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Correlation of computed tomography characteristics of cystic renal cell carcinoma with histopathology


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Figure 1

Attenuation of the solid part of tumor in the corticomedullary phase in each subtype is shown in these box plots. Median values are indicated by the central bar. Box indicates the 95% confidence intervals and the whiskers indicate maximum and minimum values. Clear cell renal cell carcinoma (RCC) was the most enhancing tumor subtype in the corticomedullary phase. The least enhancing subtype was papillary RCC (P = 0.001).
Attenuation of the solid part of tumor in the corticomedullary phase in each subtype is shown in these box plots. Median values are indicated by the central bar. Box indicates the 95% confidence intervals and the whiskers indicate maximum and minimum values. Clear cell renal cell carcinoma (RCC) was the most enhancing tumor subtype in the corticomedullary phase. The least enhancing subtype was papillary RCC (P = 0.001).

Figure 2

Images from a 78-year-old man with clear cell renal cell carcinoma at the right kidney. Axial precontrast (A), corticomedullary phase (B), and nephrogenic phase (C) images. A. Precontrast CT: A 9.0 cm × 6.0 cm mixed solid-cystic lesion at lower pole of right kidney (HU 27.3). B. Corticomedullary phase: peripheral enhancing solid portion (HU 135.1) with central nonenhancing cystic component. C: Nephrogenic phase: persistent intense enhancement of solid portion (HU 102.2). The patient underwent a radical right nephrectomy. Clear cell renal cell carcinoma was proven from the histopathology.
Images from a 78-year-old man with clear cell renal cell carcinoma at the right kidney. Axial precontrast (A), corticomedullary phase (B), and nephrogenic phase (C) images. A. Precontrast CT: A 9.0 cm × 6.0 cm mixed solid-cystic lesion at lower pole of right kidney (HU 27.3). B. Corticomedullary phase: peripheral enhancing solid portion (HU 135.1) with central nonenhancing cystic component. C: Nephrogenic phase: persistent intense enhancement of solid portion (HU 102.2). The patient underwent a radical right nephrectomy. Clear cell renal cell carcinoma was proven from the histopathology.

Figure 4

Images from a 27-year-old man with von Hippel–Lindau disease with multilocular cystic renal cell carcinoma. Axial and coronal precontrast (A), corticomedullary phase (B) and nephrogenic phase (C and D) images.A. Precontrast CT: A 2.5 cm × 3.0 cm multilocular cystic lesion at the midpole of the left kidney (arrow).B. Corticomedullary phase: enhancing thickened internal septa in the tumor. C. Nephrogenic phase: persist enhancement of thickened internal septa. D. The coronal image on nephrogenic phase: thickened enhance internal septa with multilocularity appearance of this tumor. He also had multiple simple renal cortical cysts in both kidneys, another multilocular cystic RCC in right kidney (arrowhead in D).
Images from a 27-year-old man with von Hippel–Lindau disease with multilocular cystic renal cell carcinoma. Axial and coronal precontrast (A), corticomedullary phase (B) and nephrogenic phase (C and D) images.A. Precontrast CT: A 2.5 cm × 3.0 cm multilocular cystic lesion at the midpole of the left kidney (arrow).B. Corticomedullary phase: enhancing thickened internal septa in the tumor. C. Nephrogenic phase: persist enhancement of thickened internal septa. D. The coronal image on nephrogenic phase: thickened enhance internal septa with multilocularity appearance of this tumor. He also had multiple simple renal cortical cysts in both kidneys, another multilocular cystic RCC in right kidney (arrowhead in D).

Computed tomography of septal thickening, septal enhancement, and multilocularity compared between nonmultilocular cystic renal cell carcinoma (RCC) and multilocular cystic RCC subtypes

Findings/ typesNonmultilocularMultilocular cysticP
cystic RCCRCC
Septal thickening/enhancement
absence200
presence1440.053
Multilocularity
absence210
presence1340.04

Demographic data

Clinical dataOutcome
Number of cases38 lesions (35 patients)
 Sex
 Male33 (87%)
Female5 (13%)
Male: female ratio6.6
Age, mean (range) years58.84 years (23-87)
Type of surgery
 Radical nephrectomy27 (71%)
 Tissue biopsy8 (21%)
 Partial nephrectomy3 (8%)

Stage at diagnosis and histopathologic subtypes of renal cell carcinoma (RCC)

HistopathologyStage at diagnosis (%)Total
1234
Clear cell RCC1039325
Papillary RCC10135
Multilocular cystic RCC30104
Chromophobe RCC00101
Mix subtype00123
Total14 (37)3 (8)13 (34)8 (21)38 (100)

Bosniak’s classification of renal cell carcinoma (RCC)

SubtypeIII (% in subtype)IV (% in subtype)
Clear cell RCC2 (8%)23 (92%)
Papillary RCC0 (0%)5 (100%)
Multilocular cystic RCC0 (0%)4 (100%)
Chromophobe RCC0 (0%)1 (100%)
Mix type/other subtype0 (0%)3 (100%)

Parenchymal, cystic, and solid tumor attenuation (Hounsfield Units) of renal cell carcinomas (RCCs)

Findings typesClear cellPapillaryMultilocularChromophobeMix-typeP
RCCRCCcystic RCCRCCRCC
Renal parenchymal attenuation (mean)
Precontrast33.636.034.026.333.30.51
Cyst attenuation (mean)
Precontrast21.322.612.321.817.80.446
Corticomedullary phase28.028.417.323.620.30.66
Nephrogenic phase28.226.226.319.321.30.86
Solid attenuation (mean)
Precontrast37.236.027.337.840.00.27
Corticomedullary phase135.559.485.881.599.00.001
Nephrogenic phase112.171.892.882.286.30.042

Computed tomography of septal thickening and enhancement; wall thickening and enhancement, nodular enhancement, multilocularity, and calcification of renal cell carcinomas (RCCs)

Finding/ typesClear cellPapillaryMultilocularChromophobeMix-type
RCCRCCcystic RCCRCCRCCP
Septal thickening
absence181001
presence744120.02
Septal enhancement
absence181001
presence744120.02
Wall thickening
absence122011
presence1334020.32
Wall enhancement
absence121011
presence1344020.22
Nodular enhancement
absence213412
presence420010.52
Multilocularity
absence181011
presence744020.02
Calcification
absence154412
presence1010010.49

Histopathologic subtypes of renal cell carcinoma (RCC)

Histopathologic subtypeNumber (lesion)Percentage
Clear cell RCC2566%
Papillary RCC513%
Multilocular cystic RCC411%
Chromophobe RCC13%
Mixed type/other subtype

= papillary/chromophobe = 1, clear cell/chromophobe = 1, sarcomatoid type = 1

38%
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