Severe hydronephrosis and severe renal cystic disease: ultrasonic differentiation.

End-stage renal cystic disease and severe hydronephrosis may reveal similar ultrasonographic findings. A "blind analysis" of 13 cases selected on the basis of smiliar extensive end-stage disease (little or no renal parenchyma visualized) was performed. The identification of a dilated renal pelvis was the most reliable ultrasonographic indicator of hydronephrosis. If the renal pelvis cannot be identified, renal cystic disease is the most likely diagnosis. All eight cases of hydronephrosis were correctly identified in this fashion. Four of five cases of severe cystic disease were correctly diagnosed. In one patient a peripelvic cyst was incorrectly interpreted as a dilated renal pelvis leading to the incorrect diagnosis of hydronephrosis. There may be ancillary signs that may help distinguish severe hydronephrosis from severe renal cystic disease. If these signs are not present, the only reliable criterion is whether the renal pelvis is dilated on careful examination of the renal sinus.

Hepatic metastasis in granulosa cell tumor of the ovary.

Hepatic metastases occur rarely in epithelial ovarian carcinoma and also appear to be unusual in malignant stromal tumors of the ovary (granulosa cell tumors). Recently two patients with extensive hepatic metastasis from this primary tumor, were treated. Review of the experience at the City of Hope National Medical Center provided three additional patients with a confirmed diagnosis of granulosa cell tumor of the ovary, one of whom is alive and disease-free. A review of clinical and pathologic data revealed that both of the other patients died of their disease and had hepatic metastases proven at autopsy. Hemorrhagic events complicating the clinical course of these patients were frequent. It is believed that the frequency of hepatic metastasis in granulosa cell tumor of the ovary may be higher than has been appreciated in the past, and that the cystic-hemorrhagic nature of these lesions contributes to the morbidity and mortality associated with granulosa cell tumors of the ovary.