Download Atlas of Clinical Urology: The Kidneys and Adrenals by Norm D. Smith, Frederick L. Hoff, Steven C. Campbell PDF

By Norm D. Smith, Frederick L. Hoff, Steven C. Campbell (auth.), Andrew C. Novick MD, Michael Marberger MD (eds.)

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Most solid renal cell carcinomas are isoechoic, or slightly hyperechoic or hypoechoic, to the renal parenchyma. There is no increased through-transmission. t FIGURE 2-6. Computed tomographic image of a benign simple cyst. This lesion belongs in the Bosniak category 1 classification of cystic renal masses. The wall is thin, no septations or calcifications are present, the precontrast density is 0 to 20 Hounsfield units, and there is no enhancement with intravenous contrast material. This cyst is highly unlikely ever to harbor a renal cell carcinoma, and follow-up is not necessary in the absence of other signs or symptoms.

This hemodialysis patient has acquired cystic disease of the kidney; note the multiple small cysts in both kidneys, including one adjacent to the small renal cell carcinoma. Mter 5 to 10 years of dialysis, up ro 90% of patients with end-stage renal disease have acquired renal cystic disease. Renal cell carcinoma may develop in association with cysts in 1o/o to 2% of patients [9]. This prevalence of renal cell carcinoma appears to be greater than that seen in screening or autopsy studies, but the clinical usefulness of screening is debated [10,11].

Preoperative and postop erative staging of tumors using the T NM system is encouraged . NOS- not o therwise sp ecified. t FIGURE 2-25. Magnetic resonance image demonstrating nodal metastases from renal cell carcinoma. A large retrocaval lymph node is seen adjacent to the right kidney, which shows involvement by renal cell carcinoma. CT and magnetic resonance imaging usually can clearly define adenopathy in excess of 1 em. t FIGURE 2-26. Computed tomographic image demonstrating large bilateral adrenal metastases from renal cell carcinoma.

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