Renal cell carcinoma with a fatty component mimicking angiomyolipoma on CT.
A very unusual CT appearance of renal cel carcinoma is presented, in which the fatty density mimicked a benign angiomyolipoma.
Aged↗
Biomedical subjects
C Saussine
Publications and source records attributed to C Saussine.
[Tumors of the upper excretory tract].
Most tumors of the upper urinary tract are epithelial tumors from transitional cell origin. They are more frequent in the renal pelvis than in the ureter. They may be single or multiple and rarely bilateral. Gross hematuria is the most common presenting form. Computed tomography is useful both in the diagnosis and staging and is much more contributive than intravenous pyelography. Nephroureterectomy with a bladder cuff is the standard treatment for upper tract tumors. In selected cases are low grade and low stage tumors, conservative surgery can be discussed with similar longterm results than radical surgery.
Humans↗
Benign hyperplasia in ectopic prostatic tissue: a rare cause of pelvic mass.
Four cases of a pelvic mass due to the development of benign hyperplasia within ectopic prostatic tissue are reported. They presented a hypoechoic homogeneous or heterogeneous pattern on transrectal ultrasonography and a high signal intensity on T2-weighted spin-echo sequences on MR. On CT the density was similar to that of prostatic tissue. No recent imaging findings of this rare entity have been described in the literature. Possible aetiologies are discussed. Even if it is a rare event, the correct diagnosis can be reached. It is important for radiologists to consider the presence of this lesion because of its benign nature.
Aged↗
Small pelvic lymph node metastases: evaluation with MR imaging.
The purpose of this study was to determine if lymph node asymmetry in small (< 1.0 cm) pelvic lymph nodes was a significant prognostic feature in determining metastatic disease. Two hundred and sixteen patients who presented with pelvic carcinoma underwent magnetic resonance imaging (MRI). They were correlated with pathological findings obtained at surgery. We considered the maximum diameter (MAD) of both round- or oval-shaped suspicious masses seen in the axial plane. Two different cut-off values were determined: lymph node diameter greater than 1.0 cm (criterion 1) and lymph node diameter greater than 0.5 cm with asymmetry relative to the opposite side for lymph nodes ranging from 0.5 cm to 1.0 cm (criterion 2). With criterion 1, MRI had an accuracy of 88%, a sensitivity of 65%, a specificity of 96%, a positive predictive value (PPV) of 88% and a negative predictive value (NPV) of 88% in the detection of pelvic lymph node metastasis. By considering criterion 2, MRI had an accuracy of 85%, a sensitivity of 75%, a specificity of 91%, a PPV of 71% and a NPV of 91%. Normal small asymmetric lymph nodes were present in 5.6% of cases. Normal asymmetry of pelvic lymph nodes is not uncommon. It cannot be relied on to diagnose metastatic involvement in cases of small suspicious lymph nodes.
Adult↗
[Urinary complications during laparoscopy: a urachal diverticula injury].
The authors report a bladder injury during laparoscopic procedure. A laparotomy is performed immediately and shows an urachal anomaly with the bladder reaching the umbilic. One of the accessory trocars perforates the bladder in its unusual position. Surgical repair is made and the patient discharged without sequelae 12 days later. Rate of bladder injury increases with development of advanced laparoscopy as Burch and hysterectomy. Careful drainage with folley catheter during all laparoscopic procedures present greater than morbidity. Previous laparotomy may change the usual position of the bladder. Care must be taken in case of wall anomalies as in our observation. Per-operative suspicion of bladder injury (hematuria, presence of gas in the urinary catheter collection bag) can be proved with the injection of methylene blue in the folley catheter. Laparoscopic repair is possible for an experienced surgeon, associated with 10 days continuous urinary drainage and quinolone antibiotherapy. Morbidity of unknown bladder injury is great with some death-case reports. All diagnosis technique possible must be used to light these clinical situations, urinary peritonitis symptomatology is often non specific.
Adult↗
[Ureteroscopy for ureteral calculi. 379 cases].
