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Diagnostic Yield of 58 Consecutive Imaging-Guided Biopsies of Solid Renal Masses: Should We Biopsy All That Are Indeterminate?

Michael D. Beland1, William W. Mayo-Smith1, Damian E. Dupuy1, John J. Cronan1 and Ronald A. DeLellis2

1 Department of Radiology, Diagnostic Imaging, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903.
2 Department of Pathology, Rhode Island Hospital, Providence, RI.


Figure 1
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  		Fig. 1A —77-year-old man with 2.4-cm right chromophobe renal cell carcinoma. Transverse unenhanced CT scan with patient supine shows right renal mass (arrow).

 

Figure 2
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  		Fig. 1B —77-year-old man with 2.4-cm right chromophobe renal cell carcinoma. Transverse contrast-enhanced CT scan in nephrographic phase with patient supine shows diffuse enhancement of right renal mass. With addition of immunohistochemistry, definitive diagnosis of chromophobe renal cell carcinoma was made on biopsy.

 

Figure 3
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  		Fig. 2A —Two examples of angiomyolipomas with no identifiable fat attenuation on CT. 71-year-old man with two masses in right kidney. Unenhanced CT image before biopsy with patient prone shows 1.6-cm exophytic mass (arrow) that enhanced on prior CT (not shown) and that has no visible fat attenuation. Biopsy of this mass and immunohistochemical analysis showed angiomyolipoma. Cyst (asterisk) was also noted.

 

Figure 4
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  		Fig. 2B —Two examples of angiomyolipomas with no identifiable fat attenuation on CT. 80-year-old woman with 2.5-cm solid enhancing right renal mass. Unenhanced transverse image with patient prone shows solid mass with no evidence of intralesional fat (arrow). Biopsy performed with immunohistochemical stain showed angiomyolipoma.

 

Figure 5
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  		Fig. 3A —49-year-old woman with 3.5-cm solid left renal metanephric adenoma. Transverse contrast-enhanced CT image with patient prone shows solid enhancing renal mass (arrow).

 

Figure 6
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  		Fig. 3B —49-year-old woman with 3.5-cm solid left renal metanephric adenoma. Transverse unenhanced CT fluoroscopy image obtained during renal biopsy with patient prone shows side-cutting needle biopsy tray in lesion (arrows). Biopsy specimen was analyzed with immunohistochemistry and was diagnostic of metanephric adenoma.

 

Figure 7
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  		Fig. 4A —Examples of immunohistochemistry in various types of renal tumors. CD117 (c-kit) positive staining in plasma membranes (arrow), which is strongly and consistently expressed in chromophobe renal cell carcinomas and oncocytomas. In this case, diagnosis was oncocytoma.

 

Figure 8
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  		Fig. 4B —Examples of immunohistochemistry in various types of renal tumors. Immunoperoxidase stain for Wilms tumor-1 gene product (WT1) shows distinctive nuclear pattern of staining (arrow) that is diagnostic of metanephric adenoma.

 

Figure 9
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  		Fig. 4C —Examples of immunohistochemistry in various types of renal tumors. Diffuse vimentin-positive cellular staining (arrow) in sarcomatoid tumor, rare, highly aggressive neoplasia.

 

Figure 10
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  		Fig. 4D —Examples of immunohistochemistry in various types of renal tumors. Renal cell carcinoma (RCC) monoclonal antibody stain shows focal positivity in cytoplasm and plasma membranes (arrow) of tumor cells. RCC monoclonal antibody is typically positive in clear cell and papillary renal cell carcinomas but negative in oncocytomas.

 

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