Oncologic Imaging: Urology

Preface
Contents
Contributors
1: Renal Tumors
1.1 Introduction
1.2 Detection
1.3 Characterization
1.3.1 US
1.3.1.1 Solid Renal Mass
1.3.1.2 Cystic Renal Mass
1.3.1.3 Doppler US and Contrast-­Enhanced US
1.3.2 CT
1.3.2.1 Unenhanced CT
1.3.2.2 Contrast Enhancement
1.3.3 MRI
1.3.3.1 Signal Intensity
1.3.3.2 Contrast Enhancement
1.3.3.3 Diffusion-Weighted Imaging (DWI)
1.3.4 Positron Emission Tomography
1.3.5 Biopsy
1.4 Malignant Renal Cell Tumors: Renal Cell Carcinoma
1.4.1 Pathologic Consideration
1.4.1.1 Clear Cell Renal Cell Carcinoma
1.4.1.2 Multilocular Cystic Renal Cell Carcinoma (Multilocular Cystic Neoplasm of Low Malignant Po
1.4.1.3 Papillary RCC
1.4.1.4 Chromophobe RCC
1.4.1.5 Carcinoma of Collecting Duct of Bellini (Collecting Duct Carcinoma)
1.4.1.6 MiTF/TFE Family Translocation-�Associated Carcinoma
1.4.1.7 Mucinous Tubular and Spindle Cell Carcinoma
1.4.1.8 Renal Cell Carcinoma Associated with End-Stage Renal Disease (ESRD)
Acquired Cystic Disease-Associated Renal Cell Carcinoma
Clear Cell Papillary Renal Cell Carcinoma
1.4.1.9 Unclassified Renal Cell Carcinoma
1.4.1.10 Nuclear Grading of RCC
1.4.2 Imaging
1.4.2.1 Staging
1.4.2.2 Subtypes of RCC
Clear Cell RCC
Papillary RCC
Chromophobe RCC
Multilocular Cystic RCC
Collecting Duct Carcinoma
Renal Medullary Carcinoma
Mucinous Tubular and Spindle Cell Carcinoma
Xp11.2 Translocation–TFE3 Gene Fusion Carcinoma
Hereditary RCC Syndromes
1.5 Benign Renal Cell Tumors
1.5.1 Oncocytoma
1.5.1.1 Pathologic Consideration
1.5.1.2 Imaging
1.5.2 Papillary Adenoma
1.6 Metanephric Tumors
1.6.1 Metanephric Adenoma
1.6.1.1 Pathologic Consideration
1.6.1.2 Imaging
1.7 Mesenchymal Tumors
1.7.1 Sarcoma
1.7.1.1 Pathologic Consideration
Clear Cell Sarcoma of Kidney
Malignant Rhabdoid Tumor
Other Malignant Mesenchymal Tumors
1.7.1.2 Imaging
1.7.2 Angiomyolipoma
1.7.2.1 Pathologic Consideration
1.7.2.2 Imaging
US
CT
MRI
1.7.3 Epithelioid Angiomyolipoma
1.7.3.1 Pathologic Consideration
1.7.3.2 Imaging
1.7.4 Rare Benign Renal Mesenchymal Tumors
1.7.4.1 Pathologic Consideration
1.7.4.2 Imaging
1.8 Cystic Nephroma and Mixed Mesenchymal and Epithelial Tumors
1.8.1 Pathologic Consideration
1.8.2 Imaging
1.9 Nephroblastoma
1.9.1 Pathologic Consideration
1.9.2 Imaging
1.10 Neuroendocrine Tumors
1.10.1 Pathologic Consideration
1.10.2 Imaging
1.11 Lymphoma
1.11.1 Pathologic Consideration
1.11.2 Imaging
1.12 Metastatic Tumors
1.12.1 Pathologic Consideration
1.12.2 Imaging
1.13 Therapeutic Considerations
1.13.1 Active Surveillance of Renal Tumor
1.13.2 Ablation of Renal Tumor
1.13.2.1 Introduction
1.13.2.2 Patient Selection and Preparation
1.13.2.3 Procedures
1.13.2.4 Complications
1.13.2.5 Follow-Up
1.13.2.6 Outcomes
1.13.3 Surgery
1.13.3.1 Radical Nephrectomy
1.13.3.2 Open Radical Nephrectomy
1.13.3.3 Laparoscopic Radical Nephrectomy
1.13.3.4 Partial Nephrectomy, Nephron-Sparing Surgery
1.13.3.5 Open Partial Nephrectomy
1.13.3.6 Minimally Invasive Partial Nephrectomy
1.13.3.7 Laparoscopic Partial Nephrectomy
