HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Silverman, S. G. Articles by Cibas, E. S. Search for Related Content PubMed PubMed Citation Articles by Silverman, S. G. Articles by Cibas, E. S.

Renal Masses in the Adult Patient: The Role of Percutaneous Biopsy¹

¹ From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.G.S., Y.U.G., K.J.M., K.T.), and Division of Cytology, Department of Pathology (E.S.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. Received January 14, 2005; revision requested March 17; revision received April 8; accepted May 2; final version accepted June 13; final review by S.G.S. January 19, 2006. Address correspondence to S.G.S. (e-mail: sgsilverman{at}partners.org).

View larger version (152K): [in a new window]   Figure 1a: Biopsy of solid 3.5-cm right interpolar renal mass in a 68-year-old woman referred for percutaneous ablation. (a) Percutaneous biopsy of the mass (arrowhead) with 25-gauge needle (arrow), shown on transverse CT image, yielded inadequate cellular material. (b) CT-guided biopsy, shown on transverse CT image, was repeated with 18-gauge needle (arrow). (c) Photomicrograph shows cells were immunoreactive (arrows) for renal cell carcinoma antibody. (Original magnification, x600.) (d) Photomicrograph of cell block section reveals clear cell renal cell carcinoma. (Hematoxylin-eosin stain; original magnification, x400.)

View larger version (163K): [in a new window]   Figure 1b: Biopsy of solid 3.5-cm right interpolar renal mass in a 68-year-old woman referred for percutaneous ablation. (a) Percutaneous biopsy of the mass (arrowhead) with 25-gauge needle (arrow), shown on transverse CT image, yielded inadequate cellular material. (b) CT-guided biopsy, shown on transverse CT image, was repeated with 18-gauge needle (arrow). (c) Photomicrograph shows cells were immunoreactive (arrows) for renal cell carcinoma antibody. (Original magnification, x600.) (d) Photomicrograph of cell block section reveals clear cell renal cell carcinoma. (Hematoxylin-eosin stain; original magnification, x400.)

View larger version (138K): [in a new window]   Figure 1c: Biopsy of solid 3.5-cm right interpolar renal mass in a 68-year-old woman referred for percutaneous ablation. (a) Percutaneous biopsy of the mass (arrowhead) with 25-gauge needle (arrow), shown on transverse CT image, yielded inadequate cellular material. (b) CT-guided biopsy, shown on transverse CT image, was repeated with 18-gauge needle (arrow). (c) Photomicrograph shows cells were immunoreactive (arrows) for renal cell carcinoma antibody. (Original magnification, x600.) (d) Photomicrograph of cell block section reveals clear cell renal cell carcinoma. (Hematoxylin-eosin stain; original magnification, x400.)

View larger version (136K): [in a new window]   Figure 1d: Biopsy of solid 3.5-cm right interpolar renal mass in a 68-year-old woman referred for percutaneous ablation. (a) Percutaneous biopsy of the mass (arrowhead) with 25-gauge needle (arrow), shown on transverse CT image, yielded inadequate cellular material. (b) CT-guided biopsy, shown on transverse CT image, was repeated with 18-gauge needle (arrow). (c) Photomicrograph shows cells were immunoreactive (arrows) for renal cell carcinoma antibody. (Original magnification, x600.) (d) Photomicrograph of cell block section reveals clear cell renal cell carcinoma. (Hematoxylin-eosin stain; original magnification, x400.)

View larger version (116K): [in a new window]   Figure 2a: Incidental mass in interpolar region of left kidney in a 61-year-old man. (a) Transverse T1-weighted MR image (repetition time msec/echo time msec, 285/4.2) shows 2.5-cm mass (arrowhead) that enhanced homogeneously. CT-guided percutaneous biopsy was performed (not shown). (b) Photomicrograph of cytologic preparation reveals oncocytic cells (arrows). (Giemsa stain; original magnification, x600.) Immunocytochemical reaction for keratins AE1/AE3 (not shown) was positive. Hale colloidal iron stain (not shown) was negative. Diagnosis was renal oncocytoma.

View larger version (174K): [in a new window]   Figure 2b: Incidental mass in interpolar region of left kidney in a 61-year-old man. (a) Transverse T1-weighted MR image (repetition time msec/echo time msec, 285/4.2) shows 2.5-cm mass (arrowhead) that enhanced homogeneously. CT-guided percutaneous biopsy was performed (not shown). (b) Photomicrograph of cytologic preparation reveals oncocytic cells (arrows). (Giemsa stain; original magnification, x600.) Immunocytochemical reaction for keratins AE1/AE3 (not shown) was positive. Hale colloidal iron stain (not shown) was negative. Diagnosis was renal oncocytoma.

