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Wei J, Ma Y, Liu J, Zhao J, Zhou J. A noninvasive comprehensive model based on medium sample size had good diagnostic performance in distinguishing renal fat-poor angiomyolipoma from homogeneous clear cell renal cell carcinoma. Urol Oncol 2025; 43:332.e1-332.e10. [PMID: 39648090 DOI: 10.1016/j.urolonc.2024.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 11/01/2024] [Accepted: 11/08/2024] [Indexed: 12/10/2024]
Abstract
PURPOSE To determine the diagnostic value of a comprehensive model based on unenhanced computed tomography (CT) images for distinguishing fat-poor angiomyolipoma (fp-AML) from homogeneous clear cell renal cell carcinoma (hm-ccRCC). METHODS We retrospectively reviewed 27 patients with fp-AML and 63 with hm-ccRCC. Demographic data and conventional CT features of the lesions were recorded (including sex, age, symptoms, lesion location, shape, boundary, unenhanced CT attenuation and so on). Whole tumor regions of interest were drawn on all slices to obtain histogram parameters (including minimum, maximum, mean, percentile, standard deviation, variance, coefficient of variation, skewness, kurtosis, and entropy) by two radiologists. Chi-square test, Mann-Whitney U test, or independent samples t-test were used to compare demographic data, CT features, and histogram parameters. Multivariate logistic regression analyses were used to screen for independent predictors distinguishing fp-AML from hm-ccRCC. Receiver operating characteristic curves were constructed to evaluate the diagnostic performances of the models. RESULTS Age, sex, tumor boundary, unenhanced CT attenuation, maximum tumor diameter, and tumor volume significantly differed between patients with fp-AML and those with hm-ccRCC (P < 0.05). The minimum, mean, first percentile (Perc.01), Perc.05, Perc.10, Perc.25, Perc.50, Perc.75, Perc.90, Perc.95, and Perc.99 of the Fp-AML group were higher than those of the hm-ccRCC group (P < 0.05). Coefficient of variance, skewness, and kurtosis were lower than those in the hm-ccRCC group (all P < 0.05). Age, maximum tumor diameter, unenhanced CT attenuation, and Perc.25 were independent predictors for distinguishing fp-AML from hm-ccRCC (all P < 0.05). The comprehensive model, incorporating age, maximum tumor diameter, unenhanced CT attenuation, and Perc.25, showed the best diagnostic performance (AUC = 0.979). CONCLUSION The comprehensive model based on unenhanced CT imaging can accurately distinguish fp-AML from hm-ccRCC and may assist clinicians in tailoring precise therapy, while also helping to improve the diagnosis and management of renal tumors, leading to the selection of effective treatment options.
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Affiliation(s)
- Jinyan Wei
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Yurong Ma
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Jianqiang Liu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Jianhong Zhao
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China.
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Chen ZX, Zhang Y, Ren S, Cao YY, Lan Q, Xia F, Wang ZQ, Qiu WL. Differential diagnosis of clear cell renal cell carcinoma with low signal intensity on T2WI from angiomyolipoma without visible fat on MR imaging. Front Oncol 2025; 15:1564485. [PMID: 40224181 PMCID: PMC11985441 DOI: 10.3389/fonc.2025.1564485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Accepted: 03/07/2025] [Indexed: 04/15/2025] Open
Abstract
PURPOSE This study aimed to determine the potential of magnetic resonance imaging (MRI) parameters in differentiating between angiomyolipoma without visible fat (AML.wovf) and clear cell renal cell carcinoma (ccRCC) with low signal intensity on T2-weighted imaging (T2WI). MATERIALS AND METHODS This is a retrospective study involving 36 cases of ccRCC and 17 cases of AML.wovf from September 2016 to July 2023. All patients underwent histological examination on resected specimens and contrast-enhanced magnetic resonance imaging (CE-MRI). Clinical characteristics such as age, gender, and symptoms of hematuria and lumbago were recorded. A panel of MRI parameters were analyzed, including the tumor growth patterns, the wedge-shaped sign, pseudocapsule formation, the arterial-to-delayed enhancement ratio (ADER), and the apparent diffusion coefficient (ADC). The potential of these MRI parameters in distinguishing ccRCC from AML.wovf was finally determined and visualized in a nomogram. RESULTS There were no significant differences in age, gender, and clinical symptoms between the ccRCC and AML.wovf groups. The wedge-shaped sign was more prevalent in patients with AML.wovf (p = 0.027), while pseudocapsule formation was mainly observed in cases of ccRCC (p < 0.001). Quantitative MRI revealed a significantly lower ADC in patients with AML.wovf (p = 0.007). Pseudocapsule formation (OR = 140.29, p = 0.004), the wedge-shaped sign (OR = 0.05, p = 0.047), and ADC (OR = 36.22, p = 0.037) were independent predictors for differentiating between AML.wovf and ccRCC, and their combination demonstrated the highest diagnostic accuracy, with an area under the curve (AUC) of 0.913 in the receiver operating characteristic (ROC) analysis. CONCLUSION A combination of MRI parameters, including the wedge-shaped sign, pseudocapsule formation, and ADC, can accurately differentiate between AML.wovf and ccRCC.
