Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Abdominal Radiology
Published in: Abdominal Radiology 6/2019

01-06-2019 | Lymphoma | Review

Imaging features of immune-mediated genitourinary disease

Authors: Jonathon Weber, Nancy Hammond, Vahid Yaghmai, Paul Nikolaidis, Frank Miller, Jeanne Horowitz

Published in: Abdominal Radiology | Issue 6/2019

Login to get access

Abstract

Purpose

Imaging features of immune-mediated genitourinary diseases often overlap, and the same disease may manifest in different ways, so understanding imaging findings in the context of the patient’s entire clinical picture is important in providing the correct diagnosis.

Methods

In this article, diseases mediated by the immune system which affect the genitourinary system are reviewed. Examples of immune-mediated genitourinary disease including IgG4-related disease, post-transplant lymphoproliferative disorder, immunodeficiency-associated lymphoproliferative disorder due to immunosuppressive and immunomodulatory medications, lymphoma, leukemia, myeloma, amyloidosis, and histiocytosis.

Results

Clinical and imaging features will be presented which may help narrow the differential diagnosis for each disease.

Conclusion

Recognition of immune-related genitourinary disease is important for appropriate medical management as they may mimic other diseases both by imaging and clinical presentation.
Literature
1.
Hedgire, S.S., et al., The spectrum of IgG4-related disease in the abdomen and pelvis. AJR Am J Roentgenol, 2013. 201(1): p. 14-22CrossRefPubMed
2.
3.
Della-Torre E, Lanzillotta M., Doglioni C, Immunology of IgG4-related disease. Clin Exp Immunol, 2015. 181(2): p. 191-206
4.
Bledsoe, J.R., et al., IgG4-related disease: review of the histopathologic features, differential diagnosis, and therapeutic approach. APMIS, 2018. 126(6): p. 459-476CrossRefPubMed
5.
6.
Saeki, T., et al., The clinical course of patients with IgG4-related kidney disease. Kidney Int, 2013. 84(4): p. 826-33.CrossRefPubMed
7.
Wallace, Z.S., et al., IgG4-Related Disease: Clinical and Laboratory Features in One Hundred Twenty-Five Patients. Arthritis Rheumatol, 2015. 67(9): p. 2466-75CrossRefPubMedPubMedCentral
8.
Takahashi, N., et al., Renal involvement in patients with autoimmune pancreatitis: CT and MR imaging findings. Radiology, 2007. 242(3): p. 791-801CrossRefPubMed
9.
Kim B, Kim J., Byun JH, et al, IgG4-related kidney disease: MRI findings with emphasis on the usefulness of diffusionweighted imaging. Eur J Radiol, 2014. 83: p. 1057-1062.
10.
Maruyama S, Sato Y., Taga A, Emoto I, Shirase T, Haga H, Immunoglobulin G4-related disease presenting as bilateral ovarian masses and mimicking advanced ovarian cancer. J Obstet Gynaecol Res, 2016. 42(1): p. 103-8.
11.
Ohkubo, H., et al., A rare case of IgG4-related disease involving the uterus. Rheumatology (Oxford), 2015. 54(6): p. 1124-5CrossRef
12.
13.
Hara, N., et al., Lower urinary tract symptoms in patients with Niigata Minamata disease: a case-control study 50 years after methyl mercury pollution. Int J Urol, 2013. 20(6): p. 610-5CrossRefPubMed
14.
Migita, K., et al., IgG4-related epididymo-orchitis associated with bladder cancer: possible involvement of BAFF/BAFF-R interaction in IgG4-related urogenital disease. Mod Rheumatol, 2014. 24(1): p. 188-94CrossRefPubMed
15.
