Differentiation of Pathologic Subtypes of Papillary Renal Cell Carcinoma on CT
Takayuki Yamada1,
Mareyuki Endo2,3,
Masahiro Tsuboi4,
Toshio Matsuhashi1,
Kei Takase1,
Shuichi Higano1 and
Shoki Takahashi1
1 Department of Diagnostic Radiology, Tohoku University Hospital, Tohoku
University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai,
Miyagi 980-8574, Japan.
2 Department of Pathology, Tohoku University Hospital, Miyagi, Japan.
3 Present address: Department of Pathology, Sendai Kosei Hospital, Miyagi,
Japan.
4 Department of Radiology, Osaki Municipal Hospital, Miyagi, Japan.
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Fig. 1A —Typical pathologic features of papillary renal cell
carcinoma. Type 1 tumor of 41-year-old man. Photomicrograph shows tumor has
papillae covered by small cells arranged in single layer on papillary
membrane. Foamy cells are prominent. (H and E)
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Fig. 1B —Typical pathologic features of papillary renal cell
carcinoma. Type 2 tumor of 78-year-old man. Photomicrograph shows
pseudostratified nuclei on papillary cores and nucleolus formation. (H and
E)
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Fig. 2A —62-year-old woman with type 1 papillary renal cell carcinoma.
Pathologic tumor stage is pT1a. Contrast-enhanced CT scan shows tumor in right
kidney with distinct margins and homogeneous intratumoral density.
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Fig. 2B —62-year-old woman with type 1 papillary renal cell carcinoma.
Pathologic tumor stage is pT1a. Obtained 2 years after A,
contrast-enhanced CT scan shows tumor in right kidney has enlarged slightly,
but distinct margins and homogeneous intratumoral density are preserved.
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Fig. 3A —68-year-old man with type 1 papillary renal cell carcinoma.
Pathologic tumor stage is pT3a. Unenhanced CT scan shows tumor in right
kidney. Although tumor minimally infiltrates perirenal space pathologically,
margin is distinct radiologically and internal density is homogeneous.
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Fig. 4A —Illustrations show renal cortex is preserved in papillary
renal cell carcinoma. Type 1 tumor. Distinct tumor is noted in renal
parenchyma, adjacent to which renal capsule (dashed line) is intact.
Renal cortex in vicinity is preserved.
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Fig. 4B —Illustrations show renal cortex is preserved in papillary
renal cell carcinoma. Type 2 tumor. Indistinct tumor involving renal cortex
(asterisk) infiltrates centripetally. Despite more advanced stages
and larger size of type 2 tumor, renal cortex in vicinity is frequently
preserved as well as in type 1 tumors. Tumor extends beyond renal capsule
(dashed line).
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Fig. 5A —73-year-old man with type 2 papillary renal cell carcinoma.
Pathologic tumor stage is pT3b. Large hypodense tumor in right kidney is
recognized in nephrographic phase. Note delay in contrast in right kidney
compared with left kidney. Corticomedullary contrast still remains in right
kidney, unlike left kidney. True margin between tumor and renal parenchyma is
not indicated; tumor extends into central region as well as perirenal space.
Cortex (arrow) in vicinity of tumor is preserved.
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Fig. 5B —73-year-old man with type 2 papillary renal cell carcinoma.
Pathologic tumor stage is pT3b. Image shows tumor margins of infiltrating
component (arrow) are indistinct. Tumor density is somewhat
heterogeneously hypodense.
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Fig. 6B —78-year-old man with type 2 papillary renal cell carcinoma.
Pathologic tumor stage is pT3b. Contrast-enhanced CT scan obtained 7 months
after A in nephrographic phase shows enlargement of tumor
(arrow) in right kidney.
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Fig. 6C —78-year-old man with type 2 papillary renal cell carcinoma.
Pathologic tumor stage is pT3b. Contrast-enhanced CT scan obtained 14 months
after A in nephrographic phase shows heterogeneously hypodense tumor
infiltrating right renal vein.
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Fig. 6D —78-year-old man with type 2 papillary renal cell carcinoma.
Pathologic tumor stage is pT3b. Multiplanar reformat image shows
heterogeneously hypodense tumor forming tumor thrombus in right renal vein.
Preserved cortex (arrows) is recognized. Contrast-enhanced CT scan
shows hypodense tumor infiltrating right renal vein. Growth rate of type 2
tumor is faster than that of type 1 tumor, as shown in Figure
3A,
3B. F = foot, L = left.
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