View larger version (151K): [in a new window]   Figure 3a: Small solid mass in interpolar region of left kidney in a 57-year-old man with a history of prostate cancer. (a) Transverse CT image shows enhancing 3.5-cm left renal mass (arrowhead). (b) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with patient in the prone position by using a 25-gauge needle (arrow). Cytologic preparations stained with Wright-Giemsa stain (not shown) revealed oncocytic cells. At further staining with (c) epithelial membrane antigen, as demonstrated by brown color, and (d) Hale colloidal iron stain, as demonstrated by blue color, the cells obtained at biopsy were positive. Diagnosis was chromophobe renal cell carcinoma. (Original magnification for c and d,x400.)

View larger version (140K): [in a new window]   Figure 3b: Small solid mass in interpolar region of left kidney in a 57-year-old man with a history of prostate cancer. (a) Transverse CT image shows enhancing 3.5-cm left renal mass (arrowhead). (b) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with patient in the prone position by using a 25-gauge needle (arrow). Cytologic preparations stained with Wright-Giemsa stain (not shown) revealed oncocytic cells. At further staining with (c) epithelial membrane antigen, as demonstrated by brown color, and (d) Hale colloidal iron stain, as demonstrated by blue color, the cells obtained at biopsy were positive. Diagnosis was chromophobe renal cell carcinoma. (Original magnification for c and d,x400.)

View larger version (83K): [in a new window]   Figure 3c: Small solid mass in interpolar region of left kidney in a 57-year-old man with a history of prostate cancer. (a) Transverse CT image shows enhancing 3.5-cm left renal mass (arrowhead). (b) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with patient in the prone position by using a 25-gauge needle (arrow). Cytologic preparations stained with Wright-Giemsa stain (not shown) revealed oncocytic cells. At further staining with (c) epithelial membrane antigen, as demonstrated by brown color, and (d) Hale colloidal iron stain, as demonstrated by blue color, the cells obtained at biopsy were positive. Diagnosis was chromophobe renal cell carcinoma. (Original magnification for c and d,x400.)

View larger version (150K): [in a new window]   Figure 3d: Small solid mass in interpolar region of left kidney in a 57-year-old man with a history of prostate cancer. (a) Transverse CT image shows enhancing 3.5-cm left renal mass (arrowhead). (b) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with patient in the prone position by using a 25-gauge needle (arrow). Cytologic preparations stained with Wright-Giemsa stain (not shown) revealed oncocytic cells. At further staining with (c) epithelial membrane antigen, as demonstrated by brown color, and (d) Hale colloidal iron stain, as demonstrated by blue color, the cells obtained at biopsy were positive. Diagnosis was chromophobe renal cell carcinoma. (Original magnification for c and d,x400.)

View larger version (40K): [in a new window]   Figure 4: Established indications for percutaneous biopsy of renal masses.

View larger version (32K): [in a new window]   Figure 5: Emerging indications for percutaneous biopsy of renal masses.

View larger version (147K): [in a new window]   Figure 6a: Leukemia and a small mass in a 46-year-old man. (a) Transverse T1-weighted MR image (5.9/1.9) reveals peripherally enhancing 2.1-cm mass in right renal upper pole (arrow) and perinephric stranding (arrowhead). (b) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with a 25-gauge needle (arrow). Hematoxylin-eosin–stained cell block section (not shown) revealed acute and chronic inflammatory cells. (c) Photomicrograph shows fungal organisms (arrows). The patient was treated for renal candidiasis. (Methanimine silver stain; original magnification, x600.)

View larger version (151K): [in a new window]   Figure 6b: Leukemia and a small mass in a 46-year-old man. (a) Transverse T1-weighted MR image (5.9/1.9) reveals peripherally enhancing 2.1-cm mass in right renal upper pole (arrow) and perinephric stranding (arrowhead). (b) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with a 25-gauge needle (arrow). Hematoxylin-eosin–stained cell block section (not shown) revealed acute and chronic inflammatory cells. (c) Photomicrograph shows fungal organisms (arrows). The patient was treated for renal candidiasis. (Methanimine silver stain; original magnification, x600.)

View larger version (148K): [in a new window]   Figure 6c: Leukemia and a small mass in a 46-year-old man. (a) Transverse T1-weighted MR image (5.9/1.9) reveals peripherally enhancing 2.1-cm mass in right renal upper pole (arrow) and perinephric stranding (arrowhead). (b) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with a 25-gauge needle (arrow). Hematoxylin-eosin–stained cell block section (not shown) revealed acute and chronic inflammatory cells. (c) Photomicrograph shows fungal organisms (arrows). The patient was treated for renal candidiasis. (Methanimine silver stain; original magnification, x600.)

