MRI Characteristics of Pediatric and Young-Adult Renal Cell Carcinoma: A Single-Center Retrospective Study and Literature Review

SIMPLE SUMMARY: Whereas renal cell carcinoma (RCC) is the most common renal tumor in adults, pediatric RCC is a rare malignancy. The previous literature focusing on cross-sectional imaging of RCC concerns mainly computed tomography in adults, whereas in children, a different distribution of subtypes is seen, as well as a preference for magnetic resonance imaging (MRI). Therefore, the aim of this study was to identify MRI characteristics of pediatric and young-adult RCC through a case series and literature review focusing on translocation-type RCC (MiT-RCC) and the pediatric and young-adult population. In our review as well as in our case series T2-weighted hypo-intensity seems to be a potential discriminative characteristic. Moreover, an irregular growth pattern and limited diffusion restriction were often described. Nevertheless, we conclude the discrimination of RCC subtypes, and especially the differentiation of RCC from other pediatric renal tumors, remains difficult. ABSTRACT: Pediatric renal cell carcinoma (RCC) is a rare malignancy. Magnetic resonance imaging (MRI) is the preferred imaging modality for assessment of these tumors. The previous literature has suggested that cross-sectional-imaging findings differ between RCC and other pediatric renal tumors and between RCC subtypes. However, studies focusing on MRI characteristics are limited. Therefore, this study aims to identify MRI characteristics of pediatric and young-adult RCC, through a single-center case series and literature review. Six identified diagnostic MRI scans were retrospectively assessed, and an extensive literature review was conducted. The included patients had a median age of 12 years (63–193 months). Among other subtypes, 2/6 (33%) were translocation-type RCC (MiT-RCC) and 2/6 (33%) were clear-cell RCC. Median tumor volume was 393 cm(3) (29–2191 cm(3)). Five tumors had a hypo-intense appearance on T2-weighted imaging, whereas 4/6 were iso-intense on T1-weighted imaging. Four/six tumors showed well-defined margins. The median apparent diffusion coefficient (ADC) values ranged from 0.70 to 1.20 × 10(−3) mm(2)/s. In thirteen identified articles focusing on MRI characteristics of MiT-RCC, the majority of the patients also showed T2-weighted hypo-intensity. T1-weighted hyper-intensity, irregular growth pattern and limited diffusion–restriction were also often described. Discrimination of RCC subtypes and differentiation from other pediatric renal tumors based on MRI remains difficult. Nevertheless, T2-weighted hypo-intensity of the tumor seems a potential distinctive characteristic.