Renal Sinus Tumor-MR urography

An adult male underwent USG check for left loin pain  with no hematuria. USG suggested a mixed echogenic mass for which enhanced CT showed heterogenous mildy enhancing mass in the renal sinus on left , possibly transitional cell carcinoma  with distorted collecting systems. MR urography has been advised in the light of this. It shows  a relatively  well defined complex mass lesion in the renal sinus location with stretched calyces and pelvis as such with no hydronephrosis or MR demonstrable calcification. It displays  relative bright signal on T1 and intermediate on T2 with heterogenous suppression on fat suppression. Inview of the above , mesenchymal origin  tumour lesions like fibroma are possible. Rest of  the  urography is normal

Teaching points by Dr MGK Murthy. Contributors Dr Krishna Mohan and Mr Laxman

1.Renal sinus  is perinephric space extension to deep recess on medial border of kidney

2. Has major artery/vein, major/minor collecting systems, adipose tissue/lymphatics/nerves of autonomic nervous system/varying degrees of fibrous tissue

3.Lesions are  defined as non tumorous  {lipomatosis/cysts/vascular orgin including aneurysms/fluid collections including urinomas  or extravasations}

And tumourous {renal pelvis(TCC)/mesenchymal origin(lipoma/fibroma etc)/renal parenchyma or retroperitoneal tumours projecting in to the region}

4.Parapelvic is usually referred to as alongside and peripelvic is defined as diffuse and all around the pelvis in terminology

5.USG is inadequate in tumors conditions and urography only shows sequelae

6.Coronal CT on MDCT technology is the ideal modality of choice with MRI including MR Urography playing a decisive role in  conflicting findings

7. 90%of renal pelvis tumors are Transitional cell carcinomas with 10% particularly in presence of calculus –squamous carcinoma and haematuria is  MUST

8.Mesenchymal  tumors include fibroma, hemangioma, leiomyoma, and angiomyolipoma and radiological  clue would be calyces stretching  with/ without  hydronephrosis