skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Computed tomography of renal oncocytoma

Abstract

Renal oncocytoma is a relatively rare tumor that has an excellent prognosis and usually may be treated adequately by local resection. Preoperative differentiation from renal cell carcinoma, which requires radical nephrectomy, is thus of importance. The computed tomographic (CT) and pathologic features of three incidentally-detected renal oncocytomas were compared with those of six renal cell carcinomas of comparable size. Renal cell carcinoma appears on CT as a solid mass that generally has an indistinct interface with normal renal parenchyma, a lobulated contour, and a nonhomogeneous pattern of contrast enhancement. These features correlate with the pathologic findings of an irregular tumor margin and the frequent presence of tumor hemorrhage and necrosis. Oncocytoma, on the other hand, generally has a distinct margin, a smooth contour, and a homogeneous appearance on contrast-enhanced CT scans. These findings correlate with a smooth tumor margin and absence of tumor hemorrhage and necrosis on pathologic examination. These features are not pathognomonic of oncocytoma, as angiographic evidence suggests that renal cell carcinoma may show both distinct margination and a homogeneous blush in 6% of cases. However, their demonstration by CT should alert radiologists and surgeons to the possibility that a renal mass may be an oncocytoma. Such amore » presumptive diagnosis then can lead to a surgical approach that allows for renal-conserving surgery.« less

Authors:
 [1];
  1. (Univ. of Kansas, Kansas City)
Publication Date:
OSTI Identifier:
5527917
Resource Type:
Journal Article
Resource Relation:
Journal Name: AJR, Am. J. Roentgenol.; (United States); Journal Volume: 141:4
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; 59 BASIC BIOLOGICAL SCIENCES; KIDNEYS; COMPUTERIZED TOMOGRAPHY; NEOPLASMS; DIAGNOSIS; PATHOLOGY; PATIENTS; BODY; DIAGNOSTIC TECHNIQUES; DISEASES; ORGANS; TOMOGRAPHY; 550602* - Medicine- External Radiation in Diagnostics- (1980-); 550900 - Pathology

Citation Formats

Levine, E., and Huntrakoon, M. Computed tomography of renal oncocytoma. United States: N. p., 1983. Web. doi:10.2214/ajr.141.4.741.
Levine, E., & Huntrakoon, M. Computed tomography of renal oncocytoma. United States. doi:10.2214/ajr.141.4.741.
Levine, E., and Huntrakoon, M. 1983. "Computed tomography of renal oncocytoma". United States. doi:10.2214/ajr.141.4.741.
@article{osti_5527917,
title = {Computed tomography of renal oncocytoma},
author = {Levine, E. and Huntrakoon, M.},
abstractNote = {Renal oncocytoma is a relatively rare tumor that has an excellent prognosis and usually may be treated adequately by local resection. Preoperative differentiation from renal cell carcinoma, which requires radical nephrectomy, is thus of importance. The computed tomographic (CT) and pathologic features of three incidentally-detected renal oncocytomas were compared with those of six renal cell carcinomas of comparable size. Renal cell carcinoma appears on CT as a solid mass that generally has an indistinct interface with normal renal parenchyma, a lobulated contour, and a nonhomogeneous pattern of contrast enhancement. These features correlate with the pathologic findings of an irregular tumor margin and the frequent presence of tumor hemorrhage and necrosis. Oncocytoma, on the other hand, generally has a distinct margin, a smooth contour, and a homogeneous appearance on contrast-enhanced CT scans. These findings correlate with a smooth tumor margin and absence of tumor hemorrhage and necrosis on pathologic examination. These features are not pathognomonic of oncocytoma, as angiographic evidence suggests that renal cell carcinoma may show both distinct margination and a homogeneous blush in 6% of cases. However, their demonstration by CT should alert radiologists and surgeons to the possibility that a renal mass may be an oncocytoma. Such a presumptive diagnosis then can lead to a surgical approach that allows for renal-conserving surgery.},
doi = {10.2214/ajr.141.4.741},
journal = {AJR, Am. J. Roentgenol.; (United States)},
number = ,
volume = 141:4,
place = {United States},
year = 1983,
month =
}
  • Renal oncocytoma is an apparently benign neoplasm that is being reported with increasing frequency. It is important to differentiate it from renal-cell carcinoma prior to surgery. Angiographic, CT, and ultrasound studies may suggest the diagnosis but are not pathognomonic. In 4 cases, /sup 99m/Tc-glucoheptonate imaging of the renal tubules was performed; one patient was also scanned with /sup 131/I-orthoiodohippurate. There was no evidence of radionuclide uptake by the tumor. Reasons for the lack of success in differentiating renal oncocytoma from renal-cell carcinoma are discussed.
  • Renal oncocytoma, a neoplasm thought to derive from cells of the proximal convoluted tubules, exhibits benign clinical features. Its preoperative distinction from typical renal cell carcinoma would enable the surgeon to perform a more limited procedure. In a patient who is a poor operative candidate, surgery might be deferred. However, preoperative diagnosis has been elusive. A rare case of bilateral renal oncocytoma is reported. One of these tumors represents the first reported oncocytoma showing radiologically demonstrable calcification.
  • Renal oncocytomas are uncommon, benign tumors that can be treated by local incision 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. The authors evaluated radiographic studies of 18 pathologically confirmed cases of oncocytoma and compared findings with results of CT, sonography, and angiogrpahy studies of 18 renal cell carcinoma cases. Oncocytomas can be suggested if a stellate scar is identified within an otherwise homogeneous tumor on ultrasound (US) and CT; if the mass appearsmore » homogeneous but no scar is present, angiography should be performed.« less
  • In recent years, computed tomograpphy (CT) has been found extremely useful in the diagnosis and management of renal masses. Computed tomography provides an accurate morphological picture of the renal mass, and its precise contrast resolution allows identification of characteristic attenuation values as well. Often, the CT diagnosis is conclusive enough to obviate further diagnostic or preoperative radiological studies.
  • Acute renal infarction is rarely diagnosed before death despite fairly characteristics clinical and radiographic features. Definitive radiological diagnosis of renal infarction often requires invasive procedures such as retrograde pyelogrphy and angiography. The characteristic CT findings in three patients with proven renal infarction are reported. In these patients a CT rim sign was seen: a higher-attenuation subcapsular rim surrounded renal parenchyma of lower attenuation on contrast-enhanced scans. The appearance of renal infarction varies with both the extent and age of infarction. To assess these variables, segmental, major, and total renal infarcts were created in a series of six dogs; CT scansmore » were obtaied within 2 hr after infarction, and 1, 2, 4, and 8 weeks later. In all animals the ischemic and subsequently infarcted areas were seen on the initial examination as regions of low attenuation compared to the enhanced kidney. The low-attenuation areas markedly diminished by 2 weeks after infarction. CT should be useful in the prompt and noninvasive diagnosis of renal infarction.« less