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Triphasic and epithelioid minimal fat renal angiomyolipoma and clear cell renal cell carcinoma: qualitative and quantitative CEUS characteristics and distinguishing features

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Abstract

Purpose

To determine the contrast-enhanced ultrasonography (CEUS) characteristics of minimal fat renal angiomyolipoma (AML) (triphasic and epithelioid) and compare them to each other and to clear cell renal cell carcinoma (ccRCC) to explore their differential diagnostic clue.

Methods

Qualitative and quantitative CEUS analyses were retrospectively conducted for epithelioid renal AMLs (EAMLs) (n = 15), triphasic minimal fat AMLs (TAMLs) (n = 25), and ccRCCs (n = 113). Enhancement patterns and features with CEUS were qualitatively evaluated. As for the quantitative parameters, rise times (RT), time to peak (TTP), and tumor-to-cortex enhancement ratio (TOC ratio) were compared among these renal tumor histotypes.

Results

No significant differences were detected on conventional ultrasound in the three histotypes of renal tumor. On qualitative CEUS analysis, centripetal enhancement in cortical phase (73.3% in EAMLs, 84.0% in TAMLs vs. 18.6% in ccRCCs, p < 0.001 for both), homogeneous peak enhancement (100.0% in both EAMLs and TAMLs vs. 43.4% in ccRCCs, p < 0.001 for both), and iso-enhancement in parenchyma phase (53.3% in AMLs, 52.0% in TAMLs vs. 26.5% in ccRCCs, p = 0.034 and 0.013, respectively) were valuable traits for differentiating EAMLs and TAMLs from ccRCCs. Furthermore, with quantitative analysis, RT and TTP were much shorter in ccRCCs than those in EAMLs and TAMLs. However, all these qualitative and quantitative characteristics made no significant difference between EAMLs and TAMLs. In the differential diagnosis of EAMLs from TAMLs, pseudocapsule sign was valuable (40.0% in EAMLs vs. 0.0% in TAMLs, p < 0.001), and TOC ratio was much higher in EAMLs (166.01 ± 64.47%) than that in TAMLs (93.74 ± 46.56%)(p < 0.001), though they did make overlaps with ccRCCs. With either heterogeneous peak enhancement or the presence of pseudocapsule or TOC ratio >97.34% as the criteria to differentiate ccRCCs and EAMLs from TAMLs, the sensitivity and specificity were 80.0% and 87.5%, respectively.

Conclusions

Qualitative and quantitative CEUS analyses are helpful in the differential diagnosis of ccRCCs, EAMLs, and TAMLs.

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References

  1. Bharwani N, Christmas TJ, Jameson C, Moat N, Sohaib SA (2009) Epithelioid angiomyolipoma: imaging appearances. Br J Radiol 82(984):e249–e252

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Lane BR, Aydin H, Danforth TL, et al. (2008) Clinical correlates of renal angiomyolipoma subtypes in 209 patients: classic, fat poor, tuberous sclerosis associated and epithelioid. J Urol 180(3):836–843

    Article  PubMed  Google Scholar 

  3. Kim JK, Park SY, Shon JH, Cho KS (2004) Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT. Radiology 230:677–684

    Article  PubMed  Google Scholar 

  4. Lu Q, Wang W, Huang B, Li C, Li C (2012) Minimal fat renal angiomyolipoma: the initial study with contrast-enhanced ultrasonography. Ultrasound Med Biol 38:1896–1901

    Article  PubMed  Google Scholar 

  5. Eble JN, Sauter G, Epstein JI, et al. (2004) Pathology and genetics of tumours of the urinary system and male genital organs (IARC WHO Classification of Tumours). Lyon: IARC Press, pp 9–43

  6. MacLennan GT, Cheng L (2008) Neoplasms of the kidney. In: Bostwick DG, Cheng L (eds) Urologic surgical pathology. St. Louis: Elsevier, pp 133–134

    Google Scholar 

  7. Lai HY, Chen CK, Lee YH, et al. (2006) Multicentric aggressive angiomyolipomas: a rare form of PEComas. AJR Am J Roentgenol 186:837–840

    Article  PubMed  Google Scholar 

  8. Ascenti G, Gaeta M, Magno C, et al. (2004) Contrast-enhanced second-harmonic sonography in the detection of pseudocapsule in renal cell carcinoma. AJR Am J Roentgenol 182:1525–1530

    Article  PubMed  Google Scholar 

  9. Pretorius ES, Siegelman ES, Ramchandani P, Cangiano T, Banner MP (1999) Renal neoplasms amenable to partial nephrectomy: MR imaging. Radiology 212:28–34

    Article  CAS  PubMed  Google Scholar 

  10. Goertz RS, Bernatik T, Strobel D, et al. (2010) Software-based quantification of contrast-enhanced ultrasound in focal liver lesions-A feasibility study. Eur J Radiol 75:e22–e26

    Article  PubMed  Google Scholar 

  11. Ignee A, Jedrejczyk M, Schuessler G, Jakubowski W, Dietrich CF (2010) Quantitative contrast enhanced ultrasound of the liver for time intensity curves-reliability and potential sources of errors. Eur J Radiol 73(1):153–158

    Article  PubMed  Google Scholar 

  12. Aydin H, Magi-Galluzzi C, Lane BR, et al. (2009) Renal angiomyolipoma: clinicopathologic study of 194 cases with emphasis on the epithelioid histology and tuberous sclerosis association. Am J Surg Pathol 33:289–297