Taniguchi, T., et al., A case of multifocal fibrosclerosis involving posterior mediastinal fibrosis, retroperitoneal fibrosis, and a left seminal vesicle with elevated serum IgG4. Hum Pathol, 2006. 37(9): p. 1237-9; author reply 1239.
16.
Zaidan, M., et al., The case mid R: a 69-year-old man with a 10-year history of idiopathic retroperitoneal fibrosis. Kidney Int, 2011. 80(12): p. 1379-80CrossRefPubMed
17.
Opelz, G. and R. Henderson, Incidence of non-Hodgkin lymphoma in kidney and heart transplant recipients. Lancet, 1993. 342(8886-8887): p. 1514-6CrossRefPubMed
18.
Opelz, G. and B. Dohler, Lymphomas after solid organ transplantation: a collaborative transplant study report. Am J Transplant, 2004. 4(2): p. 222-30CrossRefPubMed
19.
Bhatia S, Ramsay N., Steinbuch M, Dusenbery KE, Shapiro RS, Weisdorf DJ, et al, Malignant neoplasms following bone marrow transplantation. Blood, 1996. 87(9): p. 3633-3639.
20.
Cockfield, S.M., Identifying the patient at risk for post-transplant lymphoproliferative disorder. Transpl Infect Dis, 2001. 3(2): p. 70-8CrossRefPubMed
21.
Loren, A.W., et al., Post-transplant lymphoproliferative disorder: a review. Bone Marrow Transplant, 2003. 31(3): p. 145-55CrossRefPubMed
22.
McDonald, R.A., et al., Incidence of PTLD in pediatric renal transplant recipients receiving basiliximab, calcineurin inhibitor, sirolimus and steroids. Am J Transplant, 2008. 8(5): p. 984-9CrossRefPubMed
23.
Shapiro, R., et al., Posttransplant lymphoproliferative disorders in adult and pediatric renal transplant patients receiving tacrolimus-based immunosuppression. Transplantation, 1999. 68(12): p. 1851-4.CrossRefPubMedPubMedCentral
24.
Dharnidharka, V.R., CComprehensive Review of Post-Organ Transplant Hematologic Cancers. Am J Transplant, 2017
25.
Quinlan, S.C., et al., Risk factors for early-onset and late-onset post-transplant lymphoproliferative disorder in kidney recipients in the United States. Am J Hematol, 2011. 86(2): p. 206-9CrossRefPubMedPubMedCentral
26.
Al-Mansour, Z., B.P. Nelson, and A.M. Evens, Post-transplant lymphoproliferative disease (PTLD): risk factors, diagnosis, and current treatment strategies. Curr Hematol Malig Rep, 2013. 8(3): p. 173-83CrossRefPubMedPubMedCentral
27.
Katabathina, V., et al., Complications of Immunosuppressive Therapy in Solid Organ Transplantation. Radiol Clin North Am, 2016. 542): p. 303-19CrossRefPubMed
28.
Scarsbrook, A.F., et al., Post-transplantation lymphoproliferative disorder: the spectrum of imaging appearances. Clin Radiol, 2005. 60(1): p. 47-55CrossRefPubMed
29.
Vrachliotis, T.G., et al., CT findings in posttransplantation lymphoproliferative disorder of renal transplants. AJR Am J Roentgenol, 2000. 175(1): p. 183-8CrossRefPubMed
30.
R. Lopez-Ben, J.K.S., C.E. Kew II, et al., Focal posttransplantation lymphoproliferative disorder at renal allograft hilum. AJR Am J Roentgenol, 2000. 175: p. 1417-1422.
31.
Metser, U. and G. Lo, FDG-PET/CT in abdominal post-transplant lymphoproliferative disease. Br J Radiol, 2016. 89(1057): p. 20150844CrossRefPubMed
32.
Barrington, S.F., et al., Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol, 2014. 32(27): p. 3048-58.
33.
Vali R, P.A., Bajno L, Moineddin R, Shammas A., The value of 18F-FDG PET in pediatric patients with post-transplant lymphoproliferative disorder at initial diagnosis. Pediatr Transplant, 2015. 19(8): p. 932-9.
