Abstract
Percutaneous biopsy has long been used to diagnose malignancies of the kidney. It is an established technique with multiple indications. Percutaneous biopsy now can be used to diagnose benign conditions that may mimic a malignancy and lead to unnecessary treatments. Advances in cytological techniques such as immunocytochemistry and cytogenetics have allowed for an increased diagnostic yield. In this review, various benign entities that may present as a renal mass are discussed and the vital role of percutaneous biopsy detailed.
Similar content being viewed by others
References
Zagoria RJ (2000) Imaging of small renal masses: a medical success story. AJR Am J Roentgenol 175:945–955
Rodriguez-Rubio FI, Diez-Caballero F, Martin-Marquina A, Abad JI, Berian JM (1996) Incidentally detected renal cell carcinoma. Br J Urol 78:29–32
Thompson IM, Peek M (1988) Improvement in survival of patients with renal cell carcinoma: the role of the serendipitiously detected tumor. J Urol 140:487–490
Smith SJ, Bosniak MA, Megibow AJ, et al. (1988) Renal cell carcinoma: earlier discovery and increased detection. Radiology 170:699–703
Silverman SG, Israel GM, Herts BR, Richie JP (2008) Management of the incidental renal mass. Radiology 249:16–31
Homma Y, Kawabe K, Kitamura T, et al. (1995) Increased incidental detection and reduced mortality in renal cancer: recent retrospective analysis at eight institutions. Int J Urol 2:77–80
Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr (1999) Rising incidence of renal cell carcinoma in the United States. JAMA 281:1628–1631
Jayson M, Sanders H (1998) Increased incidence of serendipitiously discovered renal cell carcinoma. Urology 51:203–205
Greenlee RT, Hill-Harmon MB, Murray T, Thun M (2001) Cancer statistics, 2001. CA Cancer J Clin 51:15–36
Ozen H, Colowick A, Freiha FS (1993) Incidentally discovered solid renal masses: what are they? Br J Urol 72:274–276
Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158:1–10
Bosniak MA (1991) The small (≤3.0 cm) renal parenchymal tumor: detection, diagnosis and controversies. Radiology 179:307–317
Bosniak MA, Megibow AJ, Hulnick DH, Horii S, Raghavendra BN (1988) CT diagnosis of renal angiomyolipoma: the importance of detecting small amounts of fat. AJR Am J Roentgenol 151:497–501
Bosniak MA (1981) Angiomyolipoma (hamartoma) of the kidney: a preoperative diagnosis is possible in virtually every case. Urol Radiol 3:135–142
Jinzaki M, Tanimoto A, Narimatsu Y, et al. (1997) Angiomyolipoma: imaging findings in lesions with minimal fat. Radiology 205:497–502
Sherman JL, Hartman DS, Friedman AC, et al. (1981) Angiomyolipoma: computed tomographic-pathological correlation of 17 cases. AJR Am J Roentgenol 137:1221–1226
Sant GR, Heaney JA, Ucci AA Jr, Sarno RC, Meares EM Jr (1984) Computed tomographic findings in renal angiomyolipoma: an histological correlation. Urology 24:293–296
Chao DH, Zisman A, Pantuck AJ, et al. (2002) Changing concepts in the management of renal oncocytoma. Urology 59:635–642
Fielding JR, Visweswaran A, Silverman SG, Granter SR, Renshaw AA (1999) CT and ultrasound features of metanephric adenoma in adults with pathological correlation. J Comput Assist Tomogr 23:441–444
Silverman SG, Gan YU, Mortele KJ, Tuncali K, Cibas ES (2006) Renal masses in the adult patient: the role of percutaneous biopsy. Radiology 240:6–22
Silverman SG, Gan YU, Mortele KJ, Tuncali K, Cibas ES (2006) Renal mass biopsy in the new millennium: an important diagnostic procedure. In: Ramchandani P (ed) Syllabus: categorical course in diagnostic radiology – genitourinary radiology. Radiological Society of North America, Oak Brook, IL, pp 219–236
Sahni VA, Silverman SG (2009) Biopsy of renal masses: when and why. Cancer Imaging 9:44–55
Bonzanini M, Pea M, Martignoni G, et al. (1994) Preoperative diagnosis of renal angiomyolipoma: fine needle aspiration cytology and immunocytological characterization. Pathology 26:170–175
