity – out of phase signal intensity / in phasesignal intensity × 100).
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f03: Clear cell RCC variant. MRI with the chemical shift imaging technique. In phase(A) and out of phase (B) images showing expansile,solid lesion in the right kidney (arrows) presenting with subtle signal loss inthe out of phase sequence, that is difficult to be visualized, characterized onlyby the signal intensity loss índex corresponding to 11% (signal intensityloss index = in phase signal intensity – out of phase signal intensity / in phasesignal intensity × 100).

Mentions: At MRI, signal intensity similar to the one of the renal cortex at T1-weighted images,and hypersignal at T2-weighted images. Because of the presence of intracellular lipidcontent, other finding observed in up to 60% of ccRCC is signal loss at out-of-phaseimage as the chemical shift imaging technique is employed(17) (Figure 3). Itshould be observed that this is a nonspecific finding of ccRCC, since it may also beseen in angiomyolipoma without macroscopic fat and, more rarely, also in pRCC. ccRCC mayalso present a hypo-dense pseudocapsule in the corticomedullary phase at CT, and withhyposignal at MRI T1- and T2-weighted sequences. Discontinuity of this pseudocapsulegenerally indicates a high-grade tumor. The comparative analysis of the lesion signalintensity in the corticomedullary phase at contrast-enhanced MRI is an effective tool inthe differentiation between ccRCC and pRCC. Quantitative analysis of the contrast uptakeby tumors at multiphase examinations (corticomedullary, nephrographic and excretoryphases) demonstrated that the percentages of signal alteration in the three phases aftercontrast injection in relation to the pre-contrast phase were significantly higher inccRCC (230%, 250% and 227% for the corticomedullary, nephrographic and excretory phases,respectively) than in pRCC (49%, 92% and 88% for the corticomedullary, nephrographic andexcretory phases, respectively), or in crRCC (98%, 183% and 159% corticomedullary,nephrographic and excretory phases, respectively)(14).


Renal cell carcinoma: histological classification and correlation with imaging findings.

Muglia VF, Prando A - Radiol Bras (2015 May-Jun)

Clear cell RCC variant. MRI with the chemical shift imaging technique. In phase(A) and out of phase (B) images showing expansile,solid lesion in the right kidney (arrows) presenting with subtle signal loss inthe out of phase sequence, that is difficult to be visualized, characterized onlyby the signal intensity loss índex corresponding to 11% (signal intensityloss index = in phase signal intensity – out of phase signal intensity / in phasesignal intensity × 100).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492569&req=5

f03: Clear cell RCC variant. MRI with the chemical shift imaging technique. In phase(A) and out of phase (B) images showing expansile,solid lesion in the right kidney (arrows) presenting with subtle signal loss inthe out of phase sequence, that is difficult to be visualized, characterized onlyby the signal intensity loss índex corresponding to 11% (signal intensityloss index = in phase signal intensity – out of phase signal intensity / in phasesignal intensity × 100).
Mentions: At MRI, signal intensity similar to the one of the renal cortex at T1-weighted images,and hypersignal at T2-weighted images. Because of the presence of intracellular lipidcontent, other finding observed in up to 60% of ccRCC is signal loss at out-of-phaseimage as the chemical shift imaging technique is employed(17) (Figure 3). Itshould be observed that this is a nonspecific finding of ccRCC, since it may also beseen in angiomyolipoma without macroscopic fat and, more rarely, also in pRCC. ccRCC mayalso present a hypo-dense pseudocapsule in the corticomedullary phase at CT, and withhyposignal at MRI T1- and T2-weighted sequences. Discontinuity of this pseudocapsulegenerally indicates a high-grade tumor. The comparative analysis of the lesion signalintensity in the corticomedullary phase at contrast-enhanced MRI is an effective tool inthe differentiation between ccRCC and pRCC. Quantitative analysis of the contrast uptakeby tumors at multiphase examinations (corticomedullary, nephrographic and excretoryphases) demonstrated that the percentages of signal alteration in the three phases aftercontrast injection in relation to the pre-contrast phase were significantly higher inccRCC (230%, 250% and 227% for the corticomedullary, nephrographic and excretory phases,respectively) than in pRCC (49%, 92% and 88% for the corticomedullary, nephrographic andexcretory phases, respectively), or in crRCC (98%, 183% and 159% corticomedullary,nephrographic and excretory phases, respectively)(14).

Bottom Line: The histological classification of RCCs is of utmost importance, considering the significant prognostic and therapeutic implications of its histological subtypes.The present study is aimed at reviewing the main clinical and imaging findings of histological RCC subtypes.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Postdoctoral Scholar, Associate Professor at Centro de Ciências das Imagens e Física Médica (CCIFM) - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.

ABSTRACT
Renal cell carcinoma (RCC) is the seventh most common histological type of cancer in the Western world and has shown a sustained increase in its prevalence. The histological classification of RCCs is of utmost importance, considering the significant prognostic and therapeutic implications of its histological subtypes. Imaging methods play an outstanding role in the diagnosis, staging and follow-up of RCC. Clear cell, papillary and chromophobe are the most common histological subtypes of RCC, and their preoperative radiological characterization, either followed or not by confirmatory percutaneous biopsy, may be particularly useful in cases of poor surgical condition, metastatic disease, central mass in a solitary kidney, and in patients eligible for molecular targeted therapy. New strategies recently developed for treating renal cancer, such as cryo and radiofrequency ablation, molecularly targeted therapy and active surveillance also require appropriate preoperative characterization of renal masses. Less common histological types, although sharing nonspecific imaging features, may be suspected on the basis of clinical and epidemiological data. The present study is aimed at reviewing the main clinical and imaging findings of histological RCC subtypes.

No MeSH data available.


Related in: MedlinePlus