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Significance of the Pseudocapsule on MRI of Renal Neoplasms and Its Potential Application for Local Staging: A Retrospective Study

¹ University Hospital of Strasbourg, Radiology B Chirugie A, Hopital Civil CHU, 1, place de l'hopital BP 426, Strasbourg, Cedex, France 67091.
² University Hospital of Strasbourg, Hopital Civil–Urology, Strasbourg, Cedex, France 67091.

View larger version (139K): [in a new window]   Fig. 1A. —50-year-old man with clear cell renal carcinoma and intact pseudocapsule. Stage: pT2. True-negative case. Axial fast spin-echo T2-weighted MRI (1800/150eff, turbo factor: 64) shows regular and complete hypointense rim (arrow) around high signal intensity with heterogeneous pattern of tumor.

View larger version (150K): [in a new window]   Fig. 1B. —50-year-old man with clear cell renal carcinoma and intact pseudocapsule. Stage: pT2. True-negative case. Photomicrograph shows tumor and its pseudocapsule. Pseudocapsule comprises increased deposit of fibrous perirenal capsule. It is localized between the tumor (conventional carcinoma with eosinophilic cells and tubular architecture) and normal perinephric fat. (H and E, original magnification x 25)

View larger version (163K): [in a new window]   Fig. 2A. —38-year-old man with small clear cell renal carcinoma. Stage: pT1. True-negative case. Axial T1-weighted gradient-refocused echo (GRE) MRI (18/6.9; flip angle: 70°). Tumor has slightly heterogeneous isointense signal. No identification of the pseudocapsule.

View larger version (134K): [in a new window]   Fig. 2B. —38-year-old man with small clear cell renal carcinoma. Stage: pT1. True-negative case. Axial fast spin-echo T2-weighted MRI (1800/150eff, turbo factor: 64) shows clearly regular pseudocapsule (arrow) surrounding high signal intensity of tumor.

View larger version (134K): [in a new window]   Fig. 2C. —38-year-old man with small clear cell renal carcinoma. Stage: pT1. True-negative case. Photograph of coronal section of upper part of nephrectomy specimen shows tumor surrounded with thick pseudocapsule (arrowhead).

View larger version (161K): [in a new window]   Fig. 2D. —38-year-old man with small clear cell renal carcinoma. Stage: pT1. True-negative case. Photomicrograph shows the pseudocapsule composed of thick compressed renal parenchyma with increased deposition of fibrous tissue. (H and E, original magnification x 25)

View larger version (164K): [in a new window]   Fig. 3. —38-year-old man with exophytic small papillary renal carcinoma. Stage: pT1. True-negative case. Axial fast spin-echo T2-weighted MRI (1800/150eff, turbo factor: 64). It shows homogeneous low-signal-intensity mass surrounded with regular hypointense aspect of pseudocapsule.

View larger version (134K): [in a new window]   Fig. 4A. —52-year-old woman with hemorrhagic exophytic papillary renal carcinoma. Stage: pT1. True-negative case. Axial T1-weighted gradient-refocused echo (GRE) MRI (18/6.9; flip angle: 70°). Tumor contains parts with high to moderate signal intensity.

View larger version (146K): [in a new window]   Fig. 4B. —52-year-old woman with hemorrhagic exophytic papillary renal carcinoma. Stage: pT1. True-negative case. Axial fast spin-echo T2-weighted MRI (1800/150eff, turbo factor: 64). Tumor has heterogeneous pattern. Pseudocapsule obviously is hypointense, thick, and regular (arrow).

View larger version (142K): [in a new window]   Fig. 5. —56-year-old man with large clear cell renal carcinoma. Stage: pT3. True-positive case. Axial fast spin-echo T2-weighted MRI (1800/150eff, turbo factor: 64). Short segmental disruption of outer part of pseudocapsule with extension inside perinephric fat (arrow).

View larger version (141K): [in a new window]   Fig. 6. —43-year-old woman with lower-pole clear cell renal carcinoma. Stage: pT1. True-negative case. Axial fast spin-echo T2-weighted MRI (1800/150eff, turbo factor: 64). It shows intact pseudocapsule as a regular rim surrounding the tumor. Stranding inside fatty tissue around the tumor was inflammation at pathology (arrowhead). It could have been a false-positive case by considering the isolated aspect of perinephric fat.

View larger version (136K): [in a new window]   Fig. 7. —35-year-old woman with clear cell renal carcinoma. Stage: pT1. False-positive case. Axial fast spin-echo T2-weighted MRI (1800/150eff, turbo factor: 64). No pseudocapsule identified at outer margin of tumor (arrow); confirmed at pathology. There was no involvement of the fatty tissue, despite irregular border of tumor on the MRI.

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