Abstract accepted for online presentation at the ECR 2004 (European Congress of Radiology).
View Percutaneous image-guided lymph node biopsy in lymphoma: tips and tricks

Imaging features of metastases and local recurrence in
surgically treated kidney cancer

A. Guermazi (San Francisco/US), I. El-Hariry (Middx/UK), Y. Miaux (San Francisco/US)

1. To illustrate both typical and less typical US, CT and MR imaging appearances of metastases and local recurrence from renal cancers.  2. To understand the mechanisms, risk factors, and clinical timing of recurrent disease in surgically treated renal cancer....

Background

Patients with renal cell cancer develop metastatic spread in approximately 33% of cases [1, 2] and local recurrence in about 5% of cases [3]. The accurate detection of recurrent disease provides key prognostic information and assists the oncologist in making treatment decisions involving either surgery or immunotherapy [4]. Common sites of metastases include the lung, mediastinum, bones, brain, and liver. Less common sites include the contralateral kidney, and the adrenal gland, pancreas, mesentery, and abdominal wall, with case reports detailing the capacity of renal carcinoma to appear almost any where in the body [1, 5, 6]. More than one organ is often involved in the metastatic process [1]. Metastases may be found at diagnosis or at some interval after nephrectomy [1, 7]. Indeed, approximately 20-50% of patients with renal cell carcinoma (RCC) will eventually develop metastatic disease after nephrectomy [1, 5, 7]. A shorter interval between nephrectomy and the development of metastases is associated with a poorer prognosis. Patients with metastatic RCC face a dismal prognosis, with a median survival time of only 6 to 12 months and a 2-year survival rate of 10-20%. Recent advances in biologic response modifier therapy has given hope to a small percentage of patients who respond to this therapy [1], and has rekindled interest in cytoreductive nephrectomy as an integral part of the management of these patients [1, 8].

The purpose of this exhibit is to illustrate both typical and less typical US, CT and MR imaging appearances of metastases and local recurrence from renal cancers with emphasis on spiral CT, which is considered the ideal modality for conducting postoperative surveillance in patients at risk for recurrent or metastasis disease [3].

Conclusion

Metastatic lesions from kidney cancer are seen in virtually every organ: the lung, pleura, pancreas, adrenal gland, liver, contralateral kidney, bone, lymph nodes, muscles, etc. These lesions can masquerade as another primary tumor. Like the primary tumor, metastatic lesions tend to be hypervascular and underline the usefulness of intravenous contrast administration. Locally recurrent lesions are usually detected as masses in the vacant renal fossa. Whole body spiral CT is currently the method of choice for evaluating the postsurgical nephrectomy site for the presence of recurrent lesions and for detecting the usual (common) anatomical sites of metastases. Administration of oral contrast material in CT is useful to differentiate these recurrent lesions from intestinal loops. Knowledge of the mechanisms, risk factors, and clinical timing of recurrent disease in surgically treated renal cancer can assist the radiologist in understanding and detecting the patterns of recurrence observed on imaging. Other radiological modalities may be of interest when exploring particular organs such as ultrasound for the liver, and MR imaging for the brain and spine.

View Current News