Hypertrophied column of Bertin: a renal tumour mimicker

Author(s)

RM Yogipranata, T Yuliastuti

Dr. Kariadi Hospital,
Diponegoro university;
Jl. Dr. Sutomo no. 16
50244 Semarang, Indonesia;
Email:raniyogipranata@gmail.com

Patient

female, 22 year(s)

Clinical History

A 22-year-old female patient was referred to our hospital for renal biopsy due to suspicion for a left renal mass. On examination, she had minimal left flank pain and no haematuria. She had no history of stones in the urogenital tract, but she had lung tuberculosis with a completed 6-month treatment.

Imaging Findings

The patient was referred for CT urography which demonstrated an isoattenuation area in the cortical region in the upper-mid pole of the left kidney which protruded into the renal sinus. (Fig. 1, 2) During the corticomedullary and nephrographic phase, it was having the same attenuation and enhancement pattern like normal renal cortex. Additionally, a small right renal stone was also found in the right renal calyx (Fig. 3).

Discussion

Normal anatomical variants in the kidney can mimic renal mass thus leads to diagnostic errors and unnecessary biopsy or nephrectomy in some conditions. [1] Masses that consist of normal or benign renal tissue are referred as renal pseudo-tumours. The various aetiologies of renal pseudo-tumours are developmental disorder, infection, granulomatous disease and vascular in nature. [2] In this case, we report a developmental disorder, called hypertrophied column of Bertin (HCB) in a 22-year-old female patient who was suspected to have a renal mass.
Hypertrophied column of Bertin, or focal cortical hyperplasia, is defined as bands of hypertrophic cortical tissue located between the pyramids of the renal medulla. [2, 3] It often invaginates into the renal sinus, and is most often located between upper and middle calyxes. It is also frequently found unilaterally on the left side. [3] HCB is found in 47% of normal subjects and can be found bilateral in 18% of cases. In 4% of cases, two columns are found in the same kidney. [4]
HCB was named after the French anatomist Exupere Joseph Bertin (1712-1781) who described a renal cortical substance that extends towards the renal pelvis and thus separates the medullary pyramids. [1]
Radiologically, HCB usually appears as a mass that protrudes towards renal sinus and can be mistakenly reported as a tumoral lesion. Therefore recognizing imaging characteristics of HCB could avoid unnecessary interventions, such as biopsy or surgery. [1] On CT urography, HCB is isodense with the normal parenchyma on non-contrast phase, and during the corticomedullary phase, it showed the same enhancement pattern as normal renal parenchyma. [1, 3]
Other imaging, such as colour Doppler ultrasound can be used to determine normal renal parenchyma by showing normal vascular flow in the mass region. MRI and radionuclide scanning can also be a confirmatory imaging, by demonstrating a normal functioning renal parenchyma in the mass area. [5]
In this case, after the CT urography showed that the left renal mass was hypertrophied column of Bertin, the urologist aborted the renal biopsy and suggested extracorporeal shock wave lithotripsy (ESWL) for the right renal stone.

Final Diagnosis

Differential Diagnosis List

References

[1]

Algin O, Ozmen E, Gumus S (2014) Hypertrophic column of bertin: imaging findings. Eurasian J Med 46: 61-3
[2]

Bhatt S, MacLennan G, Dogra V (2007) Renal Pseudotumors. AJR 188: 1380–1387
[3]

Borhani AA, Federle MP (2016) Column of Bertin. In: Tublin M, Borhani AA, Furlan A, Heller MT, editors. Diagnostic Imaging 3rd edition. p. 126-127
[4]

Quaia E, Martingano P, Cavallaro M, Premm M, Angileri R (2014) Normal Radiological Anatomy and Anatomical Variants of the Kidney. In: Quaia E, editors. Radiological Imaging of the kidney second edition p 17-74
[5]

Zagoria RJ, Dyer R, Brady C (2016) Genitourinary imaging , 3rd edition.

Citation

RM Yogipranata, T Yuliastuti (2017, May 16).

Hypertrophied column of Bertin: a renal tumour mimicker, {Online}.

URL: http://www.eurorad.org/case.php?id=14660

DOI: 10.1594/EURORAD/CASE.14660

Public License

This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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Published 16.05.2017
DOI 10.1594/EURORAD/CASE.14660
Section Uroradiology & Genital Male Imaging
Case Type Anatomy and Functional Imaging
Views 275
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Figure 1
Left renal hypertrophied column of Bertin

a

Department of Radiology, Dr. Kariadi Central Hospital, Semarang, Indonesia

b

Department of Radiology, Dr. Kariadi Central Hospital, Semarang, Indonesia

c

Department of Radiology, Dr. Kariadi Central Hospital, Semarang, Indonesia

MSCT coronal unenhanced phase

Area of Interest: Abdomen; Kidney; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Hyperplasia / Hypertrophy;

MSCT coronal corticomedullary phase

Area of Interest: Abdomen; Kidney; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Hyperplasia / Hypertrophy;

MSCT coronal nephrographic phase

Area of Interest: Abdomen; Abdominal wall; Adrenals; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Hyperplasia / Hypertrophy;
Figure 2
MSCT axial left renal hypertrophied column of Bertin

a

Department of Radiology, Dr. Kariadi Central Hospital, Semarang, Indonesia

b

Department of Radiology, Dr. Kariadi Central Hospital, Semarang, Indonesia

c

Department of Radiology, Dr. Kariadi Central Hospital, Semarang, Indonesia

d

Department of Radiology, Dr. Kariadi Central Hospital, Semarang, Indonesia

MSCT scan axial unenhanced phase

Area of Interest: Abdomen; Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hyperplasia / Hypertrophy;

MSCT scan axial corticomedullary phase

Area of Interest: Abdomen; Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hyperplasia / Hypertrophy;

MSCT scan axial nephrographic phase

Area of Interest: Abdomen; Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hyperplasia / Hypertrophy;

MSCT scan axial delayed phase

Area of Interest: Abdomen; Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Hyperplasia / Hypertrophy;
Figure 3
Incidental finding: a right-sided renal stone

a

Department of Radiology, Dr. Kariadi Central Hospital, Semarang, Indonesia

b

Department of Radiology, Dr. Kariadi Central Hospital, Semarang, Indonesia

MSCT axial unenhanced phase

Area of Interest: Abdomen; Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

MSCT axial unenhanced phase

Area of Interest: Abdomen; Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;