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Affiliation(s)
- Zi-xuan Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yi Zhang
- Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shuai Ren
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ying-ying Cao
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Qi Lan
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Fan Xia
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhong-qiu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wen-li Qiu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Qian L, Fu B, He H, Liu S, Lu R. CECT-Based Radiomic Nomogram of Different Machine Learning Models for Differentiating Malignant and Benign Solid-Containing Renal Masses. J Multidiscip Healthc 2025; 18:421-433. [PMID: 39881821 PMCID: PMC11776415 DOI: 10.2147/jmdh.s502210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Accepted: 01/20/2025] [Indexed: 01/31/2025] Open
Abstract
Objective This study aimed to explore the value of a radiomic nomogram based on contrast-enhanced computed tomography (CECT) for differentiating benign and malignant solid-containing renal masses. Materials and Methods A total of 122 patients with pathologically confirmed benign (n=47) or malignant (n=75) solid-containing renal masses were enrolled in this study. Radiomic features were extracted from the arterial, venous and delayed phases and further analysed by dimensionality reduction and selection. Four mainstream machine learning algorithm training models, namely, support vector machine (SVM), k-nearest neighbour (kNN), light gradient boosting (LightGBM) and logistic regression (LR), were constructed to determine the best classifier model. Univariate and multivariate analyses were used to determine the best clinical characteristics for constructing a clinical model. The radiomic and clinical signatures were integrated to construct a combined radiomic nomogram model. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to evaluate the performance of the radiomic nomogram, radiomic signature, and clinical model. Results Thirteen radiomic features were selected for the development of the radiomic signature. Among the various radiomic models, the LR model demonstrated superior predictive efficiency and robustness, yielding an AUC of 0.952 in the training cohort and 0.887 in the test cohort. The AUC for the clinical model was 0.854 in the training cohort and 0.747 in the test cohort. Furthermore, the radiomic nomogram, which incorporated sex, age, alcohol consumption history, and the radiomic signature, exhibited excellent discriminative performance, yielding an AUC of 0.973 in the training cohort and 0.900 in the test cohort. Conclusion The radiomic nomogram based on CECT offers a promising and noninvasive approach for distinguishing malignant from benign solid renal masses. This tool can be used to guide treatment strategies effectively and can provide valuable insights for clinicians.
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Affiliation(s)
- Lu Qian
- Department of Pathology, the First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650032, People’s Republic of China
| | - BinHai Fu
- Department of Nuclear Medicine, The First People’s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650032, People’s Republic of China
| | - Hong He
- Department of Nuclear Medicine, The First People’s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650032, People’s Republic of China
| | - Shan Liu
- Department of Pathology, the First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650032, People’s Republic of China
| | - RenCai Lu
- Department of Nuclear Medicine, The First People’s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650032, People’s Republic of China
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Falkowski P, Jaromin M, Ojdana M, Kutwin P, Konecki T. Impact of No-Clamping Partial Nephrectomy on Early Estimated Glomerular Filtration Rate Preservation. J Clin Med 2024; 13:5491. [PMID: 39336978 PMCID: PMC11432549 DOI: 10.3390/jcm13185491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/05/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
Incidences of kidney cancers are steadily increasing. The surgical resection of renal tumors remains the treatment of choice, and different techniques provide similar oncological outcomes. Minimally invasive methods, especially partial nephrectomy (PN), have emerged as the preferred method of tumor resection, both in traditional and robot-assisted laparoscopy. PN may be performed as an open or laparoscopic operation. On-clamp PN is a variant of PN that includes the clamping of renal vessels; off-clamp PN is performed without any ischemia. Objectives: To assess the short-term loss of eGFR after on-clamp and off-clamp PN. Methods: Data from 2021 to 2024 were retrospectively collected from a hospital database. The patients included in the study had a diagnosed kidney tumor that was confirmed by MRI or CT imaging. The patients were divided into two groups depending on the type of treatment they received: on-clamp PN or off-clamp PN. Hematocrit (HCT), hemoglobin (Hb) and eGFR were measured and compared. Results: Both groups had comparable preoperative HTC, Hb, and eGFR. eGFR loss 24 h after the procedure was 35.4% lower in the off-clamp group compared to the on-clamp group (p = 0.027). Conclusions: Off-clamp PN is a safe and viable method for kidney tumor resection, both in traditional and robot-assisted laparoscopy. This technique results in a smaller perioperative loss of eGFR, which relates to better short-term functional outcomes than on-clamp PN.
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Affiliation(s)
| | - Maciej Jaromin
- 1st Urology Clinic, University Clinical Hospital No. 2 of the Medical University of Lodz., 90-419 Lodz, Poland; (P.F.); (M.O.); (P.K.); (T.K.)
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Dipinto P, Canale V, Minelli R, Capuano MA, Catalano O, Di Pierro GB, Anceschi U, Perdonà S, Tufano A. Qualitative and quantitative characteristics of CEUS for renal cell carcinoma and angiomyolipoma: a narrative review. J Ultrasound 2024; 27:13-20. [PMID: 38238503 PMCID: PMC10908740 DOI: 10.1007/s40477-023-00852-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/23/2023] [Indexed: 03/03/2024] Open
Abstract
Incidental findings of renal masses are increasing. However, a substantial portion of surgically treated renal masses turn out to be benign on histopathological examination. Thus, there is a clear need for improved pre-surgical assessment to minimize unnecessary invasive procedures. The challenge intensifies when distinguishing between renal cell carcinoma (RCC) and angiomyolipoma (AML) in renal lesions smaller than 4 cm with minimal adipose tissue. In such cases, contrast-enhanced ultrasound (CEUS) has emerged as a valuable diagnostic tool, by utilizing both qualitative and quantitative parameters. Quantitative measures offer objectivity, reliability, and reproducibility compared to qualitative parameters, enabling the characterization of RCC subtypes and differentiation from AML. Qualitative features as enhancement pattern, degree, and peak were less helpful in distinguishing triphasic minimal fat AML (TAML) from epithelioid AML (EAML), with the pseudocapsule sign potentially being the only distinguishing qualitative feature. The pseudocapsule sign was more frequently observed in ccRCCs (38.0%) than in AMLs (15.6%). Moreover, it was detected in 40.0% of EAMLs and 34.5% of ccRCCs but not in TAMLs due to similar growth patterns between EAMLs and low-grade ccRCCs. Quantitative measures such as the time-to-peak (TTP) ratio can further enhance diagnostic accuracy and also TOC ratio should be considered, as it was higher in clear cell RCCs (ccRCCs) and in EAMLs compared to TAMLs, indicating behavior similar to ccRCCs. However, CEUS remains an operator-dependent exam.
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Affiliation(s)
- Piervito Dipinto
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162, Rome, Italy
| | - Vittorio Canale
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162, Rome, Italy.
| | - Rocco Minelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, CB, Italy
| | - Marco Alex Capuano
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, CB, Italy
| | - Orlando Catalano
- Radiology Unit, Varelli Diagnostic Institute, 80126, Naples, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144, Rome, Italy
| | | | - Antonio Tufano
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162, Rome, Italy
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Dehghani Firouzabadi F, Gopal N, Hasani A, Homayounieh F, Li X, Jones EC, Yazdian Anari P, Turkbey E, Malayeri AA. CT radiomics for differentiating fat poor angiomyolipoma from clear cell renal cell carcinoma: Systematic review and meta-analysis. PLoS One 2023; 18:e0287299. [PMID: 37498830 PMCID: PMC10374097 DOI: 10.1371/journal.pone.0287299] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 06/03/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE Differentiation of fat-poor angiomyolipoma (fp-AMLs) from renal cell carcinoma (RCC) is often not possible from just visual interpretation of conventional cross-sectional imaging, typically requiring biopsy or surgery for diagnostic confirmation. However, radiomics has the potential to characterize renal masses without the need for invasive procedures. Here, we conducted a systematic review on the accuracy of CT radiomics in distinguishing fp-AMLs from RCCs. METHODS We conducted a search using PubMed/MEDLINE, Google Scholar, Cochrane Library, Embase, and Web of Science for studies published from January 2011-2022 that utilized CT radiomics to discriminate between fp-AMLs and RCCs. A random-effects model was applied for the meta-analysis according to the heterogeneity level. Furthermore, subgroup analyses (group 1: RCCs vs. fp-AML, and group 2: ccRCC vs. fp-AML), and quality assessment were also conducted to explore the possible effect of interstudy differences. To evaluate CT radiomics performance, the pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were assessed. This study is registered with PROSPERO (CRD42022311034). RESULTS Our literature search identified 10 studies with 1456 lesions in 1437 patients. Pooled sensitivity was 0.779 [95% CI: 0.562-0.907] and 0.817 [95% CI: 0.663-0.910] for groups 1 and 2, respectively. Pooled specificity was 0.933 [95% CI: 0.814-0.978]and 0.926 [95% CI: 0.854-0.964] for groups 1 and 2, respectively. Also, our findings showed higher sensitivity and specificity of 0.858 [95% CI: 0.742-0.927] and 0.886 [95% CI: 0.819-0.930] for detecting ccRCC from fp-AML in the unenhanced phase of CT scan as compared to the corticomedullary and nephrogenic phases of CT scan. CONCLUSION This study suggested that radiomic features derived from CT has high sensitivity and specificity in differentiating RCCs vs. fp-AML, particularly in detecting ccRCCs vs. fp-AML. Also, an unenhanced CT scan showed the highest specificity and sensitivity as compared to contrast CT scan phases. Differentiating between fp-AML and RCC often is not possible without biopsy or surgery; radiomics has the potential to obviate these invasive procedures due to its high diagnostic accuracy.
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Affiliation(s)
- Fatemeh Dehghani Firouzabadi
- Radiology Department, National Institutes of Health, Clinical Center (CC), Bethesda, Maryland, United States of America
| | - Nikhil Gopal
- Urology Department, National Cancer Institutes (NCI), Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Amir Hasani
- Radiology Department, National Institutes of Health, Clinical Center (CC), Bethesda, Maryland, United States of America
| | - Fatemeh Homayounieh
- Radiology Department, National Institutes of Health, Clinical Center (CC), Bethesda, Maryland, United States of America
| | - Xiaobai Li
- Biostatistics and Clinical Epidemiology Service, NIH Clinical Center, Bethesda, MD, United States of America
| | - Elizabeth C Jones
- Radiology Department, National Institutes of Health, Clinical Center (CC), Bethesda, Maryland, United States of America
| | - Pouria Yazdian Anari
- Radiology Department, National Institutes of Health, Clinical Center (CC), Bethesda, Maryland, United States of America
| | - Evrim Turkbey
- Radiology Department, National Institutes of Health, Clinical Center (CC), Bethesda, Maryland, United States of America
| | - Ashkan A Malayeri
- Radiology Department, National Institutes of Health, Clinical Center (CC), Bethesda, Maryland, United States of America
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Cytomorphology of renal angiomyolipoma: performance and accuracy of touch preparation of core needle biopsy. J Am Soc Cytopathol 2023; 12:142-152. [PMID: 36702738 DOI: 10.1016/j.jasc.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/19/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The recognition of renal angiomyolipoma (AML) can be challenging based on cytology preparations such as touch preparation (TP) of core needle biopsy (CNB) and fine needle aspiration. This study evaluated the cytologic features and performance of TP of CNB during rapid onsite evaluation (ROSE) of renal AML. MATERIALS AND METHODS A pathology database search was performed between 2000 and 2021 for renal CNB specimens with ROSE using TP that were primarily favored AML on preliminary impression and/or confirmed AML on CNB or subsequent resection. RESULTS Twenty confirmed AML were identified (90% female, median age 65.5 years). Sixteen (80%) were deemed adequate for diagnosis at the time of ROSE, and 9 of 16 (56%) had available onsite impression: AML was favored in 4 of 9 cases (44%). Examination of TP slides revealed spindle/epithelioid cells in 20 (100%), adipose tissue in 14 (70%), and blood vessels in 3 (15%). All AML cases were subsequently confirmed by immunohistochemistry. Additionally, 3 other cases with ROSE favoring AML revealed to be "renal parenchyma with fibrosis," clear cell papillary renal cell tumor and clear cell renal cell carcinoma. CONCLUSIONS Onsite evaluation of TP ensures adequate material for diagnosis in most renal AML. Spindle/epithelioid cells were the most common component seen on TP, followed by adipose tissue. Blood vessels were rarely seen. While the recognition of AML at ROSE can be challenging, proper evaluation is important in obtaining adequate diagnostic tissue. Correlation with CNB and utilization of immunohistochemistry are crucial for arriving at the diagnosis.
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Lu SQ, Lv W, Liu YJ, Deng H. Fat-poor renal angiomyolipoma with prominent cystic degeneration: A case report and review of the literature. World J Clin Cases 2023; 11:417-425. [PMID: 36686346 PMCID: PMC9850960 DOI: 10.12998/wjcc.v11.i2.417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/16/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Angiomyolipoma (AML), the most common benign tumor of the kidney, is usually composed of dysmorphic blood vessels, smooth muscle, and mature adipose tissue. To our knowledge, AML with cystic degeneration has rarely been documented. Cystic degeneration, hemorrhage, and a lack of fat bring great challenges to the diagnosis.
CASE SUMMARY A 60-year-old man with hypertension presented with a 5-year history of cystic mass in his left kidney. He fell 2 mo ago. A preoperative computed tomography (CT) scan showed a mixed-density cystic lesion without macroscopic fat density, the size of which had increased compared with before, probably due to hemorrhage caused by a trauma. Radical nephrectomy was performed. Histopathological studies revealed that the lesion mainly consisted of tortuous, ectatic, and thick-walled blood vessels, mature adipose tissue, and smooth muscle-like spindle cells arranged around the abnormal blood vessels. The tumor cells exhibited positivity for human melanoma black-45, Melan-A, smooth muscle actin, calponin, S-100, and neuron-specific enolase, rather than estrogen receptor, progesterone receptor, CD68, and cytokeratin. The Ki-67 labeling index was less than 5%. The final diagnosis was a fat-poor renal AML (RAML) with prominent cystic degeneration.
CONCLUSION When confronting a large renal cystic mass, RAML should be included in the differential diagnosis.
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Affiliation(s)
- Shi-Qi Lu
- Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Wei Lv
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610044, Sichuan Province, China
| | - You-Jun Liu
- Department of Radiology, The Fourth Affiliated Hospital of Nanchang University, Nanchang 330003, Jiangxi Province, China
| | - Huan Deng
- Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, Nanchang 330003, Jiangxi Province, China
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Yang JW, Liang C, Yang L. Advancements in the diagnosis and treatment of renal epithelioid angiomyolipoma: A narrative review. Kaohsiung J Med Sci 2022; 38:925-932. [PMID: 36056704 DOI: 10.1002/kjm2.12586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/19/2022] [Accepted: 07/31/2022] [Indexed: 11/12/2022] Open
Abstract
Renal epithelioid angiomyolipoma (EAML) is a unique subtype of angiomyolipoma that contains a variety of cytoplasmic-rich, eosinophilic cytoplasm epithelioid cells in addition to mature adipocytes, hyaline thick-walled vessels, and smooth muscle-like spindle cells. In recent years, increasing evidence has shown that EAML is a potentially malignant tumor. Due to the lack of typical clinical manifestations and imaging features, it is difficult to diagnose before surgery, and the diagnosis mainly depends on postoperative histopathological examination. With the advancement of pathological diagnostic techniques, more EAML cases has been discovered, but clinicians still lack a comprehensive understanding of EAML. This review comprehensively describes some pathological and clinical features of EAML, with special attention to the pathogenesis and treatment of malignant EAML in order to assist with clinical diagnosis and treatment.
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Affiliation(s)
- Jian-Wei Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.,Clinical Center of Gansu Province for Nephron-urology, Lanzhou, China
| | - Cheng Liang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.,Clinical Center of Gansu Province for Nephron-urology, Lanzhou, China
| | - Li Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.,Clinical Center of Gansu Province for Nephron-urology, Lanzhou, China
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Kim TM, Ahn H, Lee HJ, Kim MG, Cho JY, Hwang SI, Kim SY. Differentiating renal epithelioid angiomyolipoma from clear cell carcinoma: using a radiomics model combined with CT imaging characteristics. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2867-2880. [PMID: 35697856 DOI: 10.1007/s00261-022-03571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE This study aims to assess the computed tomography (CT) findings of renal epithelioid angiomyolipoma (EAML) and develop a radiomics-based model for differentiating EAMLs and clear cell renal cell carcinomas (RCCs). METHOD This two-center retrospective study included 28 histologically confirmed EAMLs and 56 size-matched clear cell RCCs with preoperative three-phase kidney CTs. We conducted subjective image analysis to determine the CT parameters that can distinguish EAMLs from clear cell RCCs. Training and test sets were divided by chronological order of CT scans, and radiomics model was built using ten selected features among radiomics and CT features. The diagnostic performance of the radiomics model was compared with that of the three radiologists using the area under the receiver-operating characteristic curve (AUC). RESULTS The mean size of the EAMLs was 6.2 ± 5.0 cm. On multivariate analysis, a snowman or ice cream cone tumor shape (OR 16.3; 95% CI 1.7-156.9, P = 0.02) and lower tumor-to-cortex (TOC) enhancement ratio in the corticomedullary phase (OR 33.4; 95% CI 5.7-197, P < 0.001) were significant independent factors for identifying EAMLs. The diagnostic performance of the radiomics model (AUC 0.89) was similar to those of genitourinary radiologists (AUC 0.78 and 0.81, P > 0.05) and superior to that of a third-year resident (AUC 0.63, P = 0.04). CONCLUSIONS A snowman or ice cream cone shape and lower TOC ratio were more closely associated with EAMLs than with clear cell RCCs. A CT radiomics model was useful for differentiating EAMLs from clear cell RCCs with better diagnostic performance than an inexperienced radiologist.
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Affiliation(s)
- Taek Min Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyungwoo Ahn
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Hyo Jeong Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Min Gwan Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, 03080, Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea. .,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
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11
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Xie F, Zhao J, Cheng F, Yao Z, Zheng B, Niu Z, He W. Pitfalls in the diagnosis and treatment of fat-poor angiomyolipoma of the renal pelvis mimicking urothelial carcinoma: report of three rare cases. Am J Transl Res 2022; 14:4848-4854. [PMID: 35958471 PMCID: PMC9360889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
Angiomyolipoma (AML) represents the most frequent benign neoplasm of the kidney. It arises mostly in the cortex and protrudes into the perirenal space. It is extremely rare for a fat-poor AML to originate from the renal sinus, invade the pelvis, and present with hematuria. Because of the rarity of this lesion, differentiating it from a urothelial carcinoma is difficult, thereby making a preoperative diagnosis and management complex and challenging. We report three cases of fat-poor AML centered within the renal pelvis mimicking a urothelial carcinoma that underwent radical nephroureterectomy. The clinical characteristics, surgical management, and prognosis are discussed to achieve better preoperative evaluation of these entities. This is the first report of fat-poor AMLs involving the renal pelvis and presenting with hematuria. Nephron-sparing treatment is crucial for patients with these entities. Accurate diagnosis may allow partial resection or kidney-preserving treatment.
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Affiliation(s)
- Fang Xie
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, Shandong, China
- Department of Urology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong UniversityWeihai, Shandong, China
| | - Jiming Zhao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan, Shandong, China
| | - Fajuan Cheng
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan, Shandong, China
| | - Zhigang Yao
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan, Shandong, China
| | - Bin Zheng
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, Shandong, China
- Department of Urology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong UniversityWeihai, Shandong, China
| | - Zhihong Niu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, Shandong, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan, Shandong, China
| | - Wei He
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan, Shandong, China
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12
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Trevisani F, Floris M, Minnei R, Cinque A. Renal Oncocytoma: The Diagnostic Challenge to Unmask the Double of Renal Cancer. Int J Mol Sci 2022; 23:2603. [PMID: 35269747 PMCID: PMC8910282 DOI: 10.3390/ijms23052603] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
Renal oncocytoma represents the most common type of benign neoplasm that is an increasing concern for urologists, oncologists, and nephrologists due to its difficult differential diagnosis and frequent overtreatment. It displays a variable neoplastic parenchymal and stromal architecture, and the defining cellular element is a large polygonal, granular, eosinophilic, mitochondria-rich cell known as an oncocyte. The real challenge in the oncocytoma treatment algorithm is related to the misdiagnosis due to its resemblance, at an initial radiological assessment, to malignant renal cancers with a completely different prognosis and medical treatment. Unfortunately, percutaneous renal biopsy is not frequently performed due to the possible side effects related to the procedure. Therefore, the majority of oncocytoma are diagnosed after the surgical operation via partial or radical nephrectomy. For this reason, new reliable strategies to solve this issue are needed. In our review, we will discuss the clinical implications of renal oncocytoma in daily clinical practice with a particular focus on the medical diagnosis and treatment and on the potential of novel promising molecular biomarkers such as circulating microRNAs to distinguish between a benign and a malignant lesion.
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Affiliation(s)
- Francesco Trevisani
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy;
- Unit of Urology, San Raffaele Scientific Institute, 20132 Milan, Italy
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Matteo Floris
- Nephrology, Dialysis and Transplantation, G. Brotzu Hospital, Università degli Studi di Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Roberto Minnei
- Nephrology, Dialysis and Transplantation, G. Brotzu Hospital, Università degli Studi di Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Alessandra Cinque
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
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13
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Wang XJ, Qu BQ, Zhou JP, Zhou QM, Lu YF, Pan Y, Xu JX, Miu YY, Wang HQ, Yu RS. A Non-Invasive Scoring System to Differential Diagnosis of Clear Cell Renal Cell Carcinoma (ccRCC) From Renal Angiomyolipoma Without Visible Fat (RAML-wvf) Based on CT Features. Front Oncol 2021; 11:633034. [PMID: 33968732 PMCID: PMC8103199 DOI: 10.3389/fonc.2021.633034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background Renal angiomyolipoma without visible fat (RAML-wvf) and clear cell renal cell carcinoma (ccRCC) have many overlapping features on imaging, which poses a challenge to radiologists. This study aimed to create a scoring system to distinguish ccRCC from RAML-wvf using computed tomography imaging. Methods A total of 202 patients from 2011 to 2019 that were confirmed by pathology with ccRCC (n=123) or RAML (n=79) were retrospectively analyzed by dividing them randomly into a training cohort (n=142) and a validation cohort (n=60). A model was established using logistic regression and weighted to be a scoring system. ROC, AUC, cut-off point, and calibration analyses were performed. The scoring system was divided into three ranges for convenience in clinical evaluations, and the diagnostic probability of ccRCC was calculated. Results Four independent risk factors are included in the system: 1) presence of a pseudocapsule, 2) a heterogeneous tumor parenchyma in pre-enhancement scanning, 3) a non-high CT attenuation in pre-enhancement scanning, and 4) a heterogeneous enhancement in CMP. The prediction accuracy had an ROC of 0.978 (95% CI, 0.956–0.999; P=0.011), similar to the primary model (ROC, 0.977; 95% CI, 0.954–1.000; P=0.012). A sensitivity of 91.4% and a specificity of 93.9% were achieved using 4.5 points as the cutoff value. Validation showed a good result (ROC, 0.922; 95% CI, 0.854–0.991, P=0.035). The number of patients with ccRCC in the three ranges (0 to <2 points; 2–4 points; >4 to ≤11 points) significantly increased with increasing scores. Conclusion This scoring system is convenient for distinguishing between ccRCC and RAML-wvf using four computed tomography features.
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Affiliation(s)
- Xiao-Jie Wang
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bai-Qiang Qu
- Department of Radiology, Wenling Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Jia-Ping Zhou
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiao-Mei Zhou
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan-Fei Lu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Pan
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian-Xia Xu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - You-You Miu
- Department of Ultrasonic, Wenzhou Central Hospital, Wenzhou, China
| | - Hong-Qing Wang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ri-Sheng Yu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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14
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Ma Y, Ma W, Xu X, Guan Z, Pang P. A convention-radiomics CT nomogram for differentiating fat-poor angiomyolipoma from clear cell renal cell carcinoma. Sci Rep 2021; 11:4644. [PMID: 33633296 PMCID: PMC7907210 DOI: 10.1038/s41598-021-84244-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/10/2021] [Indexed: 01/12/2023] Open
Abstract
This study aimed to construct convention-radiomics CT nomogram containing conventional CT characteristics and radiomics signature for distinguishing fat-poor angiomyolipoma (fp-AML) from clear-cell renal cell carcinoma (ccRCC). 29 fp-AML and 110 ccRCC patients were enrolled and underwent CT examinations in this study. The radiomics-only logistic model was constructed with selected radiomics features by the analysis of variance (ANOVA)/Mann–Whitney (MW), correlation analysis, and Least Absolute Shrinkage and Selection Operator (LASSO), and the radiomics score (rad-score) was computed. The convention-radiomics logistic model based on independent conventional CT risk factors and rad-score was constructed for differentiating. Then the relevant nomogram was developed. Receiver operation characteristic (ROC) curves were calculated to quantify the accuracy for distinguishing. The rad-score of ccRCC was smaller than that of fp-AML. The convention-radioimics logistic model was constructed containing variables of enhancement pattern, VUP, and rad-score. To the entire cohort, the area under the curve (AUC) of convention-radiomics model (0.968 [95% CI 0.923–0.990]) was higher than that of radiomics-only model (0.958 [95% CI 0.910–0.985]). Our study indicated that convention-radiomics CT nomogram including conventional CT risk factors and radiomics signature exhibited better performance in distinguishing fp-AML from ccRCC.
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Affiliation(s)
- Yanqing Ma
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310000, China.
| | - Weijun Ma
- Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, 312000, China
| | - Xiren Xu
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310000, China
| | - Zheng Guan
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310000, China
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15
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Pelizzo G, Vallone MG, Milazzo M, Rosone G, Amoroso S, Pavone G, D'Alessandro MM, Unti E, Calcaterra V. Renal angiomyolipomatosis and bleeding aneurysms in a tuberous sclerosis context: selective artery embolization in a girl with end-stage renal failure. Pediatr Rep 2020; 12:8352. [PMID: 32922707 PMCID: PMC7461646 DOI: 10.4081/pr.2020.8352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
Recent developments in endovascular radiological techniques and devices have rendered embolization a major therapeutic option prior to surgery in many renal vascular or neoplastic diseases. A 19-yearold female patient, with a diagnosis of tuberous sclerosis complex (TSC) in childhood, was admitted with severe anemia. Polycystic kidney disease in end-stage renal failure appeared four years before and the patient has been undergoing peritoneal dialysis. The patient's medical history also included bilateral renal angiomyolipomas (AMLs). One year earlier, a unilateral endovascular embolization was performed to repair a bleeding aneurysm at the right renal upper pole. A second bilateral ruptured renal aneurysm was diagnosed at admission. To continue with peritoneal dialysis and prevent intrarenal hemorrhage and intraperitonal bleeding, an urgent bilateral renal AE was performed. Two months later she underwent a bilateral retroperitoneal nephrectomy. The posterior surgical approach, preserved the peritoneal surface area and adequate conditions to continue dialysis. At histology, bilateral AMLs were confirmed and a renal cell carcinoma of the right kidney was concurrently discovered. She undergoes continuous peritoneal dialysis. Urgent selective renal AE represents a feasible treatment for bilateral AML bleeding. It is safe and feasible before performing nephrectomy in patients with end-stage renal failure.
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Affiliation(s)
- Gloria Pelizzo
- Department of Biomedical and Clinical Science "L Sacco", University of Milan, Department of Pediatric Surgery, Children's Hospital V. Buzzi", Milan
| | - Mario Giuseppe Vallone
- Operative Unit of Vascular Radiology and Endovascular Therapy, ARNAS Civico-Di Cristina-Benfratelli, Palermo
| | - Mario Milazzo
- Pediatric Unit, ARNAS Civico-Di Cristina-Benfratelli, Palermo
| | - Gregorio Rosone
- Pediatric Unit, ARNAS Civico-Di Cristina-Benfratelli, Palermo
| | | | - Giovanni Pavone
- Pediatric Nephrology Unit, ARNAS Civico-Di Cristina-Benfratelli, Palermo
| | | | - Elettra Unti
- Pathology Unit, ARNAS Civico-Di Cristina-Benfratelli, Palermo
| | - Valeria Calcaterra
- Pediatrics and Adolescents Unit, Department of Internal Medicine University of Pavia; Children's Hospital "Vittore Buzzi", Milano, Italy
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16
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Identification of Prognostic Biomarkers in the Urinary Peptidome of the Small Renal Mass. THE AMERICAN JOURNAL OF PATHOLOGY 2019; 189:2366-2376. [DOI: 10.1016/j.ajpath.2019.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/12/2019] [Accepted: 08/20/2019] [Indexed: 01/10/2023]
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17
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Di Meo A, Batruch I, Brown MD, Yang C, Finelli A, Jewett MA, Diamandis EP, Yousef GM. Searching for prognostic biomarkers for small renal masses in the urinary proteome. Int J Cancer 2019; 146:2315-2325. [PMID: 31465112 DOI: 10.1002/ijc.32650] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/05/2019] [Indexed: 12/20/2022]
Abstract
Renal cell carcinoma (RCC) is frequently diagnosed incidentally as an early-stage small renal mass (SRM; pT1a, ≤4 cm). Overtreatment of patients with benign or clinically indolent SRMs is increasingly common and has resulted in a recent shift in treatment recommendations. There are currently no available biomarkers that can accurately predict clinical behavior. Therefore, we set out to identify early biomarkers of RCC progression. We employed a quantitative label-free liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) proteomics approach and targeted parallel-reaction monitoring to identify and validate early, noninvasive urinary biomarkers for RCC-SRMs. In total, we evaluated 115 urine samples, including 33 renal oncocytoma (≤4 cm) cases, 30 progressive and 26 nonprogressive clear cell RCC (ccRCC)-SRM cases, in addition to 26 healthy controls. We identified six proteins, which displayed significantly elevated expression in clear cell RCC-SRMs (ccRCC-SRMs) relative to healthy controls. Proteins C12ORF49 and EHD4 showed significantly elevated expression in ccRCC-SRMs compared to renal oncocytoma (≤4 cm). Additionally, proteins EPS8L2, CHMP2A, PDCD6IP, CNDP2 and CEACAM1 displayed significantly elevated expression in progressive relative to nonprogressive ccRCC-SRMs. A two-protein signature (EPS8L2 and CCT6A) showed significant discriminatory ability (areas under the curve: 0.81, 95% CI: 0.70-0.93) in distinguishing progressive from nonprogressive ccRCC-SRMs. Patients (Stage I-IV) with EPS8L2 and CCT6A mRNA alterations showed significantly shorter overall survival (p = 1.407 × 10-6 ) compared to patients with no alterations. Our in-depth proteomic analysis identified novel biomarkers for early-stage RCC-SRMs. Pretreatment characterization of urinary proteins may provide insight into early RCC progression and could potentially help assign patients to appropriate management strategies.
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Affiliation(s)
- Ashley Di Meo
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ihor Batruch
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Marshall D Brown
- Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Chuance Yang
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Antonio Finelli
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Michael A Jewett
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Eleftherios P Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - George M Yousef
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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18
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Nie P, Yang G, Wang Z, Yan L, Miao W, Hao D, Wu J, Zhao Y, Gong A, Cui J, Jia Y, Niu H. A CT-based radiomics nomogram for differentiation of renal angiomyolipoma without visible fat from homogeneous clear cell renal cell carcinoma. Eur Radiol 2019; 30:1274-1284. [PMID: 31506816 DOI: 10.1007/s00330-019-06427-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/05/2019] [Accepted: 08/14/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To develop and validate a radiomics nomogram for preoperative differentiating renal angiomyolipoma without visible fat (AML.wovf) from homogeneous clear cell renal cell carcinoma (hm-ccRCC). METHODS Ninety-nine patients with AML.wovf (n = 36) and hm-ccRCC (n = 63) were divided into a training set (n = 80) and a validation set (n = 19). Radiomics features were extracted from corticomedullary phase and nephrographic phase CT images. A radiomics signature was constructed and a radiomics score (Rad-score) was calculated. Demographics and CT findings were assessed to build a clinical factors model. Combined with the Rad-score and independent clinical factors, a radiomics nomogram was constructed. Nomogram performance was assessed with respect to calibration, discrimination, and clinical usefulness. RESULTS Fourteen features were used to build the radiomics signature. The radiomics signature showed good discrimination in the training set (AUC [area under the curve], 0.879; 95%; confidence interval [CI], 0.793-0.966) and the validation set (AUC, 0.846; 95% CI, 0.643-1.000). The radiomics nomogram showed good calibration and discrimination in the training set (AUC, 0.896; 95% CI, 0.810-0.983) and the validation set (AUC, 0.949; 95% CI, 0.856-1.000) and showed better discrimination capability (p < 0.05) compared with the clinical factor model (AUC, 0.788; 95% CI, 0.683-0.893) in the training set. Decision curve analysis demonstrated the nomogram outperformed the clinical factors model and radiomics signature in terms of clinical usefulness. CONCLUSIONS The CT-based radiomics nomogram, a noninvasive preoperative prediction tool that incorporates the Rad-score and clinical factors, shows favorable predictive efficacy for differentiating AML.wovf from hm-ccRCC, which might assist clinicians in tailoring precise therapy. KEY POINTS • Differential diagnosis between AML.wovf and hm-ccRCC is rather difficult by conventional imaging modalities. • A radiomics nomogram integrated with the radiomics signature, demographics, and CT findings facilitates differentiation of AML.wovf from hm-ccRCC with improved diagnostic efficacy. • The CT-based radiomics nomogram might spare unnecessary surgery for AML.wovf.
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Affiliation(s)
- Pei Nie
- Radiology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guangjie Yang
- PET-CT Center, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266061, Shandong, China
| | - Zhenguang Wang
- PET-CT Center, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266061, Shandong, China.
| | - Lei Yan
- PET-CT Center, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266061, Shandong, China
| | - Wenjie Miao
- PET-CT Center, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266061, Shandong, China
| | - Dapeng Hao
- Radiology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jie Wu
- Pathology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yujun Zhao
- PET-CT Center, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266061, Shandong, China
| | - Aidi Gong
- PET-CT Center, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266061, Shandong, China
| | - Jingjing Cui
- Huiying Medical Technology Co., Ltd, Beijing, China
| | - Yan Jia
- Huiying Medical Technology Co., Ltd, Beijing, China
| | - Haitao Niu
- Urology Department, The Affiliated Hospital of Qingdao University, No. 16, Jiangsu Road, Qingdao, 266005, Shandong, China.
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19
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Drylewicz MR, Lubner MG, Pickhardt PJ, Menias CO, Mellnick VM. Fatty masses of the abdomen and pelvis and their complications. Abdom Radiol (NY) 2019; 44:1535-1553. [PMID: 30276422 DOI: 10.1007/s00261-018-1784-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There are numerous common and rare macroscopic fat-containing masses found in the abdomen and pelvis. These include benign masses, such as lipoleiomyoma, ovarian teratoma, mesenteric teratoma, and lipoma, as well as malignant masses, including liposarcoma and malignant transformation of benign entities. Any mass may become symptomatic due to the development of a complication which may range from ovarian torsion to intussusception to hemorrhage. Imaging plays a vital role in diagnosis and treatment planning when confronted with a symptomatic fat-containing mass.
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