1.13.3.8 Robot-Assisted Laparoscopic Partial Nephrectomy
1.14 Targeted Therapy in Metastatic Renal Cell Carcinoma: Advancing Paradigms
1.14.1 Introduction
1.14.2 Novel Agents in Metastatic RCC
1.14.2.1 Tyrosine Kinase Inhibitors
Sorafenib
Sunitinib
Pazopanib
Axitinib
TKI Adverse Effects
1.14.2.2 mTOR Inhibitor
Temsirolimus
Everolimus
mTOR Inhibitor Adverse Effects
1.14.2.3 Monoclonal Antibody
Bevacizumab (VEGF Monoclonal Antibody, Avastin)
Bevacizumab Adverse Effects
1.14.3 Combination and Sequencing Therapy of Targeted Agents
1.14.4 Conclusions
1.15 Radiation Therapy
References

2: Urothelial Tumors
2.1 Introduction
2.2 Urothelial Tumors
2.2.1 Transitional Cell Carcinoma: Bladder
2.2.1.1 CT
2.2.1.2 MRI
2.2.1.3 Staging
2.2.2 Transitional Cell Carcinoma: Kidney and Ureter
2.2.2.1 Intravenous Urography and Retrograde Pyelography
2.2.2.2 CT
2.2.2.3 MRI
2.2.2.4 Staging
2.3 Nonurothelial Tumors
2.3.1 Squamous Cell Carcinoma
2.3.2 Adenocarcinoma
2.3.3 Small Cell Tumors
2.3.4 Lymphoma
2.3.5 Leiomyoma
2.4 Pathologic Consideration
2.4.1 Urothelial Tumors
2.4.1.1 Papillary Urothelial Lesion
Urothelial Papilloma
Inverted Papilloma
Papillary Urothelial Neoplasm of Low Malignant Potential
Low-Grade Papillary Urothelial Carcinoma
High-Grade Papillary Urothelial Carcinoma
2.4.1.2 Fat Urothelial Lesion
Urothelial Dysplasia
Urothelial Carcinoma In Situ
Invasive Urothelial Carcinoma
2.4.2 Nonurothelial Tumors
2.4.2.1 Squamous Cell Carcinoma
2.4.2.2 Urachal Carcinoma
2.4.2.3 Metastatic Tumor
2.4.2.4 Neuroendocrine Tumors
Carcinoid
Small Cell Carcinoma
2.4.2.5 Lymphoma
2.5 Therapeutic Consideration
2.5.1 Surgical Treatment of Bladder Cancer
2.5.1.1 Transurethral Resection of Bladder Tumor
2.5.1.2 Partial Cystectomy
2.5.1.3 Radical Cystectomy with Urinary Diversion
Pelvic Lymph Node Dissection
Radical Cystectomy in Male Patients
Radical Cystectomy in Female Patients
Urinary Diversion
2.5.1.4 Ileal Conduit
2.5.1.5 Ileal Neobladder (Studer Type)
2.5.2 Surgical Treatment of Upper Tract Carcinoma
2.5.2.1 Radical Nephroureterectomy (RNU)
2.5.2.2 Ureteroscopy
2.5.2.3 Segmental Resection
2.5.3 Radiation Therapy
2.6 Chemotherapy in Advanced Urothelial Carcinoma
2.6.1 Introduction
2.6.2 Chemotherapy Regimens
2.6.2.1 Single-Agent Chemotherapy
2.6.2.2 Combination Chemotherapy
MVAC Regimen
GC Regimen
Carboplatin-Based Chemotherapy
2.6.3 Timing of Chemotherapy
2.6.3.1 Neoadjuvant Chemotherapy (NACH)
2.6.3.2 Adjuvant Chemotherapy (ACH)
2.6.4 Conclusions
References

3: Prostatic Tumors
3.1 Introduction
3.2 Anatomy
3.3 US
3.3.1 Conventional US
3.3.2 US Elastography
3.3.3 Contrast-Enhanced TRUS
3.3.4 Image Fusion
3.3.5 TRUS-Guided Biopsy
3.4 CT
3.5 MRI
3.5.1 Conventional MRI
3.5.2 Diffusion-Weighted Image (DWI)
3.5.3 Dynamic Contrast-Enhanced MRI
3.5.4 MR Spectroscopy
3.5.5 Multiparametric MRI
3.5.6 MR PI-RADS
3.5.7 MRI-Guided Biopsy
3.5.8 MRI for Active Surveillance
3.5.9 MR Imaging of Treated Prostate Cancer
3.5.10 Hyperpolarized MRI
3.5.11 The Future of Prostate MR
3.6 PET-CT
3.7 Pathology of Prostate Cancer
3.7.1 Acinar Adenocarcinoma