34.
Vali R, Punnett A., Bajno L, Moineddin R, Shammas A., The value of 18F-FDG PET in pediatric patients with post-transplant lymphoproliferative disorder at initial diagnosis. Pediatr Transplant, 2015. 19(8): p. 932-9CrossRefPubMed
35.
Inoue T, S. Satoh, Saito M, Horikawa Y, Tsuchiya N, Habuchi T, Post-transplant lymphoproliferative disorder involving the ovary as an initial manifestation: a case report. Journal of Medical Case Reports., 2010(4): p. 184.
36.
Loo, E.Y., et al., Classical Hodgkin lymphoma arising in the setting of iatrogenic immunodeficiency: a clinicopathologic study of 10 cases. Am J Surg Pathol, 2013. 37(8): p. 1290-7CrossRefPubMed
37.
Kubica, M.G. and N.A. Sangle, Latrogenic immunodeficiency-associated lymphoproliferative disorders in transplant and nontransplant settings. Indian J Pathol Microbiol, 2016. 59(1): p. 6-15PubMed
38.
Kamel OW (1997) Iatrogenic lymphoproliferative disorders in nontransplantation settings. Semin Diagn Pathol 14(1):27–34PubMed
39.
Ohkura Y, S.J., Haruta S, et al., Primary Adrenal Lymphoma Possibly Associated With Epstein-Barr Virus Reactivation Due to Immunosuppression Under Methotrexate Therapy. Medicine, 2015. 94(31): p. 1270.
40.
41.
Chen L, Richendollar B., Bunting S, Campbell S, Zhou M., Lymphomas and lymphoproliferative disorders clinically presenting as renal carcinoma: a clinicopathological study of 14 cases. Pathology, 2013. 45(7): p. 756-53.
42.
Sandrasegaran, K., et al., Imaging features of haematological malignancies of kidneys. Clin Radiol, 2016. 71(3): p. 195-202CrossRefPubMed
43.
Bach, A.G., et al., Prevalence and patterns of renal involvement in imaging of malignant lymphoproliferative diseases. Acta Radiol, 2012. 53(3): p. 343-8CrossRefPubMed
44.
Sheth S, Ali S., Fishman E., Imaging of renal lymphoma: patterns of disease with pathologic correlation. Radiographics, 2006. 26(4): p. 1151-1168.
45.
Emad-Eldin S, Rakha S., Hanna AZ, Badawy H, Usefulness of diffusion-weighted magnetic resonance imaging for the characterization of benign and malignant renal lesions. The Egyptian Journal of Radiology and Nuclear Medicine, 2015. 47: p. 325-333.
46.
47.
48.
Crasta JA, Vallikad E., Ovarian Lymphoma. Indian J Med Pediatr Oncol, 2009. 30(1): p. 28-30
49.
Zhou, L., et al., Primary adrenal lymphoma: radiological; pathological, clinical correlation. Eur J Radiol, 2012. 81(3): p. 401-5CrossRefPubMed
50.
Thakore P, A.S., Turner C, Vaslyeva T, Acute Lymphocytic Leukemia with Bilateral Renal Masses Masquerading as Nephroblastomatosis. Case reports in pediatrics, 2015. 2015.
51.
Luciano, R.L. and U.C. Brewster, Kidney involvement in leukemia and lymphoma. Adv Chronic Kidney Dis, 2014. 21(1): p. 27-35CrossRefPubMed
52.
Lanore, J.J., et al., Hemodialysis for acute renal failure in patients with hematologic malignancies. Crit Care Med, 1991. 19(3): p. 346-51CrossRefPubMed
53.
Richmond, J., et al., Renal lesions associated with malignant lymphomas. Am J Med, 1962. 32: p. 184-207CrossRefPubMed
54.
Araki, T., Leukemic involvement of the kidney in children: CT features. J Comput Assist Tomogr, 1982. 6(4): p. 781-4CrossRefPubMed
55.
Greenstein, F., et al., Ureteral obstruction from isolated focus of chronic lymphocytic leukemia. Urology, 1984. 24(1): p. 70-2CrossRefPubMed
56.
