Question:

Which MR finding was noted to be present most frequently in patients with sarcomatoid renal cell carcinoma?
1. Renal vein invasion.
2. Perirenal fat invasion.
3. Renal sinus invasion.
4. Necrosis.
5. Distant metastases.





Answer:

The correct answer for the question "Which MR finding was noted to be present most frequently in patients with sarcomatoid renal cell carcinoma?" is:

4. Necrosis.



Explanation
A) While present in a majority of patients with sarcomatoid renal cell carcinoma, renal vein invasion is not as frequent as tumor necrosis. [Other findings which were seen in the majority of cases and indicate aggressive local behavior included renal sinus invasion and perirenal fat invasion.]

B) While present in a majority of patients with sarcomatoid renal cell carcinoma, perirenal fat invasion is not as frequent as tumor necrosis. [Other findings which were seen in the majority of cases and indicate aggressive local behavior included renal sinus invasion and perirenal fat invasion.]

C) While present in a majority of patients with sarcomatoid renal cell carcinoma, renal sinus invasion is not as frequent as tumor necrosis. [Other findings which were seen in the majority of cases and indicate aggressive local behavior included renal sinus invasion and perirenal fat invasion.]

D) Tumor necrosis is invariably present in sarcomatoid renal cell carcinoma. [Owing to its aggressive nature, necrosis is an expected feature of sarcomatoid differentiation, and all nine cases demonstrated necrosis in this series (reference 4).]

E) While present in a majority of patients with sarcomatoid renal cell carcinoma, distant metastases are not as frequent as tumor necrosis. [Other findings which were seen in the majority of cases and indicate aggressive local behavior included renal sinus invasion and perirenal fat invasion.]



From the manuscript:
Sarcomatoid renal cell carcinoma: A case report and literature review
Radiology Case. 2012 Apr; 6(4):11-16


This article belongs to the GU section.




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From the manuscript

Sarcomatoid renal cell carcinoma: A case report and literature review

Free full text article: Sarcomatoid renal cell carcinoma: A case report and literature review

Abstract
Renal cell carcinoma (RCC) is the most common malignancy of the kidney and consists of multiple subtypes. The sarcomatoid variety, while previously considered a distinct histologic subtype, is now categorized as a form of dedifferentiated carcinoma. When present, it is associated with a significant decrease in patient survival due to its rapid growth and intrusive behavior. Preoperative knowledge of this diagnosis may be beneficial to clinicians in order to modify treatment options and follow-up protocols. This report describes a case of sarcomatoid renal cell carcinoma in which the patient initially presented with flank pain. We then discuss the clinical features of sarcomatoid renal cell carcinoma and its imaging appearance on computed tomography (CT), and succinctly review the subtypes of renal cell carcinoma and their imaging characteristics.






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