Gupta RK, Nowitz M, Wakefield SJ (1998) Fine-needle aspiration cytology of renal angiomyolipoma: report of a case with immunocytochemical and electron microscopic findings. Diagn Cytopathol 18:297–300
Liu J, Fanning CV (2001) Can renal oncocytomas be distinguished from renal cell carcinoma on fine-needle aspiration specimens? A study of conventional smears in conjunction with ancillary studies. Cancer 93:390–397
Roh MH, dal Cin P, Silverman SG, Cibas ES (2009) Cytogenetics as an adjunct to fine needle aspiration in the diagnosis and classification of renal masses (abstract). Mod Pathol 21:94A
Bhatt S, MacLennan , Dogra V (2007) Renal pseudotumors. AJR Am J Roentgenol 188:1380–1387
Kawashima A, Sandler CM, Ernst RD, et al. (2000) CT evaluation of renovascular disease. Radiographics 20:1321–1340
Kendall AR, Senay BA, Coll ME (1988) Spontaneous subcapsular renal hematoma: diagnosis and management. J Urol 139:246–250
Belville JS, Morgentaler A, Loughlin KR, Tumeh SS (1989) Spontaneous perinephric and subcapsular renal hemorrhage: evaluation with CT, US, and angiography. Radiology 172:733–738
Silverman SG, Mortele KJ, Tuncali K, Jinzaki M, Cibas ES (2007) Hyperattenuating renal masses: etiologies, pathogenesis, and imaging evaluation. Radiographics 27:1131–1143
Demertzis J, Menias C (2007) State of the art: imaging of renal infection. Emerg Radiol 14:13–22
Kurowski K (1998) The woman with dysuria. Am Fam Physician 57:2155–2170
Rosenfield AT, Glickman MG, Taylor KJ, Crade M, Hodson J (1979) Acute focal bacterial nephritis (acute lobar nephronia). Radiology 132:553–561
Lee JK, McClennan BL, Melson GL, Stanley RJ (1980) Acute focal bacterial nephritis: emphasis on gray scale sonography and computed tomography. AJR Am J Roentgenol 135:87–92
McKinstry CS (1985) Acute lobar nephronia. Br J Radiol 58:1217–1219
Kawashima A, Sandler CM, Goldman SM, Raval BK, Fishman EK (1997) CT of renal inflammatory disease. Radiographics 17:851–866
Beland MD, Mayo-Smith WW, Dupuy DE, Cronan JJ, DeLellis RA (2007) Diagnostic yield of 58 consecutive imaging-guided biopsies of solid renal masses: should we biopsy all that are indeterminate? AJR Am J Roentgenol 188:792–797
Duchene DA, Lotan Y, Cadeddu JA, Sagalowsky AI, Koeneman KS (2003) Histopathology of surgically managed renal tumors: analysis of contemporary series. Urology 62:827–830
Li G, Cuilleron M, Gentil-Perret A, Tostain J (2004) Characteristics of image-detected solid renal masses: implication for optimal treatment. Int J Urol 11:63–67
Frank I, Blute ML, Cheville JC, et al. (2003) Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 170:2217–2220
McKiernan J, Yossepowitch O, Kattan MW, et al. (2002) Partial nephrectomy for renal cortical tumors: pathological findings and impact on outcome. Urology 60:1003–1009
Silver DA, Morash C, Brenner P, Campbell S, Russo P (1997) Pathological findings at the time of nephrectomy for renal mass. Ann Surg Oncol 4:570–574
Silverman SG, Tuncali K, vanSonnenberg E, et al. (2005) Renal tumors: MR imaging-guided percutaneous cryotherapy—initial experience in 23 patients. Radiology 236:716–724
Atwell TD, Farrell MA, Leibovich BC, et al. (2008) Percutaneous renal cryoablation: experience treating 115 tumors. J Urol 179:2136–2140
Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR (2005) Radio-frequency ablation of renal cell carcinoma: part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol 185:64–71
Liang P, Wang Y, Zhang D, et al. (2008) Ultrasound guided percutaneous microwave ablation for small renal cancer: initial experience. J Urol 180:844–848
Wu F, Wang ZB, Chen WZ, et al. (2003) Preliminary experience using high intensity focused ultrasound for the treatment of patients with advanced stage renal malignancy. J Urol 170:2237–2240
Kim JK, Park SY, Shon JH, Cho KS (2004) Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT. Radiology 230:677–684