Bogdan, C.A., et al., Chronic lymphocytic leukemia with prostate infiltration mediated by specific clonal membrane-bound IgM. Cancer Res, 2003. 63(9): p. 2067-71PubMed
57.
Mazzu, D., R.B. Jeffrey, Jr., and P.W. Ralls, Lymphoma and leukemia involving the testicles: findings on gray-scale and color Doppler sonography. AJR Am J Roentgenol, 1995. 164(3): p. 645-7CrossRefPubMed
58.
Geetha N, Lali V., Mathews A, Prakash NP., Acute lymphoblastic leukaemia presenting with a uterine cervical mass. Clin Cancer Investig J, 2015. 4: p. 280-281.
59.
Oliva E, Ferry J., Young RH, Prat J, Srigley JR, Scully RE, Granulocytic sarcoma of the female genital tract: A clinicopathologic study of 11 cases. Am J Surg Pathol, 1997. 21: p. 1156-65.
60.
Valbuena, J.R., et al., Myeloid sarcoma involving the testis. Am J Clin Pathol, 2005. 124(3): p. 445-52CrossRefPubMed
61.
62.
Rajkumar, S.V., Updated Diagnostic Criteria and Staging System for Multiple Myeloma. Am Soc Clin Oncol Educ Book, 2016. 35: p. e418-23CrossRefPubMed
63.
Oshima, K., et al., Clinical and pathologic findings in 52 consecutively autopsied cases with multiple myeloma. Am J Hematol, 2001. 67(1): p. 1-5CrossRefPubMed
64.
Philips, S., et al., Abdominal manifestations of extraosseous myeloma: cross-sectional imaging spectrum. J Comput Assist Tomogr, 2012. 36(2): p. 207-12CrossRefPubMed
65.
Kapadia, S.B., Multiple myeloma: a clinicopathologic study of 62 consecutively autopsied cases. Medicine (Baltimore), 1980. 59(5): p. 380-92CrossRef
66.
Birjawi, G.A., et al., Abdominal manifestations of multiple myeloma: a retrospective radiologic overview. Clin Lymphoma Myeloma, 2008. 8(6): p. 348-51CrossRefPubMed
67.
IIgel, T.C., et al., Renal plasmacytoma: Mayo Clinic experience and review of the literature. Urology, 1991. 37(4): p. 385-9CrossRefPubMed
68.
Sedlic, A., et al., Abdominal extraosseous lesions of multiple myeloma: imaging findings. Can Assoc Radiol J, 2014. 65(1): p. 2-8CrossRefPubMed
69.
Yang, G. F., Zhu, H., Zhang, L. J., & Lu, G. M, Primary renal plasmacytoma: Case report and literature review. J Cancer Res Exp Oncol., 2009. 2
70.
Sered, S. and P. Nikolaidis, CT findings of perirenal plasmacytoma. AJR Am J Roentgenol, 2003. 181(3): p. 888CrossRefPubMed
71.
Li, Y., et al., Beyond Prostate Adenocarcinoma: Expanding the Differential Diagnosis in Prostate Pathologic Conditions. Radiographics, 2016. 36(4): p. 1055-75CrossRefPubMed
72.
Mimura, R., et al., Extramedullary plasmacytoma involving perirenal space accompanied by extramedullary hematopoiesis and amyloid deposition. Japanese Journal of Radiology, 2010. 28(4): p. 309-13CrossRefPubMed
73.
Jinzaki, M., et al., Role of computed tomography urography in the clinical evaluation of upper tract urothelial carcinoma. International Journal of Urology, 2016. 23(4): p. 284-98CrossRefPubMed
74.
Fitzpatrick, R., et al., Primary amyloidosis of the bladder; a mimicker of bladder cancer. Canadian Journal of Urology, 2017. 24(3): p. 8868-8870PubMed
75.
Levine, E., Abdominal visceral calcification in secondary amyloidosis: CT findings. Abdom Imaging, 1994. 19(6): p. 554-5CrossRefPubMed
76.
Kim, B., et al., Imaging of the seminal vesicle and vas deferens. Radiographics, 2009. 29(4): p. 1105-21CrossRefPubMed
77.
Stephens, M., et al., Intense Uptake in Amyloidosis of the Seminal Vesicles on 68Ga-PSMA PET Mimicking Locally Advanced Prostate Cancer. Clinical Nuclear Medicine, 2017. 42(2): p. 147-148CrossRefPubMed
