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Urogenital Imaging

Sarcoma, renal

rare tumour of the kidneys, representing 2-3% of all malignant renal lesions. Most common is leiomyosarcoma (58%), followed by haemangiopericytoma genitourinary (20% arise from the capsule and do not usually invade the parenchyma), rhabdomyosarcoma (3.8%) or liposarcoma. Granulocytic sarcoma is usually associated with myelogenous leukaemia.

Renal sarcomas are usually clinically and radiologically indistinguishable from renal cell carcinoma. Histologically, renal sarcoma may be difficult to distinguish from sarcomatoid renal cell carcinoma. Sarcomas increase in incidence with age, and usually present with weight loss, pain, haematuria, or a flank mass. Leiomyosarcomas comprise about 50% of renal sarcomas. The remainder consist of a wide variety of sarcomas, including fibrosarcoma, liposarcoma and haemangiopericytoma.

At imaging, by CT, MRI or ultrasound, renal sarcomas appear as a large inhomogeneous mass (Fig.1). Fat may be seen in liposarcomas, and bone may be present in osteosarcomas. Otherwise, the tumours are of soft tissue density. Renal sarcomas probably arise from the renal capsule or sinus, and this may be recognized at CT or MRI. Sarcomas tend to spread haematogenously, with metastases to liver and lung, rather than to lymph nodes. The absence of lymphadenopathy in a patient with a large renal mass centred in the renal sinus or capsule should raise consideration of a sarcoma rather than a carcinoma. Angiographically, renal sarcomas are hypovascualr without arteriovenous fistulae. Renal sarcoma is managed by radical nephrectomy, but the prognosis is very poor, even with adjuvant radiotherapy or chemotherapy.

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