View larger version (122K): [in a new window]   Figure 7a: Incidental hyperattenuating mass in interpolar portion of right kidney in a 67-year-old woman. (a) Transverse unenhanced CT image shows 2.3-cm mass (arrowhead) with hyperattenuating (54-HU) areas within the mass and no evidence of fat. (b) Transverse CT image shows enhancement (77 HU) of the mass (arrowhead). (c) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with a 25-gauge needle (arrow), with patient in prone position. (d) Photomicrograph reveals spindle cells (arrow). (Papanicolaou stain; original magnification, x400.) (e) Photomicrograph of cell block shows fat cells (arrow). (Hematoxylin-eosin stain; original magnification, x400.) (f, g) Photomicrographs of immunocytochemical-stained specimens are positive for (f) smooth muscle actin and (g) MART1 (melanoma antigen recognized by T cells), which are both demonstrated as brown areas. Diagnosis was an angiomyolipoma with minimal fat. (Original magnification for f and g,x400.)

View larger version (139K): [in a new window]   Figure 7b: Incidental hyperattenuating mass in interpolar portion of right kidney in a 67-year-old woman. (a) Transverse unenhanced CT image shows 2.3-cm mass (arrowhead) with hyperattenuating (54-HU) areas within the mass and no evidence of fat. (b) Transverse CT image shows enhancement (77 HU) of the mass (arrowhead). (c) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with a 25-gauge needle (arrow), with patient in prone position. (d) Photomicrograph reveals spindle cells (arrow). (Papanicolaou stain; original magnification, x400.) (e) Photomicrograph of cell block shows fat cells (arrow). (Hematoxylin-eosin stain; original magnification, x400.) (f, g) Photomicrographs of immunocytochemical-stained specimens are positive for (f) smooth muscle actin and (g) MART1 (melanoma antigen recognized by T cells), which are both demonstrated as brown areas. Diagnosis was an angiomyolipoma with minimal fat. (Original magnification for f and g,x400.)

View larger version (124K): [in a new window]   Figure 7c: Incidental hyperattenuating mass in interpolar portion of right kidney in a 67-year-old woman. (a) Transverse unenhanced CT image shows 2.3-cm mass (arrowhead) with hyperattenuating (54-HU) areas within the mass and no evidence of fat. (b) Transverse CT image shows enhancement (77 HU) of the mass (arrowhead). (c) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with a 25-gauge needle (arrow), with patient in prone position. (d) Photomicrograph reveals spindle cells (arrow). (Papanicolaou stain; original magnification, x400.) (e) Photomicrograph of cell block shows fat cells (arrow). (Hematoxylin-eosin stain; original magnification, x400.) (f, g) Photomicrographs of immunocytochemical-stained specimens are positive for (f) smooth muscle actin and (g) MART1 (melanoma antigen recognized by T cells), which are both demonstrated as brown areas. Diagnosis was an angiomyolipoma with minimal fat. (Original magnification for f and g,x400.)

View larger version (119K): [in a new window]   Figure 7d: Incidental hyperattenuating mass in interpolar portion of right kidney in a 67-year-old woman. (a) Transverse unenhanced CT image shows 2.3-cm mass (arrowhead) with hyperattenuating (54-HU) areas within the mass and no evidence of fat. (b) Transverse CT image shows enhancement (77 HU) of the mass (arrowhead). (c) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with a 25-gauge needle (arrow), with patient in prone position. (d) Photomicrograph reveals spindle cells (arrow). (Papanicolaou stain; original magnification, x400.) (e) Photomicrograph of cell block shows fat cells (arrow). (Hematoxylin-eosin stain; original magnification, x400.) (f, g) Photomicrographs of immunocytochemical-stained specimens are positive for (f) smooth muscle actin and (g) MART1 (melanoma antigen recognized by T cells), which are both demonstrated as brown areas. Diagnosis was an angiomyolipoma with minimal fat. (Original magnification for f and g,x400.)

View larger version (117K): [in a new window]   Figure 7e: Incidental hyperattenuating mass in interpolar portion of right kidney in a 67-year-old woman. (a) Transverse unenhanced CT image shows 2.3-cm mass (arrowhead) with hyperattenuating (54-HU) areas within the mass and no evidence of fat. (b) Transverse CT image shows enhancement (77 HU) of the mass (arrowhead). (c) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with a 25-gauge needle (arrow), with patient in prone position. (d) Photomicrograph reveals spindle cells (arrow). (Papanicolaou stain; original magnification, x400.) (e) Photomicrograph of cell block shows fat cells (arrow). (Hematoxylin-eosin stain; original magnification, x400.) (f, g) Photomicrographs of immunocytochemical-stained specimens are positive for (f) smooth muscle actin and (g) MART1 (melanoma antigen recognized by T cells), which are both demonstrated as brown areas. Diagnosis was an angiomyolipoma with minimal fat. (Original magnification for f and g,x400.)

