Renal Oncocytoma: Angiographic Features of Two Cases1

Diagnostic Radiology

Shelley N. Weiner, M.D., and Robert G. Bernstein, M.D. Two cases of renal oncocytoma (proximal tubular adenoma) with a similar angiograph lc appearance are reported . The vascular supply to the lesion tends to be arranged In a "spoke-wheel" pattem with vessels radiatingtoward the center of the lesion; the angiographic appearance may help to differentiate renal oncocytoma from hypernephroma preoperatively. INDEX TERMS: (Kidney, adenoma, 8[1].317) Kidney neoplasms, angiography. Kidney neoplasms, blood supply. Kidney neoplasms, diagnosis. Renal angiography, indications Radiology 125:633-635, December 1977

to be characteristic of this neoplasm and may suggest the diagnosis preoperatively.

NCOCYTOMA was the term first used by Jaffe in

1932 to describe an adenolymphoma of the parotid gland composed of oncocytes (5). These are transformed epithelial cells which are larger than their cells of or igin (4), and have a fine, granular eosinophilic cytoplasm with an abundance of mitochondria (4,6). Oncocytoma may also be called oxyphilic adenoma (6). Oncocytomas of the thyroid, parathyroid, pituitary, adrenal and kidney have been described (2, 4). In the kidney the histologic features of oncocytomas suggest that the cells come from the proximal tubules, and that this tumor is a type of proximal tubular adenoma (6). Only twenty cases of renal oncocytoma have been reported; all of these are from the pathology literature, without the presentation of radiological findings (1,2,6-8). In the past year we have seen two patients with renal oncocytoma (proximal tubular adenoma). We believe that this is the first report of the angiographic findings, which seem

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CASE I. F.V., a 35-year-old white man, was admitted to the Hospital of the Albert Einstein College of Medicine following the discovery of a large right renal mass on intravenous urography performed for abdominal pain on the right side. Physical examination revealed a soft, non-tender, right upper quadrant mass which was felt to be separate from the liver. The blood urea nitrogen and creatinine levels were within normal limits. There was no hematuria. Ultrasoundexamination revealed a large solid mass of the right k idney. Selective right renal angiography (Fig. 1) demonstrated a highly vascular, well-encapsulated mass of the right kidney without puddling of contrast material or arteriovenous shunting. The renal vein was patent. A "spoke-wheel" appearance of the arterial pattern (Fig. 1, A) was observed. A right radical nephi"ectomy was performed. The kidney weighed 650 grams. The tumor , 10.6 em in diameter, was yellow-brown with areas of fibrosis and necrosis, and was sharply demarcated from the normal renal parenchyma. There was no invasion of the renal capsule of perinephric fat. Histologically, the tumor was found to be an oncocytic

Fig. 1. A. "Spoke-wheel" appearance to the arterial pattern is clearly demonstrated at the time of selective renal angiography. B. The mass is highly vascular without puddling of contrast material or A-V shunting . C. The later phase demonstrates how well the lesion is encapsulated without venous collateral circulation. 1 From the Department of Radiology of the Albert Einstein College of Medicine, Yeshiva University , Bronx, New York. Accepted for publication in August 1977. emt

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N. WEINER AND ROBERT G. BERNSTEIN

December 1977

Fig. 2. A. Selective right renal angiography demonstrated a highly vascular encapsulated tumor . B. Magnification study demonstrated " spoke-whee!" appearance to the arterial pattern. C. The later phase of the magnification study demonstrates the absence of puddling or A-V shunting.

proximal tubular adenoma. The patient recovered well after surgery . CASE II. G.S., a 79-year-old white man, "(as examined in the Urology Clinic of the Bronx Municipal Hospital Center for symptoms of prostatism . The blood urea nitrogen and creatinine were normal. Hematuria

was not present. Intravenous urography and tomography demonstrated a large mass of the right kidney, as well as an enlarged prostate and trabeculated bladder . Ultrasound examination showed that the mass was solid . Selective renal angiography demonstrated a well-encap-

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RENAL ONCOCYTOMA: ANGIOGRAPHIC FEATURES

sulated vascular mass of the right kidney without puddling of contrast material or arteriovenous shunting. The vessels were arranged in a "spoke-wheel" pattern (Fig. 2, A). The patient underwent a right radical nephrectomy. The tumor measured 9 X 6 X 5 cm, and was yellow-brown in color with an area of peripheral fibrosis. The tumor did not invade the renal capsule, collectingsystem, or renal vein. Histologicallyit was an oncocytic proximal tubular adenoma.

Diagnostic Radiology

in 1973 (1). A dense parenchymal blush is present without evidence of contrast medium puddling, arteriovenous shunting, or renal vein invasion, as is often seen in hypernephromas.

DISCUSSION

Renal oncocytoma is a very rare type of renal adenoma which appears to be increasing in incidence (6), although this may be attributed to an increasing awareness of this entity as a separate pathologic division of renal adenomas. This lesion is most likely benign (6), but long term follow-up studies have not been done. Renal adenomas (including renal oncocytomas) as well as some hypernephromas may be silent lesions discovered incidentally on intravenous urography performed for nonspecific symptoms. However, most hypernephromas and some renal adenomas may present with pain, fever, weight loss and hematuria. By the time of diagnosis, renal oncocytomas are usually large with an average diameter of 7 cm (1,2,6-8). Oncocytomas and most hypernephromas are highly vascular lesions; however, we believe that there are angiographic differences. In our two cases the angiographic findings are similar enough to warrant the suggestion of the diagnosis of oncocytoma preoperatively. Angiography shows avascular, well-encapsulated mass of the renal parenchyma fed by interlobar arteries. The internal vascular architecture, arranged in a "spoke-wheel" pattern with the peripheral vessels radiating toward the center of the lesion, is consistent with the micro-angiographic appearance of renal oncocytoma reported by Berger et al.

Shelly N. Weiner, M.D. The Hospital of the Albert Einstein College of Medicine 1825 Eastchester Road Bronx, New York 10461

REFERENCES 1. BergerG, Clermont A, PinetF, et al: Oncocytomepluricentrique du rein etude microangiographlque. Arch Anat Path 19:287-292, Sep 1973 2. Blank C, Eneroter C, Jakobssin P: Oncocytoma of the parotid gland: neoplasm or nodular hyperplasia. Cancer 25 (4):919-925, Apr 1970 3. Blessing MA, Wienert G: Onkozytom der niere. Zentralbl AUg Pathol 117:227-234, 1973 4. Hemperl A: Benign and malignant oncocytoma. Cancer 15: 1019-1027,Sep-Oct 1962 5. Jaffe RH: Adenolymphoma (oncocytoma) of the parotid gland. Am J Cancer 16:1415-1423, 1932 6. Klein MJ, Valensi OJ: Proximal tubular adenomasof the kidney with so-called oncocytic features-a clinicopathologic study of 13 cases of a rarely reported neoplasm. Cancer 38 (2):906-914, Aug 1976 7. Wasilkowski A, Dabrowski H: Eosinophilic adenoma of the kidney (oncocytoma). Pol Przgel Chir, 43: 1051-1054, 1971 8. Zippel L: Zur kenntnis dar onkocyten. Virchows Arch 3-8: 360-382, 1942

Renal oncocytoma: angiographic features of two cases.

Renal Oncocytoma: Angiographic Features of Two Cases1 Diagnostic Radiology Shelley N. Weiner, M.D., and Robert G. Bernstein, M.D. Two cases of renal...
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