The Urinary System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
The glandular portion of the kidney that surrounds the structures of the renal sinus is divided into the medulla and the cortex [Figure 11.1(B)], The medullary portion consists of a series of conical structures called renal pyramids with their blunted points facing in toward the renal sinus. The blunted end of each renal pyramid is perforated by the openings of ducts and projects into a minor calyx. The cortex lies between the bases of these pyramids and the capsule or surface of the kidney and projects between the pyramids in the renal columns.
Paper 1
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw in The Final FRCR, 2020
An 11 month old baby has an abdominal ultrasound for possible intussusception following an episode of abdominal pain and haematochezia. This does not identify any evidence of intussusception and the child’s symptoms resolve after treatment for constipation. During this scan the right kidney was noted to have a 20-mm hypoechoic, peripherally sited, right renal lesion distant to the renal sinus. The left kidney has normal appearances. An MRI abdomen confirmed the presence of the lesion, which was limited to the kidney and demonstrated homogenously low signal on T1 and T2 weighted imaging. Following contrast there was minimal homogenous enhancement compared to the adjacent renal cortex.
Renal cancer
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
Over 90% of tumours greater than 10 cm demonstrate extracapsular, perirenal fat involvement and are therefore T3 disease (100). In contrast, the renal sinus is not separated from the renal cortex by capsule, and assessment of invasion of the renal sinus on imaging is relatively insensitive (82). Underestimating renal sinus invasion is the most frequent cause for surgical upstaging to T3 disease (101). Abutment of the renal sinus by a cortically based tumour (even without overt invasion) should be considered as highly suspicious for renal sinus invasion and therefore T3 disease (102).
Hot topics in renal cancer pathology: implications for clinical management
Published in Expert Review of Anticancer Therapy, 2022
Alessia Cimadamore, Anna Caliò, Laura Marandino, Stefano Marletta, Carmine Franzese, Luigi Schips, Daniele Amparore, Riccardo Bertolo, Stijn Muselaers, Selcuk Erdem, Alexandre Ingels, Nicola Pavan, Angela Pecoraro, Önder Kara, Eduard Roussel, Umberto Carbonara, Riccardo Campi, Michele Marchioni
Renal sinus invasion can be present as direct soft tissue invasion or involvement of vascular spaces within the adipose tissue of the renal hilum (Figure 4). Contrarily to the renal capsule, the renal sinus has no discrete capsular barrier and houses prominent vessels. The likelihood of invasion of the renal sinus increases sharply with increasing tumor size [39–41]. Variability in specimen handling may affect tumor staging, with laboratories that normally sample 2 to 3 blocks of the tumor-sinus interface even if there is low suspicion of tumor invasion and other than sample just one block of the hilum or even none if the mass is grossly not in contact with the sinus adipose tissue. Often sinus fat invasion occurs as well circumscribed tumor nodules, or as lymphovascular invasion, sometimes not easily discernible one another. In any case, the ISUP consensus statement indicates that any lymphovascular invasion in the renal sinus can be considered as renal sinus invasion.
The superiority of contact surface area as a predictor of renal cortical volume change after partial nephrectomy compared to RENAL, PADUA and C-index: an approach using computed tomography-based renal volumetry
Published in Scandinavian Journal of Urology, 2019
Chan Ho Lee, Ja Yoon Ku, Young Joo Park, Won Ik Seo, Hong Koo Ha
The NSs were calculated based on the RENAL, PADUA, C-index and CSA scores [6,14–16]. Preoperative contrast-enhanced CT was used to determine the four NSs by two urologists with experience in NS according to the published protocols. Using contrast-enhanced CT scans carried out preoperatively and postoperatively, the RCV of the tumor-bearing kidney was measured using ImageJ software (National Institutes of Health, Bethesda, MD, USA) and the Measure Stack ImageJ plugin (OptiNav, Bellevue, WA, USA) by a single reviewer (Figure 1). As we previously reported [12], the CT images, with a slice thickness of 3.8–5 mm, were saved in the digital imaging and communications in medicine format. An enhanced renal cortex contour at each slice of the CT image was semi-automatically outlined by the software excluding the pelvicaliceal system, renal sinus fat, vessels and renal tumors and cysts. The software automatically calculated the RCV of each slide by multiplying the outlined area with the slice thickness and finally gave the entire RCV of the kidney by summating the RCV of each slide. Volume measurement for each kidney required an average of 5 min. Percent changes in RCV (PCR) were calculated in the following manner: PCR (%) = ((preoperative RCV – postoperative RCV)/preoperative RCV) × 100.
Confirmation of Xp22.11 Duplication as a Germline Susceptibility Alteration in a Wilms Tumor Arising in Horseshoe Kidney
Published in Fetal and Pediatric Pathology, 2022
Hui-fang Zhou, Ina E. Amarillo, Stacy Snyder, Jorge L. Granadillo, Christopher J. O’Conor, Patrick Dillon, David Wilson, Frederick S. Huang, Louis P. Dehner, Mai He
On pathological evaluation, the left kidney had an 8.0 × 7.0 × 6.5 cm, well-circumscribed upper pole mass with a typical post-treatment Wilms tumor appearance. The mass had a heterogenous white/tan/yellow cut surface, containing a 4.0 × 2.0 × 1.0 cm necrotic nodule adjacent to the intact capsule (Fig. 2A). A white, firm capsule of 3 mm thickness enclosed the entire tumor mass (Fig. 2B). Microscopically, the tumor mass of the left kidney showed post-treatment Wilms tumor with triphasic components, heterologous cartilage, and extensive treatment effect but without anaplasia (Fig. 2B). Clusters of viable tumor were present within a renal sinus soft tissue. Above findings supported a favorable histology Wilms tumor with extensive therapy effects, post-therapy local stage of III. The right upper posterior pole lesion contained microscopic foci of well-encapsulated Wilms tumor with treatment effect. The viable component consists of small clusters showing blastemal morphology, consistent with a post-therapy intermediate risk category. The right anterior medial lesion contained perilobar nephrogenic rest. Both lesions on the right side were confined within the renal parenchyma and wereexcised with free surgical margins (post-therapy local stage I). The pulmonary artery and inferior vena cava thrombus contained residual Wilms tumor. The morphology of renal hilum, iliac bifurcation and portal lymph nodes consisted only of reactive changes with nometastatic tumor.