OBJECTIVE: We report the experience of a centre which treated symptomatic ureteric stones exclusively by ureteroscopy. METHODS: From 1987 to 1993, 379 patients underwent ureteroscopy for ureteric stones, corresponding to 231 men and 148 women, between the ages of 8 and 80 years. The stones were situated in the pelvic ureter in 78.9% of cases, iliac ureter in 15.8%, and lumbar ureter in 5.3% of cases. An 11 F or Gautier ureteroscope was used. The only intracorporeal lithotripsy method consisted of an ultrasound transducer. Finally, our department does not possess an extracorporeal lithotripsy apparatus allowing the treatment of ureteric stones. RESULTS: The stone was eliminated immediately in 288 patients (76%), the stone was pushed back into the renal cavities in 40 patients (1.5%) and partial failures (residual fragments) or complete failures were observed in 51 patients (13.5%). 13 ureteric perforations (3.43%), treated by means of a double J ureteric stent, and one surgically drained urinoma were observed. 13 false passages of the ureteric meatus had an uneventful course by drainage with a double J stent. CONCLUSION: Ureteroscopy remains an effective method for the treatment of ureteric stones. It is associated with a definite morbidity, probably higher in a University Centre in which future urologists are trained.
Adolescent↗
Assessment of painful ureterohydronephrosis during pregnancy by MR urography.
The purpose of this study was to assess the value of the fast imaging sequence called RARE (rapid acquisition with relaxation enhancement) MR urography (or RMU) in pregnant women with painful ureterohydronephrosis. A total of 17 pregnant women with an acute flank pain were examined with RMU. Results were compared with those of US, X-rays and the evolution of symptoms. The gold standard techniques used to evaluate the results of MR urography were US when it showed the entire dilated urinary tract and the nature of the obstruction (9 cases), limited intravenous urography (IVU) when performed (3 cases) or endoscopic procedure (5 cases). The accuracy of RMU in the detection of urinary tract dilatation and the localization of the level of obstruction was excellent (sensitivity 100% in our series). The determination of the type of obstruction, intrinsic vs extrinsic, was always exact. The RMU technique alone could not specify the exact nature of the obstruction. The RMU technique is able to differentiate a physiological from a pathological ureterohydronephrosis during pregnancy. It could be considered as the procedure of choice when US failed to establish the differential diagnosis.
Adult↗
Effect of intrarenally infused parathyroid hormone-related protein on renal blood flow and glomerular filtration rate in the anaesthetized rat.
1. Parathyroid hormone-related protein (PTHrP) is expressed in the kidney and acts on vascular PTH/ PTHrP receptors to vasodilate the isolated kidney and to stimulate renin release. However, effects of PTHrP on renal blood flow (RBF) and glomerular filtration rate (GFR) in vivo have not been assessed in the absence of its cardiac, peripheral and central effects. We investigated the renal effects of PTH and PTHrP infused into the left renal artery of anaesthetized rats. 2. Intrarenal infusions, adjusted to generate increasing concentrations of human PTHrP(1-34) and rat PTH(1-34) in renal plasma (2 x 10(-11) to 6 x 10(-9) M) produced a comparable dose-dependent increase in RBF. The rise was 4% at the lowest and 34% at the highest concentrations of peptides. Up to a concentration of 2 x 10(-9) M, mean arterial pressure (MAP) and heart rate were not affected, but at 6 x 10(-9) M, intrarenally infused peptides reached the peripheral circulation, and caused a fall in MAP within a few minutes. While MAP returned to basal value after the last peptide infusion, RBF remained more than 10% above control for at least 30 min. 3. Two competitive PTH/PTHrP receptor antagonists, [Nle8,18, Tyr34]-bPTH(3-34)amide and [Leu11, D-Trp12]-hPTHrP(7-34)amide (2 x 10(-8) M) were devoid of agonist activity, but markedly antagonized the dose-dependent increase in RBF elicited by PTHrP. 4. GFR and urine flow were measured in left PTHrP-infused experimental kidney and right control kidney. Renal PTHrP concentration of 10(-10) M elevated left RBF by 10%, and GFR by 20% without significantly increasing filtration fraction, and increased urine flow by 57%. In the right control kidney GFR and diuresis did not change. 5. The results indicate that PTHrP has similar renal haemodynamic effects as PTH and increases RBF, GFR and diuresis in anaesthetized rats.
Animals↗
Radical nephrectomy for renal cell carcinoma 30 mm. or less: long-term follow results.
