Renal and Adrenal Tumors: Pathology, Radiology, Ultrasonography, Therapy, Immunology

388 Pages·1979·14.533 MB·English

by  R. Ackermann, K. D. Bachmann, A. Baert, H. Behrendt, D. Beyer, W. Bischoff, E. Boijsen, H. Chr. Dominick, V. Fiedler, W. A. Fuchs, M. Georgi, U. Goerttler, H. I. Goldberg, R. Günther, W. Havers, R. Heckemann, H. Holfeld, L. Jeanmart, J. V. Kaude, L.-D. Leder, E. Löhr, M. Marberger, G. Marchal, P. Mellin, A. A. Moss, O. Olsson, M. Osteaux, H. J. Richter, E. Scherer, Chr. Stambolis, M. W. Strötges, B. Swart, G. Wilms (auth.), Eberhard Löhr (eds.)

Renal and Adrenal Tumors
Renal and
Adrenal Tumors
Pathology, Radiology, Ultrasonography,
Therapy, Immunology
R. Ackermann· K.D. Bachmann· A. Baert . H. Behrendt· D. Beyer
W.Bischoff· E.Boijsen· H. Chr. Dominick . Y.Fiedler· W.A.Fuchs
M. Georgi· U. Goerttler . H. Goldberg· R. Gunther· W. Havers
R. Heckemann . H. Holfeld . L. Jeanmart . J.Y. Kaude . L.-D. Leder
E. Lohr . M. Marberger· G. Marchal· P. Mellin· A. Moss· O. Olsson
M. Osteaux . H.J. Richter· E. Scherer· Chr. Stambolis . M.W. Strotges
B.Swart· G.Wilms
Edited by E. L6hr
Translated in Part by H.-U. Eickenberg
With 208 Figures (14 in Color) in 344 Separate Illustrations
Springer-Verlag Berlin Heidelberg New York 1979
Eberhard Lohr
R6ntgendiagnostisches Zentralinstitut, Klinikum der Universitat Essen (G.H.S.),
Hufelandstral3e 55, D-4300 Essen
ISBN-13: 978-3-642-96496-1 e-ISBN-13: 978-3-642-96494-7
DOl: 10.1007/978-3-642-96494-7
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by Springer-Verlag, Berlin· Heidelberg 1979
Softcover reprint of the hardcover I st edition 1979
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2127/3130-543210
Preface
The present volume constitutes an attempt to compile contem
porary features of diagnosis and treatment of renal and adrenal
tumors. A thorough survey of the field is ensured by the authors'
considerable scientific experience.
Tumors of the kidneys and the adrenal glands are being diagnosed
and treated by physicians of different medical disciplines. For
both types of tumor, the pathologic cellular substrate is of crucial
importance in diagnosis and therapy.
In recent years significant diagnostic advances have been made,
ranging from angiography through ultrasonography and computer
tomography to immunology. New impulses in oncologic therapy
have occurred in surgery, radiation therapy, and tumor emboliza
tion.
A further important topic is renal tumors in infants. Such tumors
involve special aspects of both diagnosis and therapy and also
have a distinctive prognosis.
We are indebted both to Springer-Verlag, who supported us in
our intention to write this book, and to our colleagues, whose
help is greatly appreciated.
For the authors:
E. LOHR
Essen/Heidelberg, September 1979
Contents
(Chapters marked with an asterisk have been translated by H.-U. Eickenberg)
Pathology of Renal and Adrenal Neoplasms
L.-D. Leder, H.J. Richter, and Chr. Stambolis ...... .
1. Tumors and Tumor-Like Lesions of the Kidney in the Adult
1.1. General Remarks .
1.2. Heterotopic Tissue . . . .
l.2.l. Adrenal Tissue . . . . . .