Oliva MR, Glickman JN, Zou KH, et al. (2009) Renal cell carcinoma: T1 and T2 signal intensity characteristics of papillary and clear cell types correlated with pathology. AJR Am J Roentgenol 192:1524–1530
Shinmoto H, Yuasa Y, Tanimoto A, et al. (1998) Small renal cell carcinoma: MRI with pathological correlation. J Magn Reson Imaging 8:690–694
Sussman SK, Glickstein MF, Krzymowski GA (1990) Hypointense renal cell carcinoma: MR imaging with pathological correlation. Radiology 177:495–497
Pedrosa I, Chou MT, Ngo L, et al. (2008) MR classification of renal masses with pathological correlation. Eur Radiol 18:365–375
Jinzaki M, Tanimoto A, Mukai M, et al. (2000) Double-phase helical CT of small renal parenchymal neoplasms: correlation with pathological findings and tumor angiogenesis. J Comput Assist Tomogr 24:835–842
Kim JK, Park S, Shon J, Cho K (2002) Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT. Radiology 184:493–498
Nelson CP, Sanda MG (2002) Contemporary diagnosis and management of renal angiomyolipoma. J Urol 168:1315–1325
Nguyen GK (1984) Aspiration biopsy cytology of renal angiomyolipoma. Acta Cytol 42:293–296
Glenthoj A, Partoft S (1984) Ultrasound-guided percutaneous aspiration of renal angiomyolipoma. Acta Cytol 28:265–268
Sturtz CL, Dabbs DJ (1994) Angiomyolipomas: the nature and expression of the HMB45 antigen. Mod Pathol 7:842–845
Tikkakoski T, Paivansalo M, Alanen A, et al. (1991) Radiological findings in renal oncocytoma. Acta Radiol 32:363–367
Harmon WJ, King BF, Lieber MM (1996) Renal oncocytoma: magnetic resonance imaging characteristics. J Urol 155:863–867
Davidson AJ, Hayes WS, Hartman DS, McCarthy WF, Davis CJ Jr (1993) Renal oncocytoma and carcinoma: failure of differentiation with CT. Radiology 186:693–696
Wiatrowska BA, Zakowski MF (1999) Fine-needle aspiration biopsy of chromophobe renal cell carcinoma and oncocytoma: comparison of cytomorphological features. Cancer 87:161–167
Zhou M, Andres R, Magi-Galluzzi C (2005) The usefulness of immunohistochemical markers in the differential diagnosis of renal neoplasms. Clin Lab Med 25:247–257
Rocca PC, Brunelli M, Gobbo S, et al. (2007) Diagnostic utility of S100A1 expression in renal cell neoplasm: an immunohistochemical and quantitative RT-PCR study. Mod Pathol 20:722–728
Li G, Barthelemy A, Feng G, et al. (2007) S100A1: a powerful marker to differentiate chromophobe renal cell carcinoma from renal oncocytoma. Histopathology 50:642–647
Bove KE, Bhathena D, Wyatt RJ, Lucas BA, Holland NH (1979) Diffuse metanephric adenoma after in utero aspirin intoxication. A unique case of progressive renal failure. Arch Pathol Lab Med 103:187–190
Davis CJ Jr, Barton JH, Sesterhenn IA, Mostofi FK (1995) Metanephric adenoma: clinicopathological study of fifty patients. Am J Surg Pathol 19:1101–1114
Bastide C, Rambeaud J, Bach AM, Russo P (2009) Metanephric adenoma of the kidney: clinical and radiological study of nine cases. BJU Int 103:1544–1548
Araki T, Hata H, Asakawa E, Araki T (1998) MRI of metanephric adenoma. J Comput Assist Tomogr 22:87–90
Hwang SS, Choi YJ (2004) Metanephric adenoma of the kidney: case report. Abdom Imaging 29:309–311
Patel NP, Geisinger KR, Zagoria RJ, Bergman S (2009) Fine needle aspiration biopsy of metanephric adenoma. A case report. Acta Cytol 53:327–331
Jimenez-Hefferman JA, Tejerina E, Gonzalez-Peramato P, Vicandi P, Lopez-Garcia A (2009) Cytological features of metanephric adenoma of the kidney. Cytojournal 6:7
Azabdaftari G, Alroy J, Banner BF, et al. (2008) S100 protein expression distinguishes metanephric adenomas from other renal neoplasms. Pathol Res Pract 204:719–723
Brunelli M, Eble JN, Zhang S, Martignoni G, Cheng L (2003) Metanephric adenoma lacks the gains of chromosomes 7 and 17 and loss of Y that are typical of papillary renal cell carcinoma and papillary adenoma. Mod Pathol 16(10):1060–1063
