The radiologist's role in the management of papillary renal cell carcinoma.
Papillary carcinoma is the second most common renal cell carcinoma. It has a better prognosis than the more frequent clear cell carcinoma, although this does not hold true for advanced cases, because no specific treatment exists. It presents as a circumscribed peripheral tumor (small and homogeneously solid or larger and cystic/hemorrhagic) or as an infiltrating lesion that invades the veins, which has a worse prognosis. Due to their low vascular density, papillary renal cell carcinomas enhance less than other renal tumors, and this facilitates their characterization. On computed tomography, they might not enhance conclusively, and in these cases they are impossible to distinguish from hyperattenuating cysts. Contrast-enhanced ultrasonography and magnetic resonance imaging are more sensitive for detecting vascularization. Other characteristics include a specific vascular pattern, hypointensity on T2-weighted images, restricted water diffusion, and increased signal intensity in opposed phase images. We discuss the genetic, histologic, clinical, and radiological aspects of these tumors in which radiologists play a fundamental role in management.
Servicio de Radiodiagnóstico, Complejo Asistencial de Ávila, Ávila, España. Electronic address: migcorral@gmail.com.
M Á
MÁ
Corral de la Calle
Servicio de Radiodiagnóstico, Complejo Asistencial de Ávila, Ávila, España.
J
J
Encinas de la Iglesia
Servicio de Anatomía Patológica, Complejo Asistencial de Ávila, Ávila, España.
M R
MR
Martín López
Servicio de Radiodiagnóstico, Hospital Universitario del Río Hortega, Valladolid, España.
G C
GC
Fernández Pérez
Servicio de Radiodiagnóstico, Complejo Asistencial de Ávila, Ávila, España.
D S
DS
Águeda Del Bas
D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000235:genetics / Q000473:pathology; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging*; D010819:Physician's Role; D011379:Prognosis; D011871:Radiology
Carcinoma de células renales; Carcinoma papilar; Carcinoma papilar de células renales; Clinical decision making; Contrast-enhanced ultrasonography; Ecografía; Ecografía con contraste; Hallazgos incidentales; Hereditary neoplastic syndromes; Imagen por resonancia magnética; Incidental findings; Magnetic resonance imaging; Multidetector computed tomography; Papillary carcinoma; Papillary renal cell carcinoma; Renal cell carcinoma; Síndromes neoplásicos hereditarios; Toma clínica de decisiones; Tomografía computarizada multidetector; Ultrasonography