Preoperative Diagnosis of Juxtaglomerular Cell Tumors in Eight Patients

Abstract

The aim of this study was to improve the diagnostic efficiency for juxtaglomerular cell tumors (JCTs) and to determine whether clinical and magnetic resonance imaging features can help to differentiate JCTs from clear cell renal cell carcinoma (ccRCC). The clinical features of eight patients with JCTs and 27 patients with ccRCCs were analyzed. A flow diagram for young people with hypertension was applied to facilitate the diagnosis. Clinical presentations were analyzed, including age, hypertension, and hypokalemia. The results of our study produced a flow diagram that narrowed the scope of diagnosis. The statistical results demonstrated that patients with a renal mass aged 14 to 30 years, had grade 3 hypertension, or had moderate hypokalemia had a greater possibility of having a JCT than a ccRCC (P<.0000, P<.01, P<.0005, respectively). In addition, the flow diagram and magnetic resonance imaging features were useful to distinguish JCTs from other renal tumors.

Figure 1

The diagnostic flow diagram of JCT before operation. BP, blood pressure; PRA, plasma renin activity; CT, computed tomography; MRI, magnetic resonance imaging; US, ultrasonography; PAC, plasma aldosterone concentration; LAT, lateralization of renal vein; SP, serum potassium; JCT, juxtaglomerular cell tumor; ccRCC, clear cell renal cell carcinoma; T2WI, T2‐weighted imaging; DWI, diffusion‐weighted imaging; VHL; Von Hippel‐Lindau.

Figure 2

(a) Light microscopy, renin ×100; (b) Electron microscopy, ×6000; renin‐like granules (arrows).

Figure 3

(a) An 18‐year‐old man with a solid tumor on the pole of the right kidney. On T2‐weighted image, the lesion (short arrow) shows mild hyperintensity with a low‐signal capsule (long arrow). (b) On the corticomedullary phase image, the lesion (short arrow) indicates a mild enhancement.