1.2.2. Endometriosis of the Kidney
l.2.3. Cartilaginous Islands 1
l.3. Benign Mesenchymal Tumors. 2
l.3.l. Leiomyoma and Lipoma . 2
l.3.2. Angiomyolipoma... 2
1.3.3. Hemangioma..... 4
1.3.4. Juxtaglomerular Tumor 4
1.3.5. Lymphangioma.... 6
1.3.6. Fibroma (Renomedullary Interstitial Cell Tumor) 6
1.3.7. Neurogenic Tumors. . . . . . 6
1.4. Malignant Mesenchymal Tumors 7
1.4.1. Leiomyosarcoma.. 7
1.4.2. Rhabdomyosarcoma...... 7
1.4.3. Liposarcoma......... 8
l.4.4. Angiosarcoma (Hemangioendothelioma) 8
1.4. 5. Hemangiopericytoma 9
1.4.6. Fibrosarcoma.... II
1.4.7. Fibroxanthosarcoma. 11
1.4.8. Osteogenic Sarcoma. 11
1.4.9. Hemoblastoses... 11
1.5. Epithelial Tumors (Adenomas and Adenocarcinomas) 14
1.5.1. Introduction.... . . . .. .... 14
l.5.2. Relationship Between Renal Adenoma and Adenocarci-
noma .... 14
1.5.3. Epidemiology. . . . 16
1.5.4. Causes ...... . 16
1.5.5. Paraneoplastic Syndromes 17
1.5.6. Cytologic Diagnosis 17
1.5.7. Renal Biopsy. . . 18
1.5.8. Gross Pathology . 18
1.5.9. Histologic Features 20
1.5.lO. Histologic Differential Diagnosis 25
1.5.11. Grading 27
1.5.12. Staging . . . . . . . . . . . 28
VIII Contents
1.5.13. Spread. 29
1.5.14. Prognosis 30
2. Renal Neoplasias of Infancy and Childhood 31
2.1. N ephro blastoma 31
2.1.1. General Remarks 31
2.1.2. Epidemiology. 31
2.1.3. Cause 32
2.1.4. Gross Pathology 33
2.1.5. Histopathology 35
2.1.6. Classification . 39
2.1.7. Staging in Wilms' Tumors 41
2.1.8. Spread and Biology Behavior 41
2.2. Congenital and Infantile Congeners of Nephroblastoma 42
2.2.1. Congenital Mesoblastic Nephroma 42
2.2.2. Nodular Renal Blastema and Nephroblastomatosis 43
2.2.3. Others. 43
3. Tumors of the Renal Pelvis. 43
3.1. General Remarks 43
3.2. Causes. 43
3.3. Epidemiology. 44
3.4. Papilloma 45
3.5. Carcinoma. 45
3.5.1. Introduction 45
3.5.2. Transitional Cell Carcinoma 46
3.5.3. Squamous Epithelial Carcinoma. 48
3.5.4. Adenocarcinoma 49
3.5.5. Undifferentiated Carcinoma 49
3.5.6. Grading 50
3.5.7. Staging 50
3.5.8. Spread. 51
3.5.9. Prognosis 51
4. Tumors of the Adrenal. 51
4.1. Introduction 51
4.2. Tumors of the Adrenal Cortex 52
4.2.1. General Remarks 52
4.2.2. Adenomas 53
4.2.3. Primary Carcinoma 55
4.2.4. Secondary Carcinoma 57
4.3. Tumors of the Adrenal Medulla. 57
4.3.1. General Remarks 57
4.3.2. Neuroblastoma and Ganglioneuroblastoma . 58
4.3.3. Ganglioneuroma 62
4.4.4. Pheochromocytoma 63
4.4. Myelolipoma and Cysts 68
4.4.1. Myelolipoma 68
4.4.2. Cysts 68
Kidney Tumor Vascularization: Morphology and Angiogenesis,
a Microangiographic Experimental Study
M. Osteaux and L. Jeanmart . . . . . . . . 69
1. Introduction . . . . . . . . . . . . . 69
2. Macro- and Microangiographic Methods. 70
Contents IX
2.1. Injection Technique . . . . . . . . . . . . . . . 70
2.2. Preparation of the Specimen . . . . . . . . . . . 70
2.3. Microradiographic Technique: Photographic Supports 70
3. Experimental Kidney Tumors. . . . . 71
3.1. Kidney Carcinogenesis in the Rat . . . 71
3.2. Endemic Adenocarcinoma of the Mouse 71