3.7.1.1 Macroscopy
3.7.1.2 Microscopy
3.7.1.3 Gleason Grading
3.7.1.4 Variants of Acinar Adenocarcinoma
3.7.1.5 High-Grade Prostatic Intraepithelial Neoplasia
3.7.2 Other Carcinomas
3.7.2.1 Ductal Adenocarcinoma
3.7.2.2 Urothelial Carcinoma
3.7.2.3 Small Cell Carcinoma
3.8 Staging
3.9 Treatment of Prostate Cancer
3.9.1 Active Surveillance
3.9.1.1 Introduction
3.9.1.2 Definition of CIPC
3.9.1.3 Selection of Patients and Triggers for Intervention in AS
3.9.1.4 Methods of AS
3.9.1.5 Conclusions
3.9.2 Focal Therapy
3.9.2.1 Introduction
3.9.2.2 Cryosurgery
3.9.2.3 HIFU
3.9.3 Conclusion
3.9.4 Radiation Therapy
3.9.5 Surgical Management
3.9.5.1 Introduction
3.9.5.2 Major Complications
Urinary Continence
Erectile Dysfunction
3.9.5.3 Pelvic Lymph Node Dissection in Radical Prostatectomy
3.9.5.4 Surgical Procedure and Anatomy
RRP
RALP
3.9.6 Hormonal Therapy
3.9.6.1 Introduction
3.9.6.2 Hormonal Regulation of the Prostate
3.9.6.3 Types of Hormonal Therapy
Simple Orchiectomy (Physical Castration)
Estrogen Agent
LHRH Agonist
LHRH Antagonist
Antiandrogens
Combination Hormonal Therapy
Intermittent ADT Versus Continuous ADT
Immediate ADT Versus Deferred ADT
3.10 Imaging and Pathologic Finding of Unusual Tumors
3.10.1 Pathology of Stromal Tumor and Stromal Sarcoma
3.10.1.1 STUMP
3.10.1.2 Stromal Sarcoma
3.10.2 Epithelial Tumors
3.10.2.1 Mucinous Adenocarcinoma
3.10.2.2 Squamous Cell Carcinoma
3.10.2.3 Transitional Cell Carcinoma
3.10.3 Neuroendocrine Neoplasm
3.10.3.1 Carcinoid Tumor
3.10.3.2 Small Cell Carcinoma
3.10.4 Mesenchymal Tumors
3.10.4.1 Leiomyosarcoma
3.10.4.2 Rhabdomyosarcoma
3.10.4.3 Malignant Fibrous Histiocytoma (MFH)
3.10.4.4 Synovial Sarcoma
3.10.5 Hematopoietic Malignancy
3.10.5.1 Lymphoma
3.10.6 Non-tumorous or Benign Condition Mimicking Malignancy
3.10.6.1 Benign Prostatic Hyperplasia (BPH)
3.10.6.2 Prostatitis and Prostatic Abscesses
3.10.6.3 Tuberculous Prostatitis
3.10.6.4 Prostatic Cystadenoma
3.10.6.5 Leiomyoma
3.10.7 Summary
References

4: Tumors of the Male Genitalia
4.1 Scrotal Tumor
4.1.1 Imaging Anatomy
4.1.2 Tumor of the Testis
4.1.2.1 Tumor Subtypes
4.1.2.2 Spread of Testicular Tumors
4.1.2.3 US Characterization of the Scrotal Mass
4.1.2.4 Rare Exception
4.1.2.5 Staging
4.1.3 Special Consideration in Testis Tumor
4.1.3.1 Testicular Microlithiasis
4.1.3.2 Burned-Out Germ Cell Tumor
4.1.3.3 Germ Cell Tumor in Undescended Testis
4.1.4 Tumor of the Epididymis and Spermatic Cord
4.1.4.1 Epididymal Tumor
4.1.4.2 Spermatic Cord Tumor
4.1.5 Pathologic Consideration of Scrotal Tumors
4.1.5.1 Pathology of Germ Cell Tumor
Seminoma
Embryonal Carcinoma
Yolk Sac Tumor
Choriocarcinoma
Teratoma
Dermoid Cyst and Epidermoid Cyst
Mixed Germ Cell Tumor
4.1.5.2 Pathology of Sex Cord Stromal Tumor
Leydig Cell Tumor
Sertoli Cell Tumor
4.1.5.3 Tumors of Paratesticular Structures
Adenomatoid Tumor
Papillary Cystadenoma of Epididymis
4.1.6 Therapeutic Consideration of Scrotal Tumors
4.1.6.1 Surgical Management
Radical Orchiectomy
Testis-Sparing Surgery
Simple Orchiectomy