78.
Ogawa, Y., M. Nakagawa, and S. Ikeda, Prostate amyloid tumor is a clue leading to the diagnosis of systemic AL amyloidosis. Amyloid, 2013. 20(3): p. 193-4CrossRefPubMed
79.
Casella, R., et al., Primary testicular amyloidosis mimicking tumor in a cryptorchid testis. Urology, 2002. 59(3): p. 445CrossRefPubMed
80.
Winkler, D.D., J.A. Emery, and C.B. Alan, Amyloidosis of the endometrium: an asymptomatic presentation. Obstetrics & Gynecology, 2004. 104(5 Pt 2): p. 1144-7CrossRef
81.
Mar, W.A., et al., Rosai–Dorfman Disease: Manifestations Outside of the Head and Neck. AJR Am J Roentgenol, 2017. 208(4): p. 721-732CrossRefPubMed
82.
Brown, W.E., F.V. Coakley, and M. Heaney, Renal involvement by Rosai–Dorfman disease: CT findings. Abdom Imaging, 2002. 27(2): p. 214-6CrossRefPubMed
83.
Rodriguez Torres, C., et al., Rosai–Dorfman disease with atypical intrascrotal involvement. Int J Urol, 2015. 22(8): p. 794-6CrossRefPubMed
84.
Alberti, N., et al., Erdheim–Chester disease: a rare diagnosis with evocative imaging. Diagnostic and Interventional Imaging, 2013. 94(4): p. 457-9CrossRefPubMed
85.
Arnaud, L., et al., Systemic perturbation of cytokine and chemokine networks in Erdheim–Chester disease: a single-center series of 37 patients. Blood, 2011. 117(10): p. 2783-90CrossRefPubMed
86.
Balink, H., et al., Scintigraphic diagnosis of Erdheim–Chester disease. Journal of Clinical Oncology, 2011. 29(16): p. e470-2CrossRefPubMed
87.
Yun, E.J., et al., Erdheim–Chester disease: case report and review of associated urological, radiological and histological features. Journal of Urology, 2003. 169(4): p. 1470-1CrossRefPubMed
88.
Courtillot, C., et al., Endocrine Manifestations in a Monocentric Cohort of 64 Patients With Erdheim–Chester Disease. Journal of Clinical Endocrinology & Metabolism, 2016. 101(1): p. 305-13CrossRef
Metadata
Title
Imaging features of immune-mediated genitourinary disease
Authors
Jonathon Weber
Nancy Hammond
Vahid Yaghmai
Paul Nikolaidis
Frank Miller
Jeanne Horowitz
Publication date
01-06-2019
Publisher
Springer US
Published in
Abdominal Radiology / Issue 6/2019
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-019-01946-z

Other articles of this Issue 6/2019

Abdominal Radiology 6/2019 Go to the issue

Hepatobiliary

Differentiating IgG4-related sclerosing cholangiopathy from cholangiocarcinoma using CT and MRI: experience from a tertiary referring center

Technical

Identification of the feeding arteries of hepatocellular carcinomas by performing dual arterial phase CT during pre-transarterial chemoembolization angiography

OriginalPaper

Incidence of major hemorrhage after aggressive image-guided liver mass biopsy in the era of individualized medicine

Kidneys, Ureters, Bladder, Retroperitoneum

Risk factors associated with significant bleeding events after ultrasound-guided percutaneous native renal biopsies: a review of 2204 cases

OriginalPaper

Are we at a crossroads or a plateau? Radiomics and machine learning in abdominal oncology imaging

Special Section: Radiogenomics

Association between CT-texture-derived tumor heterogeneity, outcomes, and BRCA mutation status in patients with high-grade serous ovarian cancer
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits