Renal oncocytoma differential diagnosis: Difference between revisions
Homa Najafi (talk | contribs) No edit summary |
Homa Najafi (talk | contribs) |
||
Line 26: | Line 26: | ||
===Differentiating renal oncocytoma from other diseases on the basis of abdominal pain, hematuria, and headache === | ===Differentiating renal oncocytoma from other diseases on the basis of abdominal pain, hematuria, and headache === | ||
[[Category:Up-To-Date]] | |||
[[Category:Medicine]] | |||
[[Category:Oncology]] | |||
[[Category:Nephrology]] | |||
[[Category: Primary care]] | |||
{| class="wikitable" | {| class="wikitable" | ||
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" + |S.No. | ! rowspan="2" style="background:#4479BA; color: #FFFFFF;" + |S.No. | ||
Line 70: | Line 75: | ||
*All the 3 types are not required for the diagnosis of Wilms tumor. | *All the 3 types are not required for the diagnosis of Wilms tumor. | ||
*Primitive tubules and [[Glomerulus|glomeruli]] are often seen comprised of [[Cancer|neoplastic]] cells. | *Primitive tubules and [[Glomerulus|glomeruli]] are often seen comprised of [[Cancer|neoplastic]] cells. | ||
*Beckwith and Palmer reported in NWTS the different histopathologic types of Wilms tumor to categorize them based on prognosis. | *Beckwith and Palmer reported in NWTS the different histopathologic types of Wilms tumor to categorize them based on prognosis. | ||
*Spindled cell [[stroma]] surrounding abortive tubules and [[Glomerulus|glomeruli]] is characteristic. | *Spindled cell [[stroma]] surrounding abortive tubules and [[Glomerulus|glomeruli]] is characteristic. | ||
Line 90: | Line 95: | ||
*It is the best initial diagnostic study used in cases suspected with [[Wilms tumor]]. | *It is the best initial diagnostic study used in cases suspected with [[Wilms tumor]]. | ||
*[[Ultrasonography]] can help identify the mass as a kidney mass. | *[[Ultrasonography]] can help identify the mass as a kidney mass. | ||
*It can distinguish [[tumor]] mass from other causes of renal swelling like [[hydronephrosis]]. | *It can distinguish [[tumor]] mass from other causes of renal swelling like [[hydronephrosis]]. | ||
*[[Doppler ultrasonography]] can help to detect invasion of [[renal vein]] and [[Inferior vena cava|IVC]] by the tumor. | *[[Doppler ultrasonography]] can help to detect invasion of [[renal vein]] and [[Inferior vena cava|IVC]] by the tumor. | ||
| | | | ||
*Findings on [[CT scan]] which can be suggestive of [[Wilms tumor]] include: | *Findings on [[CT scan]] which can be suggestive of [[Wilms tumor]] include: | ||
**Heterogeneous soft-tissue density masses | **Heterogeneous soft-tissue density masses | ||
**These masses have frequent areas of [[calcification]] (~10%) and fat-density regions | **These masses have frequent areas of [[calcification]] (~10%) and fat-density regions | ||
Line 155: | Line 160: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| | | | ||
Ultrasound may be helpful in the diagnosis of polycystic kidney disease. Findings on an ultrasound diagnostic of polycystic kidney disease include: | Ultrasound may be helpful in the diagnosis of polycystic kidney disease. Findings on an ultrasound diagnostic of polycystic kidney disease include: | ||
*At least three unilateral or bilateral [[cysts]] in patients 15 - 39 years old | *At least three unilateral or bilateral [[cysts]] in patients 15 - 39 years old | ||
*Atleast two [[cysts]] in each [[kidney]] in patients 40 - 59 years old | *Atleast two [[cysts]] in each [[kidney]] in patients 40 - 59 years old | ||
Line 166: | Line 171: | ||
* Multiple [[homogeneous]] and hypoattenuating [[cystic]] lesions in the [[liver]] in patients with [[liver]] involvement | * Multiple [[homogeneous]] and hypoattenuating [[cystic]] lesions in the [[liver]] in patients with [[liver]] involvement | ||
| | | | ||
*On microscopic histopathological analysis, interstitial fibrosis, tubular atrophy, thickening and lamellation of tubular basement membranes, microcysts and negative immunofluorescence for complement and immunoglobulin are characteristic findings of ADPKD. | *On microscopic histopathological analysis, interstitial fibrosis, tubular atrophy, thickening and lamellation of tubular basement membranes, microcysts and negative immunofluorescence for complement and immunoglobulin are characteristic findings of ADPKD. | ||
| | | | ||
Line 179: | Line 184: | ||
| | | | ||
* CT is the preferred imaging modality for the diagnosis of pheochromocytoma. | * CT is the preferred imaging modality for the diagnosis of pheochromocytoma. | ||
|The following findings may be observed on [[CT scan]]: | |The following findings may be observed on [[CT scan]]: | ||
*Most common extra-[[Adrenal gland|adrenal]] locations are superior and inferior [[abdominal]] [[Paraaortic lymph node|paraaortic]] areas, the [[urinary bladder]], [[thorax]], [[head]], [[neck]] and [[pelvis]]. | *Most common extra-[[Adrenal gland|adrenal]] locations are superior and inferior [[abdominal]] [[Paraaortic lymph node|paraaortic]] areas, the [[urinary bladder]], [[thorax]], [[head]], [[neck]] and [[pelvis]]. | ||
*In sporadic pheochromocytoma, [[CT]] and [[MRI]] are good choices. The choice depends on availability and cost. | *In sporadic pheochromocytoma, [[CT]] and [[MRI]] are good choices. The choice depends on availability and cost. | ||
*In patients with the [[multiple endocrine neoplasia]] type 2 ([[Multiple endocrine neoplasia type 2|MEN2]]) syndrome, [[CT]] may miss the [[tumors]]. | *In patients with the [[multiple endocrine neoplasia]] type 2 ([[Multiple endocrine neoplasia type 2|MEN2]]) syndrome, [[CT]] may miss the [[tumors]]. | ||
| | | | ||
* On microscopic pathology, [[Pheochromocytoma]] typically demonstrates a nesting (Zellballen) pattern on microscopy. This pattern is composed of well-defined clusters of tumor cells containing [[eosinophilic]] cytoplasm separated by fibrovascular [[stroma]]. | * On microscopic pathology, [[Pheochromocytoma]] typically demonstrates a nesting (Zellballen) pattern on microscopy. This pattern is composed of well-defined clusters of tumor cells containing [[eosinophilic]] cytoplasm separated by fibrovascular [[stroma]]. | ||
Line 198: | Line 203: | ||
* Abdominal [[ultrasonography]] may show [[splenomegaly]] and [[ascites]]. | * Abdominal [[ultrasonography]] may show [[splenomegaly]] and [[ascites]]. | ||
| | | | ||
* Chest, abdomen, and pelvis [[CT]] scan may be helpful in the diagnosis of [[Burkitt's lymphoma]] but it is not done routinely. | * Chest, abdomen, and pelvis [[CT]] scan may be helpful in the diagnosis of [[Burkitt's lymphoma]] but it is not done routinely. | ||
| | | | ||
*On microscopic histopathological analysis, characteristic findings of Burkitt's lymphoma include: | *On microscopic histopathological analysis, characteristic findings of Burkitt's lymphoma include: | ||
:*Medium-sized (~1.5-2x the size of a RBC) with uniform size ("monotonous") -- '''key feature''' (i.e. tumor nuclei size similar to that of [[histiocytes]] or [[endothelial cells]]) | :*Medium-sized (~1.5-2x the size of a RBC) with uniform size ("monotonous") -- '''key feature''' (i.e. tumor nuclei size similar to that of [[histiocytes]] or [[endothelial cells]]) | ||
:*Round nucleus | :*Round nucleus | ||
Line 220: | Line 225: | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | | | ||
* [[Ultrasound]] is the [[Gold standard (test)|gold standard]] imaging modality used to diagnose intussusception | * [[Ultrasound]] is the [[Gold standard (test)|gold standard]] imaging modality used to diagnose intussusception | ||
**Target or doughnut sign | **Target or doughnut sign | ||
***Edematous intussuscipien forms an external ring around the centrally located intussusceptum | ***Edematous intussuscipien forms an external ring around the centrally located intussusceptum | ||
***Target sign is usually seen in right lower quadrant | ***Target sign is usually seen in right lower quadrant | ||
Line 273: | Line 278: | ||
|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
| | | | ||
* On ultrasound, neuroblastoma is characterized by a heterogeneous [[echogenicity]] due to the [[vascular]], [[necrotic]], and calcified content of the mass. | * On ultrasound, neuroblastoma is characterized by a heterogeneous [[echogenicity]] due to the [[vascular]], [[necrotic]], and calcified content of the mass. | ||
| | | | ||
*CT scan is the investigation of choice for the diagnosis of neuroblastoma. | *CT scan is the investigation of choice for the diagnosis of neuroblastoma. | ||
*On CT scan, neuroblastoma is characterized by: | *On CT scan, neuroblastoma is characterized by: | ||
:*Heterogeneous mass | :*Heterogeneous mass | ||
:*[[Calcification]] | :*[[Calcification]] | ||
Line 285: | Line 290: | ||
| | | | ||
*On microscopic histopathological analysis the presence of round blue cells separated by thin [[fibrous]] septa are characteristic findings of neuroblastoma. | *On microscopic histopathological analysis the presence of round blue cells separated by thin [[fibrous]] septa are characteristic findings of neuroblastoma. | ||
*Other findings of neuroblastoma on [[light microscopy]] may include: | *Other findings of neuroblastoma on [[light microscopy]] may include: | ||
:*Homer-Wright rosettes (rosettes with a small meshwork of fibers at the center) | :*Homer-Wright rosettes (rosettes with a small meshwork of fibers at the center) | ||
:*Neuropil-like [[stroma]] (paucicellular stroma with a cotton candy-like appearance) | :*Neuropil-like [[stroma]] (paucicellular stroma with a cotton candy-like appearance) | ||
Line 320: | Line 325: | ||
| | | | ||
*[[Ultrasound]] may be helpful in the diagnosis of mesoblastic nephroma. | *[[Ultrasound]] may be helpful in the diagnosis of mesoblastic nephroma. | ||
*Mesoblastic nephroma may presents as a well-defined [[mass]] with low-level homogeneous echoes. | *Mesoblastic nephroma may presents as a well-defined [[mass]] with low-level homogeneous echoes. | ||
*The presence of concentric echogenic and hypoechoic rings can be a helpful diagnostic feature of [[mesoblastic nephroma]]. | *The presence of concentric echogenic and hypoechoic rings can be a helpful diagnostic feature of [[mesoblastic nephroma]]. | ||
| | | | ||
Line 329: | Line 334: | ||
:* No [[calcification]] | :* No [[calcification]] | ||
| | | | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
|} | |} | ||
References{{reflist|2}} |
Revision as of 16:58, 28 May 2019
Renal oncocytoma Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Renal oncocytoma differential diagnosis On the Web |
American Roentgen Ray Society Images of Renal oncocytoma differential diagnosis |
Risk calculators and risk factors for Renal oncocytoma differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2] Shanshan Cen, M.D. [3]Sargun Singh Walia M.B.B.S.[4]
Overview
Renal oncocytoma must be differentiated from other diseases that cause abdominal mass, abdominal pain and hematuria such as wilms tumor, renal cell carcinoma, rhabdoid kidney disease, Polycystic kidney disease, and other urogenital mass.