Retroperitoneal Lymph Node Dissection (RPLND)
4.1.6.2 Radiation Therapy
4.1.6.3 Chemotherapy
4.2 Penile Tumor
4.2.1 Imaging Anatomy
4.2.2 Penile Cancer
4.2.2.1 Staging of Penile Cancer
4.2.2.2 Treatment
4.2.2.3 Role of Imaging
4.2.3 Pathologic Consideration of Penile Tumors
4.2.3.1 Squamous Cell Carcinoma
4.2.3.2 Other Carcinomas
4.2.3.3 Other Tumors
4.2.4 Therapeutic Consideration of Penile Cancer
4.2.4.1 Surgical Management
Circumcision
Laser Therapy
Mohs Micrographic Surgery
Partial Penectomy
Total Penectomy
Radical Penectomy
Inguinal Lymph Node Dissection
Modified Inguinal Lymph Node Dissection
Standard Inguinal Lymph Node Dissection
4.2.4.2 Radiation Therapy
4.2.4.3 Chemotherapy
References

5: Adrenal Tumors
5.1 Introduction
5.2 Anatomy
5.3 Detection
5.3.1 Conn Syndrome
5.3.2 Cushing Syndrome
5.3.3 Catecholamines
5.4 Characterization
5.4.1 Benign Adrenal Tumors and Tumorlike Conditions
5.4.1.1 Cortical Adenoma
5.4.1.2 Hyperplasia
5.4.1.3 Hemorrhage
5.4.1.4 Cyst
5.4.1.5 Myelolipoma
5.4.1.6 Pheochromocytoma
5.4.1.7 Hemangioma
5.4.1.8 Lymphangioma
5.4.1.9 Schwannoma
5.4.1.10 Ganglioneuroma
5.4.1.11 Adenomatoid Tumor
5.4.1.12 Oncocytoma
5.4.1.13 Adrenal Infection
5.5 Malignant Adrenal Tumors
5.5.1 Cortical Carcinoma
5.5.2 Lymphoma
5.5.3 Metastases
5.6 Pathology of Adrenal Tumors
5.6.1 Adrenal Cortical Adenoma
5.6.2 Adrenal Cortical Carcinoma
5.6.3 Pheochromocytoma
5.6.4 Neuroblastic Tumors
5.6.5 Other Tumors
5.6.5.1 Adrenal Cyst
5.6.5.2 Myelolipoma
5.7 Percutaneous Thermal Ablation
5.8 Surgery for Adrenal Tumors
5.8.1 Open Surgical Approach to Adrenal Gland
5.8.2 Laparoscopic Approach to Adrenal Gland
5.8.3 Approach to Adrenal Gland with Laparoendoscopic Single-Site Surgery (LESS)
5.8.4 Robot-Assisted Laparoscopic Approach to Adrenal Gland
5.9 Radiotherapy
References

6: Retroperitoneal Tumors
6.1 Introduction
6.2 Diagnostic Evaluation
6.3 Tumors of Mesodermal Origin
6.3.1 Liposarcoma
6.3.2 Leiomyosarcoma
6.3.3 Undifferentiated/Unclassified Sarcoma
6.3.4 Solitary Fibrous Tumor
6.3.5 Less Common Sarcomas
6.4 Tumors of Neurogenic Origin
6.4.1 Schwannoma
6.4.2 Neurofibroma
6.4.3 Malignant Peripheral Nerve Sheath Tumor
6.4.4 Ganglioneuroma
6.4.5 Ganglioneuroblastoma and Neuroblastoma
6.4.6 Paraganglioma (Extra-adrenal Pheochromocytoma)
6.5 Tumors of Germ Cell, Sex Cord, and Stromal Cell Origin
6.5.1 Primary Extragonadal Germ Cell Tumors
6.5.2 Primary Sex Cord–Stromal Tumors
6.6 Tumors of Lymphoid Origin
6.6.1 Lymphoma
6.6.2 Metastatic Retroperitoneal Lymphadenopathy
6.7 Miscellaneous Retroperitoneal Conditions
6.7.1 Erdheim–Chester Disease
6.7.2 Castleman Disease
6.8 Cystic Neoplastic Masses in Retroperitoneum
6.8.1 Lymphangioma
6.8.2 Mucinous Cystadenoma and Cystadenocarcinoma
6.8.3 Tailgut Cyst
6.8.4 Bronchogenic Cyst
6.8.5 Cystic Change in Solid Neoplasms
6.9 Pathologic Consideration of Retroperitoneal Tumors
6.9.1 Schwannoma
6.9.2 Liposarcoma
6.9.3 Leiomyosarcoma
6.9.4 Ganglioneuroma
6.10 Surgery of Retroperitoneal Tumor
6.10.1 Introduction
6.10.2 Surgical Procedure and Anatomy
References