Pseudotumors of the genitourinary tract
Number:27ESURABS0022
Type:Educational Electronic Presentation
Authors: Akshya Gupta, Vikram Dogra
Keywords:Pseudotumor, Adrenal, Kidney, Bladder
SECTIONS
Educational objective

Pseudotumors of the genitourinary tract are uncommon pathologies that can mimic tumors of the adrenal glands, kidneys and collecting system, and urinary bladder. This exhibit will use a case based format to review various benign conditions that radiologists should be cognizant of when considering genitourinary neoplasms, to avoid surgical intervention whenever possible. 


Topic Review

Adrenal Glands:

Adrenal nodules are common incidental findings in abdominal cross sectional imaging. While most nodules are benign, in the presence of a primary neoplasm, metastatic disease is frequently in the differential. Adrenal protocol CT or MRI wtih dedicated in and out of phase imaging can help distinguish primary or metastatic adrenal neoplasms from the more commonly identified adrenal adenomas. However imaging findings are not always diagnostic and tissue confirmation may be needed. 

 

Case 1: A 42 year old male presents with weight loss and epigastric discomfort (Figure 1). 

What is the differential diagnosis for bilateral asymmetric adrenal lesions? Granulomatous disease, tuberculosis, histoplasmosis, hemorrhage, and metastatic disease should be considered. Primary adrenal tumors such as...

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Figure 1: Axial MRI images demonstrate a left adrenal mass with no loss of signal on out of phase imaging. Right adrenal thickening is also present.
Figure 2: Axial MRI images demonstrate bilateral asymmetric masses which are T1 hypointense, T2 heterogeneous, and non-enhancing. Courtesy Gertraud Heinz–Peer, MD , Vienna


Conclusions

Pseudotumors of the genitourinary tract must be considered in the differential diagnosis of genitourinary pathology. The imaging features are not always diagnostic, and tissue sampling may be necessary. However in the appropriate clinical context, biopsy may prevent unnecessary surgical intervention. 

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