PURPOSE: We investigated the clinical and pathological features, and long-term followup of patients with radical nephrectomy for renal cell carcinoma of 30 mm. or smaller and a normal contralateral kidney. MATERIALS AND METHODS: Between 1973 and 1993, 74 patients 29 to 83 years old (average age 60) underwent radical nephrectomy for renal cell carcinoma of 30 mm. or smaller. Average followup was 101 months (range 10 to 236). Of the 74 tumors 21 were stage pT1, 36 stage pT2 and 12 stage pT3 (all 69 stag N0 to NxM0), while 5 were stages pT1 to 3, N1 or M1. A total of 27 patients died during follow-up. Of 11 patients who died of disease progression 5 had metastatic disease initially. RESULTS: Overall survival rates were 73% at 5 years, 55% at 10 years and 38% at 20 years. Cancer-specific survival rates without the 5 patients with stage N1 or M1 disease were 91% at 5 years, and 80% at 10 and 20 years. For the group with nonmultifocal renal cell carcinoma, stage NO to Nx and/or MO, the cancer-specific survival rates were 93% at 5 years, and 81% at 10 and 20 years. For the group with multifocal renal cell carcinoma, stage NO to Nx and/or MO, the cancer-specific survival rate was 75% at 5, 10, and 20 years. There was a significant survival difference between the nonmultifocal and multifocal renal cell carcinoma groups at 5 years (p<0.05) but not at 10 and 20 years. CONCLUSIONS: Small renal cell carcinoma is definitively not a benign disease and a tumor of 30 mm. or smaller does not mean there is no risk of metastatic or multifocal disease.
Adult↗
[Endovascular treatment of hemorrhagic renal angiomyolipoma with platinum microcoils].
Haemorrhage is the major complication of renal angiomyolipoma and is classically treated surgically, but embolization constitutes an alternative treatment. Improvement of catheters and embolization materials now allows highly selective embolization. The authors present a case in which the use of a variable stiffness catheter and platinum microcoils allowed highly selective embolization of a haemorrhagic renal angiomyolipoma while preserving the functional renal parenchyma.
Adult↗
[Value of asymmetry criterion in MRI for the diagnosis of small pelvic lymphadenopathies (inferior or equal to 1 cm)].
The purpose of this study was to determine if lymph node asymmetry in small (< 1.0 cm) pelvic nodes was a significant prognostic feature in determining metastatic disease. 216 patients who presented pelvic carcinoma underwent MR imaging. They were correlated to pathological findings obtained by surgery. We considered on the axial plan the maximum diameter (MAD) of both round or oval-shaped suspicious masses. Two different cut-off values were determined: node diameter superior to 1.0 cm (criterion 1) and node diameter superior to 0.5 cm with asymmetry relative to the opposite side for nodes ranging from 0.5 cm to 1.0 cm (criterion 2). With criterion 1 MR Imaging had an accuracy of 88%, a sensitivity of 65%, a specificity of 96%, a PPV of 88% and a NPV of 88% in detection of pelvic node metastasis. By considering criterion 2, MR Imaging had an accuracy of 85%, a sensitivity of 75%, a specificity of 89%, a PPV of 71% and a NPV of 91%. Normal small asymmetric lymph nodes were present in 5.6% of cases. Asymmetry of normal or inflammatory pelvic nodes is not uncommon. It cannot be relied on to diagnose metastatic involvement in cases of small suspicious lymph nodes, especially because of its low specificity and positive predictive value.
Adult↗
Fast imaging MR assessment of ureterohydronephrosis during pregnancy.
PURPOSE: to assess the value of the fast imaging sequence called RARE-MR-Urography (RMU) for the diagnosis of pathologic ureterohydronephrosis during pregnancy. MATERIALS AND METHODS: 15 pregnant women with an acute flank pain were examined with RMU. Results were compared with those of ultrasonography (US), X-rays, and the evolution of symptoms. RESULTS: the accuracy of RMU in the detection of urinary tract dilatation and the localization of the level of obstruction was excellent (100%). The determination of the type of obstruction, intrinsic vs. extrinsic, was always exact. RMU alone cannot specify the exact nature of the intrinsic obstruction. Ultrasonography gave less sensitive information in terms of level (60%) and type of obstruction (53%). CONCLUSION: RMU is able to differentiate a physiological from a pathologic ureterohydronephrosis during pregnancy. It could be considered as a procedure of choice for special cases when US failed to establish this differential diagnosis.
Adult↗
Superselective endo-vascular treatment of renal vascular lesions.