    Article  PubMed  Google Scholar 

  13. Prasad SR, Sahani DV, Mino-Kenudson M, et al. (2007) Neoplasms of the perivascular epithelioid cell involving the abdomen and the pelvis: cross-sectional imaging findings. J Comput Assist Tomogr 31(5):688–696

    Article  PubMed  Google Scholar 

  14. Kim JK, Kim SH, Jang YJ, et al. (2006) Renal angiomyolipoma with minimal fat: differentiation from other neoplasms at double-echo chemical shift FLASH MRI imaging. Radiology 239:174–180

    Article  PubMed  Google Scholar 

  15. Milner J, McNeil B, Alioto J, Proud K, et al. (2006) Fat poor renal angiomyolipoma: patient, computerized tomography and histological findings. J Urol 176:905–909

    Article  PubMed  Google Scholar 

  16. Tsai CC, Wu WJ, Li CC, et al. (2009) Epithelioid angiomyolipoma of the kidney mimicking renal cell carcinoma: a clinicopathologic analysis of cases and literature review. Kaohsiung J Med Sci 25:133–140

    Article  PubMed  Google Scholar 

  17. Xu ZF, Xu HX, Liu GJ, Zheng YL, Lu MD (2010) Renal cell carcinoma and renal angiomyolipoma: differential diagnosis with real-time contrast-enhanced ultrasonography. J Ultrasound Med 29:709–717

    PubMed  Google Scholar 

  18. Jiang J, Chen Y, Zhou Y, Zhang H (2010) Clear cell carcinoma: contrast enhanced ultrasound features relation to tumor size. Eur J Radiol 73:162–167

    Article  PubMed  Google Scholar 

  19. Froemming AT, Boland J, Cheville J, Takahashi N, Kawashima A (2013) Renal epithelioid angiomyolipoma: imaging characteristics in nine cases with radiologic-pathologic correlation and review of the literature. AJR Am J Roentgenol 200:w178–w186

    Article  PubMed  Google Scholar 

  20. Pickhardt PJ, Lonergan GJ, Davis CJ Jr, Kashitani N, Wagner BJ (2000) From the archives of the AFIP Infiltrative renal lesions: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics 20:215–243

    Article  CAS  PubMed  Google Scholar 

  21. Yamashita Y, Honda S, Nishiharu T, Urata J, Takahashi M (1996) Detection of pseudocapsule of renal cell carcinoma with MR imaging and CT. AJR Am J Roentgenol 166:1151–1155

    Article  CAS  PubMed  Google Scholar 

  22. Pea M, Bonetti F, Martignoni G, et al. (1998) Apparent renal cell carcinomas in tuberous sclerosis are heterogeneous: the identification of malignant epithelioid angiomyolipoma. Am J Surg Pathol 22:180–187

    Article  CAS  PubMed  Google Scholar 

  23. Eble JN, Amin MB, Young RH (1997) Epithelioid angiomyolipoma of the kidney. A report of five cases with a prominent and diagnostically confusing epithelioid smooth muscle component. Am J Surg Pathol 21:1120–1130

    Article  Google Scholar 

  24. Forsberg F (2010) Can the effect of antiangiogenic treatments be monitored and quantified noninvasively by using contrast-enhanced US. Radiology 254(2):317–318

    Article  PubMed  Google Scholar 

  25. Quaia E, Alaimo V, Baratella E, et al. (2010) Effect of observer experience in the differentiation between benign and malignant liver tumors after ultrasound contrast agent injection. J Ultrasound Med 29(1):25–36

    PubMed  Google Scholar 

  26. Dong XQ, Shen Y, Xu LW, et al. (2009) Contrast-enhanced ultrasound for detection and diagnosis of renal cell carcinoma. Chin Med J 122(10):1179–1183

    PubMed  Google Scholar 

  27. Gerst S, Hann LE, Li D, et al. (2011) Evaluation of renal massed with contrast-enhanced ultrasound: initial experience. AJR Am J Roentgenol 197(4):897–906

    Article  PubMed Central  PubMed  Google Scholar 

  28. Kim JK, Kim TK, Ahn HJ, et al. (2002) Differentiation of subtypes of renal cell carcinoma on helical CT scans. AJR Am J Roentgenol 178:1499–1506

    Article  PubMed  Google Scholar 

  29. El-Esawy SS, Abou El-Ghar ME, Gaballa GM, et al. (2009) Characterization of solid renal masses using 64-slice multidetector CT scanner. Sci World J 12:441–448

    Article  Google Scholar 

  30. Zhang J, Lefkowitz RA, Ishill NM, et al. (2007) Solid renal cortical tumors differentiation with CT. Radiology 244(2):494–504

    Article  PubMed  Google Scholar 

  31. Kato I, Inavama Y, Yamanaka S, et al. (2009) Epithelioid angiomyolipoma of the kidney. Pathol Int 59:38–43

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ultrasound, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China

    Qing Lu, Cui-xian Li, Bei-jian Huang, Li-yun Xue & Wen-ping Wang

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  1. Qing Lu
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  2. Cui-xian Li
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  3. Bei-jian Huang
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  4. Li-yun Xue
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  5. Wen-ping Wang
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Corresponding author

Correspondence to Bei-jian Huang.

Additional information

Qing Lu and Cui-xian Li have contributed equally to the work.

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Lu, Q., Li, Cx., Huang, Bj. et al. Triphasic and epithelioid minimal fat renal angiomyolipoma and clear cell renal cell carcinoma: qualitative and quantitative CEUS characteristics and distinguishing features. Abdom Imaging 40, 333–342 (2015). https://doi.org/10.1007/s00261-014-0221-y

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