Eosinophilic Vacuolated Tumor of the Kidney: A Case Report and Literature Review
Poster #: 066
Session/Time: A
Author:
Benjamin Samberg, BS
Mentor:
Frances Lazarow, MD
Research Type: Case Report
Abstract
INTRODUCTION:
Renal Oncocytoma (RO) is a relatively rare benign neoplasm of the kidney. Eosinophilic vacuolated tumor (EVT) is a distinct subtype of RO, distinguished primarily by unique morphologic features. While typically benign, this lesion's clinical importance lies primarily in distinguishing it from renal cell carcinoma, which can be difficult in the preoperative setting due to similarities in the epidemiology, clinical presentation, and imaging features of these entities. The following is a case report of EVT followed by a literature review discussing the epidemiology, clinical presentation, imaging features, management, and prognosis.
CASE INFORMATION:
A 24 year old gravid female was admitted to the hospital for preeclampsia, where workup revealed an incidental 6.1 cm mass in the left kidney. A subsequent multiphase contrast enhanced-CT demonstrated heterogeneous enhancement and raised suspicion for renal cell carcinoma. The patient underwent a radical left nephrectomy, and pathological analysis classified the tumor as an eosinophilic vacuolated tumor of the kidney.
DISCUSSION:
EVT represents a solid neoplasm of the kidney, with higher prevalence in males than females and with an average age of onset is approximately 55 years. Patients are often asymptomatic at discovery, with the lesions often detected incidentally. Unfortunately, the imaging features of EVT are difficult to distinguish from renal cell carcinoma and they are typically resected. They usually appear as well-marginated lesions and are often large at presentation. They typically demonstrate homogenous enhancement on post-contrast images, with up to 1/3rd of cases demonstrating a characteristic "central-stellate" non-enhancing scar. The most reliable feature, however, is the presence of metastasis or local invasion of adjacent structures, in which case the diagnosis of renal cell carcinoma is favored. Given the overlap of imaging features with RCC, confident preoperative distinction is often not possible, and so most are resected.
CONCLUSION:
Although EVT - and more broadly RO - are benign lesions, a definitive preoperative diagnosis is difficult to make as the epidemiology, clinical presentation, and imaging features overlap considerably with RCC.
Renal Oncocytoma (RO) is a relatively rare benign neoplasm of the kidney. Eosinophilic vacuolated tumor (EVT) is a distinct subtype of RO, distinguished primarily by unique morphologic features. While typically benign, this lesion's clinical importance lies primarily in distinguishing it from renal cell carcinoma, which can be difficult in the preoperative setting due to similarities in the epidemiology, clinical presentation, and imaging features of these entities. The following is a case report of EVT followed by a literature review discussing the epidemiology, clinical presentation, imaging features, management, and prognosis.
CASE INFORMATION:
A 24 year old gravid female was admitted to the hospital for preeclampsia, where workup revealed an incidental 6.1 cm mass in the left kidney. A subsequent multiphase contrast enhanced-CT demonstrated heterogeneous enhancement and raised suspicion for renal cell carcinoma. The patient underwent a radical left nephrectomy, and pathological analysis classified the tumor as an eosinophilic vacuolated tumor of the kidney.
DISCUSSION:
EVT represents a solid neoplasm of the kidney, with higher prevalence in males than females and with an average age of onset is approximately 55 years. Patients are often asymptomatic at discovery, with the lesions often detected incidentally. Unfortunately, the imaging features of EVT are difficult to distinguish from renal cell carcinoma and they are typically resected. They usually appear as well-marginated lesions and are often large at presentation. They typically demonstrate homogenous enhancement on post-contrast images, with up to 1/3rd of cases demonstrating a characteristic "central-stellate" non-enhancing scar. The most reliable feature, however, is the presence of metastasis or local invasion of adjacent structures, in which case the diagnosis of renal cell carcinoma is favored. Given the overlap of imaging features with RCC, confident preoperative distinction is often not possible, and so most are resected.
CONCLUSION:
Although EVT - and more broadly RO - are benign lesions, a definitive preoperative diagnosis is difficult to make as the epidemiology, clinical presentation, and imaging features overlap considerably with RCC.