Embolization with platinum micro-coils delivered through the Tracker-18 micro-catheter was performed in 6 patients when peripheral selective catheterization with standard angiographic catheters was not possible. The patients had a total of 7 peripheral renal vascular lesions (3 arteriovenous fistulas, 2 false aneurysms, 1 direct vascular trauma and 1 arteriovenous malformation). In all patients we initially used platinum micro-coils as the embolic agent. Two patients required repeat embolization with glue. Endo-vascular treatment was technically successful in all cases and no complications were encountered. There was no renal parenchyma infarction in 3 patients and small peripheral infarctions (10 to 15% of the renal parenchyma) occurred in 3. Super selective endo-vascular treatment with a variable stiffness catheter is safe and useful technique when classical methods of embolization are not possible.
Adult↗
[Post-traumatic hematoma of the adrenal gland. Apropos of a case and review of the literature].
The authors report a case of delayed diagnosis of traumatic haematoma of the right adrenal gland. Chronic unilateral haematomas are rare and their preoperative diagnosis is often difficult because of the long interval since trauma, which may be completely forgotten. This raises the problem of an adrenal mass whose origin is often only detected on histology of the operative specimen.
Adrenal Gland Diseases↗
[Quid? Calcification of the inferior vena cava in an adult].
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Age Factors↗
Involvement of nitric oxide in the vasodilatory response to parathyroid hormone-related peptide in the isolated rabbit kidney.
1. The present study was designed to explore the role of NO derived from L-arginine in the vasodilatory response to synthetic human parathyroid hormone-related peptide-(1-34) in the isolated rabbit kidney perfused in the presence of indomethacin (10 mumol/l) and preconstricted with noradrenaline (7.2 nmol/min). 2. Under control conditions, bolus administrations of acetylcholine (10 mumol/l), an NO-dependent renal vasodilator, verapamil (0.1 mmol/l), an NO-independent renal vasodilator, and parathyroid hormone-related peptide (87 nmol/l) decreased the preconstriction pressure, by 31%, 71% and 43%, respectively. 3. Bolus administration of 100 mumol/l NG-nitro-L-arginine-methyl ester caused a 20% increment in the perfusion pressure of the noradrenaline-preconstricted kidney. NG-nitro-L-arginine methyl ester inhibited the vasodilatory effect of acetylcholine and parathyroid hormone-related peptide, by 68% and 44%, respectively, but did not alter the verapamil-induced vasodilatation. 4. Unlike L-arginine, the bolus administration of 1 mumol/l of a mono-substituted L-arginine derivative, N-alpha-benzoyl-L-arginine ethyl ester, durable decreased the noradrenaline/NG-nitro-L-arginine methyl ester-induced preconstriction by 57%. 5. Both L-arginine and N-alpha-benzoyl-L-arginine ethyl ester effectively reversed the inhibition induced by NG-nitro-L-arginine methyl ester on the vasodilatation elicited by acetylcholine and parathyroid hormone-related peptide. 6. In conclusion, the formation of NO from L-arginine contributes a substantial part to the vasodilatory action of parathyroid hormone-related peptide. Therefore, parathyroid hormone-related peptide appears to have a place among the renal haemodynamically active substances, whose vasodilatory actions are tuned by NO.
Acetylcholine↗
[Vaginal metastasis from cancer of the kidney].
Authors report a new case of vaginal metastasis from renal cell carcinoma. Their main characteristics are reviewed. Possible retrograde venous spread and genital vein ligation prior to manipulation of the kidney are highlighted.
Angiography↗
[Vesico-sphinteral disorders in multiple sclerosis: value of urodynamic tests].
Vesicosphincteric disorders are frequent in multiple sclerosis and lead to the diagnosis of this disease in 2 to 5% of cases. The clinical signs are dominated by urgency (60 to 80%), frequency (40 to 60%) and incontinence due to vesical disinhibition. Dysuria (15 to 30%) occurs in an areflexive or hyperactive bladder, associated with vesicosphincteric dyssnergia. These signs are frequently associated (50 to 80%). Cystomanometry shows detrusor hyperactivity in 50 to 78% of cases and hypoactivity in 20 to 40% of cases and dyssnergia is frequent (50 to 80%). There is no correlation between the clinical and urodynamic signs. Consequently, urodynamic studies are useful for establishing a precise urological diagnosis and to prescribe adapted and early treatment due to the long-term risk of upper tract damage.
Electrophysiology↗