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Contrast-Enhanced Second-Harmonic Sonography in the Detection of Pseudocapsule in Renal Cell Carcinoma

Giorgio Ascenti1, Michele Gaeta1, Carlo Magno2, Silvio Mazziotti1, Alfredo Blandino1, Darwin Melloni2 and Giovanni Zimbaro1

1 Department of Radiological Sciences, University of Messina, Via Consolare Valeria-Gazzi, Messina 98100, Italy.
2 Clinic of Urology, University of Messina, Messina 98100, Italy.



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  		Fig. 1A. —46-year-old man with renal cell carcinoma (RCC). Conventional sonogram shows 4-cm hyperechoic renal mass with no sign of pseudocapsule.

 


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  		Fig. 1B. —46-year-old man with renal cell carcinoma (RCC). After SonoVue ([an aqueous suspension of stabilized sulfur fluoride microbubbles] Bracco) injection on real-time second-harmonic mode, sonogram shows renal mass with intense and homogeneous contrast enhancement during early corticomedullary and late nephrographic phases. Pseudocapsule appears as hypoechoic rim during early contrast phase (B), becoming hyperechoic during late contrast phase (C).

 


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  		Fig. 1C. —46-year-old man with renal cell carcinoma (RCC). After SonoVue ([an aqueous suspension of stabilized sulfur fluoride microbubbles] Bracco) injection on real-time second-harmonic mode, sonogram shows renal mass with intense and homogeneous contrast enhancement during early corticomedullary and late nephrographic phases. Pseudocapsule appears as hypoechoic rim during early contrast phase (B), becoming hyperechoic during late contrast phase (C).

 


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  		Fig. 1D. —46-year-old man with renal cell carcinoma (RCC). After contrast medium is broken with high-acoustic pressure pulse, sonogram shows that pseudocapsule is hypoanechoic.

 


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  		Fig. 1E. —46-year-old man with renal cell carcinoma (RCC). Photomicrograph of histopathologic specimen obtained after radical nephrectomy reveals presence of thick pseudocapsule (asterisk) between RCC and normal parenchyma.

 


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  		Fig. 2A. —57-year-old man with renal cell carcinoma (RCC). Conventional sonogram shows inhomogeneous hyperechoic renal mass (3.5 cm) without evidence of pseudocapsule.

 


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  		Fig. 2B. —57-year-old man with renal cell carcinoma (RCC). After SonoVue ([an aqueous suspension of stabilized sulfur fluoride microbubbles] Bracco) injection on real-time second-harmonic imaging, sonogram shows that complete peritumoral enhanced hyperechoic rim (arrows), representing pseudocapsule, is clearly visible in later contrast phase.

 


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  		Fig. 2C. —57-year-old man with renal cell carcinoma (RCC). Photomicrograph of histopathologic specimen obtained after radical nephrectomy confirms presence of pseudocapsule (asterisk) around RCC.

 


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  		Fig. 3A. —52-year-old man with renal cell carcinoma (RCC). Conventional sonogram shows presence of 2-cm slightly hyperechoic renal mass (arrows) surrounded by hypoechoic halo.

 


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  		Fig. 3B. —52-year-old man with renal cell carcinoma (RCC). Contrast-enhanced second-harmonic sonogram shows that pseudocapsule appears as hyperechoic peritumoral rim (arrows). Pathologic examination (not shown) performed after nephron-sparing surgery confirmed presence of encapsulated RCC.

 

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