Case Presentation

M/39C/C: Incidentally found renal mass

3

AssessmentProbably, renal cell carcinoma

DDx

OncocytomaMetastasis from an extra-renal primary neoplasm Renal lymphomaRenal parenchymal sarcomaTransitional cell cancers of the renal pelvis (more centrally located, involvement of the collecting system) Angiomyolipomas (fat density usually visible by CT)

REVIEW of DiseaseRenal Cell CarcinomaEssentials of DiagnosisGross or microscopic hematuriaFlank pain or mass in some patientsSystemic symptoms such as fever, weight loss may be prominentSolid renal mass on imaging

More commonly, these lesions are being discovered incidentally before symptoms have developed

Imaging StudiesRenal mass on intravenous urography, ultrasound, CT or MRI scanDiagnostic ProceduresCT scanningfor character of the mass, stages the lesion

Chest radiographs for pulmonary metastases

Bone scans for large tumors, bone pain, elevated alkaline phosphatase levels

MRI and duplex Doppler ultrasonography for the presence and extent of tumor thrombus within the renal vein or vena cava in selected patientsRadiologic charactersOn ultrasound nonspecific renal massthese lesions may be hyperechoic, isoechoic central necrosis mimicking the central scar of oncocytomas

By CTrounded, soft-tissue massesenhancing after the administration of intravenous contrast agentoften homogeneous on small lesionheterogeneous frequently with necrosis and often with calcifications on large lesionReference pollack, mcclennan: clinical urography 2nd volume 2, p.1413-1641

Judson R. Gash & D. Matthew Bowen: Basic Radiology,Part 4. Abdomen, Chapter 9. Radiology of the Urinary Tract

: , p.323

Maxine A. Papadakis and Stephen J. McPhee: 2007 Current Consult: Medicine

Hope S. Rugo, MD: Current Medical Dx & Tx, Oncology

Thank you ~