View larger version (133K): [in a new window]   Figure 7f: Incidental hyperattenuating mass in interpolar portion of right kidney in a 67-year-old woman. (a) Transverse unenhanced CT image shows 2.3-cm mass (arrowhead) with hyperattenuating (54-HU) areas within the mass and no evidence of fat. (b) Transverse CT image shows enhancement (77 HU) of the mass (arrowhead). (c) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with a 25-gauge needle (arrow), with patient in prone position. (d) Photomicrograph reveals spindle cells (arrow). (Papanicolaou stain; original magnification, x400.) (e) Photomicrograph of cell block shows fat cells (arrow). (Hematoxylin-eosin stain; original magnification, x400.) (f, g) Photomicrographs of immunocytochemical-stained specimens are positive for (f) smooth muscle actin and (g) MART1 (melanoma antigen recognized by T cells), which are both demonstrated as brown areas. Diagnosis was an angiomyolipoma with minimal fat. (Original magnification for f and g,x400.)

View larger version (141K): [in a new window]   Figure 7g: Incidental hyperattenuating mass in interpolar portion of right kidney in a 67-year-old woman. (a) Transverse unenhanced CT image shows 2.3-cm mass (arrowhead) with hyperattenuating (54-HU) areas within the mass and no evidence of fat. (b) Transverse CT image shows enhancement (77 HU) of the mass (arrowhead). (c) CT-guided percutaneous biopsy, shown on transverse CT image, was performed with a 25-gauge needle (arrow), with patient in prone position. (d) Photomicrograph reveals spindle cells (arrow). (Papanicolaou stain; original magnification, x400.) (e) Photomicrograph of cell block shows fat cells (arrow). (Hematoxylin-eosin stain; original magnification, x400.) (f, g) Photomicrographs of immunocytochemical-stained specimens are positive for (f) smooth muscle actin and (g) MART1 (melanoma antigen recognized by T cells), which are both demonstrated as brown areas. Diagnosis was an angiomyolipoma with minimal fat. (Original magnification for f and g,x400.)

View larger version (131K): [in a new window]   Figure 8a: Small, hyperattenuating, enhancing mass in upper pole of right kidney of an 82-year-old man with bladder carcinoma. (a) Transverse unenhanced CT image shows 2.8-cm mass with attenuation of 40 HU (arrowhead). (b) Transverse CT image shows enhancement (60 HU) of the mass (arrowhead). (c) Transverse T2-weighted MR image (2500/87) shows that the mass is hypointense (arrowhead). CT-guided percutaneous fine-needle aspiration biopsy was performed. (d) Photomicrograph reveals characteristic morphologic features of papillary renal cell carcinoma. (Papanicolaou stain; original magnification, x400.)

View larger version (133K): [in a new window]   Figure 8b: Small, hyperattenuating, enhancing mass in upper pole of right kidney of an 82-year-old man with bladder carcinoma. (a) Transverse unenhanced CT image shows 2.8-cm mass with attenuation of 40 HU (arrowhead). (b) Transverse CT image shows enhancement (60 HU) of the mass (arrowhead). (c) Transverse T2-weighted MR image (2500/87) shows that the mass is hypointense (arrowhead). CT-guided percutaneous fine-needle aspiration biopsy was performed. (d) Photomicrograph reveals characteristic morphologic features of papillary renal cell carcinoma. (Papanicolaou stain; original magnification, x400.)

View larger version (99K): [in a new window]   Figure 8c: Small, hyperattenuating, enhancing mass in upper pole of right kidney of an 82-year-old man with bladder carcinoma. (a) Transverse unenhanced CT image shows 2.8-cm mass with attenuation of 40 HU (arrowhead). (b) Transverse CT image shows enhancement (60 HU) of the mass (arrowhead). (c) Transverse T2-weighted MR image (2500/87) shows that the mass is hypointense (arrowhead). CT-guided percutaneous fine-needle aspiration biopsy was performed. (d) Photomicrograph reveals characteristic morphologic features of papillary renal cell carcinoma. (Papanicolaou stain; original magnification, x400.)

View larger version (101K): [in a new window]   Figure 8d: Small, hyperattenuating, enhancing mass in upper pole of right kidney of an 82-year-old man with bladder carcinoma. (a) Transverse unenhanced CT image shows 2.8-cm mass with attenuation of 40 HU (arrowhead). (b) Transverse CT image shows enhancement (60 HU) of the mass (arrowhead). (c) Transverse T2-weighted MR image (2500/87) shows that the mass is hypointense (arrowhead). CT-guided percutaneous fine-needle aspiration biopsy was performed. (d) Photomicrograph reveals characteristic morphologic features of papillary renal cell carcinoma. (Papanicolaou stain; original magnification, x400.)