3.3. Tumorous Kidney Macrovascularization 72
3.3.1. Peripheric Encircling. . . . . 72
3.3.2. Peripheric Tumorous Network . . . . 72
3.3.3. "Venous Lakes" . . . . . . . . . . 72
4. Microangiographic Study of Experimental Tumors. 74
4.1. Avascular Stage. . . . . . . . . . 74
4.2. Capillary Penetration . . . . . . . 74
4.3. Elementary Tumorous Capillary Bed. 74
4.4. Macrovascular Connections. . . 74
4.5. Microcirculation of Large-Sized Tumors (Microangiog-
raphy of Human Tumors) . . . . . . . 75
4.6. Neoplasic Circulation and Tumorous Necrosis . .. 76
Angiography in Renal Tumors: Indications and Technique
E. Boijsen ........... 78
l. Urography: No Abnormality 78
2. Urography: Cystic Lesion . 80
3. Urography: Solid Tumor. . 81
3.l. Typical Renal Adenocarcinoma . 81
3.2. Probably Solid Renal Tumor 81
3.3. Renal Pelvic Tumor. . . 81
4. Urography: Tumor? .. 83
5. Angiographic Techniques. 84
6. Summary ....... . 90
Pharmacoangiography of the Kidney
O. Olsson ............ . 91
Value of Computerized Tomography and Ultrasonography in the
Diagnosis of Renal and Adrenal Space-Occupying Lesions
G. Marchal, A. Baert, and G. Wilms. . . . . . . . . . . 98
1. Computerized Tomographic Diagnosis of Renal Space-Oc-
cupying Lesions. . . . 98
1.1. Technique...... 98
1.2. Normal Renal Anatomy 98
l.3. Renal Masses. . . . . 99
1.4. Cystic Processes. . . . 100
1.5. Solid Space-Occupying Lesions 102
2. Sonographic Diagnosis of Renal Space-Occupying Lesions 108
2.1. Technique...... 109
2.2. Normal Renal Anatomy 110
2.3. Pathology.... 110
2.4. Renal Cysts 112
2.5. Polycystic Disease. 114
x
Contents
2.6. Solid Processes . . . . . . . . . . . . . . . . . . . 115
2.7. Palpable Abdominal Mass in Children: Echographic Value
in Differential Diagnosis . . . . . . . . . . . . . . . 117
3. Value ofSonography and CT in the Diagnosis of Suprarenal
Space-Occupying Lesions. . . . . . . . . . . . . . . 118
Radiologic Evaluation of Bilateral Space-Occupying Lesions
of the Kidney: a Multifaceted Approach
B. Swart, D. Beyer, and V. Fiedler 123
1. Introduction . . . . 123
2. Pathologic Anatomy. 123
3. Advances in Diagnostic Radiology. 124
4. Advances in Therapy 125
5. Material and Results 126
6. Conclusions . . . . 134
Radiologic Diagnosis of Renal Mass Lesions:
a Rational Approach
W.A. Fuchs ..... . 136
1. Urography . . . 137
2. Ultrasonography 137
3. Retrograde Pyelography 137
4. Angiography . . . . . 139
5. Computerized Tomography. 141
6. Current Diagnostic Approach. 141
Angiographic Diagnosis of Poorly Vascularized Renal Tumors
with Emphasis on Electronic Harmonization and Magnification
E. L6hr. . . . . . . . . . 143
1. Introduction . . . . 143
2. Methods and Patients 144
3. Results. . 145
4. Discussion . . . . . 154
Roentgen-Guided Percutaneous Punctures of the Kidney
B. Swart, D. Beyer, and V. Fiedler. . . 155
1. History . . . . . . . . . . . . . 155
2. Renal Cyst Puncture and Aspiration. 155
2.1. Puncture Technique . . . . . . . 156
2.2. Material and Results. . . . . . . . 160