Khayyata S, Grignon DJ, Aulicino MR, Al-Abbadi MA (2007) Metanephric adenoma vs Wilms’ tumor. Acta Ctyol 51:464–467
Prasad SR, Surabhi VR, Menias CO, Raut AA, Chintapalli KN (2008) Benign renal neoplasms in adults: cross-sectional imaging findings. AJR Am J Roentgenol 190:158–164
Derchi LE, Grenier G, Heinz-Peer G (2008) Imaging of renal leiomyomas. Acta Radiol 49:833–838
Selli C, Masi A, Vanni L, et al. (1992) Conflicting aspects of renal leiomyoma with different imaging techniques. Urol Int 48:219–222
Aronson S, Frazier HA, Baluch JD, Hartman DS, Christenson PJ (1991) Cystic renal masses: usefulness of the Bosniak classification. Urol Radiol 13:83–90
Brown WC, Amis ES Jr, Kaplan SA, Blaivas JG, Axelrod SL (1989) Renal cystic lesions: predictive value of preoperative computerized tomography (abstr). J Urol 141:426A
Cloix P, Martin X, Pangaud C, et al. (1996) Surgical management of complex renal cysts: a series of 32 cases. J Urol 156:28–30
Curry NS, Cochran ST, Bissada NK (2000) Cystic renal masses: accurate Bosniak classification requires adequate renal CT. AJR Am J Roentgenol 175:339–342
Israel GM, Bosniak MA (2003) Follow-up CT of moderately complex cystic lesions of the kidney (Bosniak category IIF). AJR Am J Roentgenol 181:627–633
Lang EK (1987) Renal cyst puncture studies. Urol Clin North Am 14:91–102
Harisinghani MG, Maher MM, Gervais DA (2003) Incidence of malignancy in complex cystic renal masses (Bosniak category III): should imaging-guided biopsy precede surgery? AJR Am J Roentgenol 180:755–758
Rybicki FJ, Shu KM, Cibas ES, et al. (2003) Percutaneous biopsy of renal masses: sensitivity and negative predictive value stratified by clinical setting and size of masses. AJR Am J Roentgenol 180:1281–1287
Renshaw AA, Granter SR, Cibas ES (1997) Fine-needle aspiration of the kidney. Cancer 81:71–88
Michal M, Syrucek M (1998) Benign mixed epithelial and stromal tumor of the kidney. Pathol Res Pract 194:445–448
Sahni VA, Mortele KJ, Glickman J, Silverman SG (2009) Mixed epithelial and stromal tumor of the kidney: features on imaging. BJU Int [Epub ahead of print]
Lane BR, Campbell SC, Remer EM, et al. (2008) Adult cystic nephroma and mixed epithelial stromal tumor of the kidney: clinical, radiographic, and pathological characteristics. Urology 71:1142–1148
Zhou M, Kort E, Hoekstra P, et al. (2009) Adult cystic nephroma and mixed epithelial and stromal tumor of the kidney are the same disease entity. Molecular and histological evidence. Am J Surg Pathol 33:72–80
Turbiner J, Amin MB, Humphrey PA, et al. (2007) Cystic nephroma and mixed epithelial and stromal tumor of kidney: a detailed clinicopathological analysis of 34 cases and proposal for renal and epithelial stromal tumor (REST) as a unifying term. Am J Surg Pathol 31:489–500
Chen KTK (2008) Cytology of cystic nephroma. Acta Cytol 52:91–93
Adsay NV, Eble JN, Srigley JR, Jones EC, Grignon DJ (2000) Mixed epithelial and stromal tumor of the kidney. Am J Surg Pathol 24:958–970
Svec A, Hes O, Michal M, Zachoval R (2001) Malignant mixed epithelial and stromal tumor of the kidney. Virchows Arch 439:700–702
Nakagawa T, Kanai Y, Fujimoto H, et al. (2004) Malignant mixed epithelial and stromal tumours of the kidney: a report of the first two cases with a fatal outcome. Histopathology 44:302–304
Sukov WR, Cheville JC, Lager DJ, et al. (2007) Malignant mixed epithelial and stromal tumor of the kidney with rhabdoid features: report of a case including immunohistochemical molecular genetic studies and comparison to morphologically similar renal tumors. Hum Pathol 38:1432–1437
Acknowledgement
The authors thank Dr. Edmund S. Cibas for help editing the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sahni, V.A., Ly, A. & Silverman, S.G. Usefulness of percutaneous biopsy in diagnosing benign renal masses that mimic malignancy. Abdom Imaging 36, 91–101 (2011). https://doi.org/10.1007/s00261-009-9597-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-009-9597-5