Differentiating renal oncocytoma from other Diseases
Renal oncocytoma must be differentiated from other diseases that cause abdominal mass, abdominal pain and hematuria such as wilms tumor, renal cell carcinoma, rhabdoid kidney disease, Polycystic kidney disease, and other urogenital mass..
Genetic differentiation between renal oncocytoma and RCC subtypes | |||||||||||||||||||||||||||||||||||||||||||||||||
Common chromosomal alteration | |||||||||||||||||||||||||||||||||||||||||||||||||
1. Deletion of chromosome 1 and X/Y
2. A balanced translocation involving 11q13 3. Sporadic or no chromosomal alterations | Loss of heterozygosity chromosome 1, 2, 6, 10, 13,17, and 21 | Additional copies of chromosomes 7, 12, and 17 | Loss of heterozygosity chromosome 3p | ||||||||||||||||||||||||||||||||||||||||||||||
Oncocytoma | chromophobe RCC | Papillary RCC | Nonpapillary RCC | ||||||||||||||||||||||||||||||||||||||||||||||
Differentiating renal oncocytoma from other diseases on the basis of abdominal pain, hematuria, and headache
S.No. | Disease | Symptoms | Signs | Diagnosis | Comments | |||||
---|---|---|---|---|---|---|---|---|---|---|
Abdominal Pain | Hematuria | Headache | Abdominal mass | Abdominal tenderness | Ultrasonography | CT scan | Histology | |||
1. | Renal oncocytoma | +/- | + /- | - | +/- | +/- | Renal ultrasound in renal oncocytoma patients may show: | Abdominal CT scan may be helpful in the diagnosis of renal oncocytoma. Findings on CT scan suggestive of renal oncocytoma include: |
|
|
2. | Wilms tumor | + | + | - | + | + |
|
|
|
|
3. | Renal cell carcinoma | + | + | +/- | + | - |
|
Both CT and MRI may be used to detect neoplastic masses that may define renal cell carcinoma or metastasis of the primary cancer. CT scan and use of intravenous (IV) contrast is generally used for work-up and follow-up of patients with renal cell carcinoma. | The histological pattern of renal cell carcinoma depends whether it is papillary, chromophobe or collecting duct renal cell carcinoma. | |
4. | Rhabdoid kidney disease | + | + | - | + | - |
|
|
|
|
5. | Polycystic kidney disease | + | + | + (from hypertension) | + | - |
Ultrasound may be helpful in the diagnosis of polycystic kidney disease. Findings on an ultrasound diagnostic of polycystic kidney disease include: |
Renal CT scan may be helpful in the diagnosis of polycystic kidney disease. Findings on CT scan diagnostic of ADPKD include:
|
|
|
6. | Pheochromocytoma | - | - | + (as a part of the hypertension paroxysm) | - | - |
|
The following findings may be observed on CT scan:
|
|
|
7. | Burkitt lymphoma | +/- (in non-endemic or sporadic form of the disease) | - | - | - | - |
|
|
|
|
8. | Intussusception | + | - | - | +/- | + |
|
|
|
|
9. | Hydronephrosis | + | +/- | - | - | + (CVA tenderness in case of pyelonephritis) |
|
|
|
|
10. | Dysplastic kidney | N/A | N/A | N/A | N/A | N/A |
MCDK is usually diagnosed by ultrasound examination before birth.
|
|
||
11. | Pediatric Neuroblastoma | + | - | - | +/- | +/- |
|
|
|
|
12. | Pediatric Rhabdomyosarcoma | + | +/- | +/- | - | +/- | On CT scan, rhabdomyosarocma is characterized by:
|
|
||
13. | Mesoblastic nephroma | + | + | - | + | - |
|
|
References