2.3. Arguments Against Cyst Puncture. . 161
2.4. Arguments in Favor of Cyst Puncture 165
2.5. Conclusions . . . . . . . . . . . 166
3. Trans1umbar Antegrade Pyelography. 166
3.1. Introduction . . . . . . . . . . . 166
Contents XI
3.2. Indications . 167
3.3. Puncture Technique 167
3A. Complications 168
3.5. Material and Results. 168
3.6. Conclusions 169
*
Ultrasound Diagnosis of Renal and Pararenal Tumors
R. Heckemann 170
1. Introduction 170
2. Method 170
2.1. Physical Principles. 170
2.2. Apparature . 170
2.2.1. Real-Time Method 170
2.2.2. Compound Procedure 171
2.3. Technique of Examination 171
3. Anatomy of the Normal Kidney. 171
4. The Non-normal Kidney. 172
4.1. Cysts 172
4.2. Solid Tumors. 173
4.3. Cystic Renal Disease. 175
4A. Hydronephrosis . 176
4.5. Pararenal Space-Occupying Processes 178
5. Diagnostic Accuracy and Methodologic Limitations 180
5.1. Advantages of Ultrasound 181
5.2. Needle Puncture 181
6. Diagnostic Procedure 183
6.1. In Renal Transplant . 185
6.2. In Radiation Therapy 186
6.3. In Adrenal Tumors 187
7. Summary. 187
*
Diagnosis of Renal and Adrenal Tumors in Nuclear Medicine
M.W. Strotges 188
1. Nuclear Medicine in the Diagnosis of Renal Tumor 188
1.1. The Isotope Nephrogram. 188
1.2. The Split Renal Clearance 191
1.3. Renal Scintigram 191
lA. Radionuclide Perfusion 192
1.5. Radioactive Labeled Particles. 192
1.6. Clearance of 133Xe-Radioxenon . 192
1. 7. Summary. 192
2. Diagnostic Methods of the Adrenal Glands with Nuclear
Medicine. 193
2.1. The Adrenal Medulla 193
2.2. The Adrenal Cortex . 193
2.2.1. Stimulating and Suppression 196
2.2.2. Use of Scintigram . 197
3. Results. 198
4. Summary. 199
XII Contents
*
Retrospective and Prospective Clinical Aspects in Hypernephroma
H. Behrendt. . . . 200
1. Introduction . 200
2. Etiology . . . 200
3. Epidemiology. 201
4. Symptomatology and Clinical Findings. 201
5. Diagnosis 203
6. Staging 204
7. Therapy . 204
7.1. Surgery . 204
7.2. Surgical Procedure 206
7.3. Radiotherapy. . . 206
7.4. Conservative Therapy (Cytostatic, Hormonal, and Immu-
notherapy) . . 208
8. Prognosis .. 208
9. Final Remarks 210
*
Nonoperative Treatment of Hypernephroma
E. Scherer and H. Holfeld 212
1. General Remarks 212
2. Radiotherapy .. 214
3. Medical Therapy 218
Balloon Occlusion and Embolization of the Renal Arteries:
*
Indications and Clinical Results
W. Bischoff and U. Goerttler . 220
1. Introduction . . . . . . . 220
2. Material and Methods .. . 220
2.1. Operable Adenocarcinoma of the Kidney (Hypernephroma) 220
2.2. Inoperable Adenocarcinoma of the Kidney (Hyperne-
phroma) . 221
3. Results. . 221
4. Discussion 222
5. Summary. 227
Transcatheter Embolization of the Kidney:
*
Experimental and Clinical Data
R. Gunther and M. Marberger. 229
1. Introduction 229
2. Technique . . . . . 229
3. Results. . . . . . . 230
3.1. Animal Experiments. 230
3.2. Clinical Results. . . 233
4. Discussion . . . . . 234
4.1. Embolization Material. 234
4.2. Complications.... 236
4.3. Indications for Embolization 238
5. Summary ........ . 239