Renal cell carcinoma

Clinical:

  • A 55 years old man
  • Underlying hypertension and DM
  • Complains of left flank pain for few months
  • Associated with loss of appetite and loss of weight
  • No fever, no hematuria and no bowel related symptoms
Abdominal radiograph AP supine view

Radiographic findings:

  • Soft tissue density seen at left lumbar region (yellow arrow)
  • No obvious calcification is seen within the lesion
  • There is peripheral displacement of bowel loops.
  • Otherwise no dilatation of the bowel is seen
Ultrasound of left kidney in longitudinal plane

Ultrasound findings:

  • A huge mass is seen in the inferior pole of left kidney
  • It showed heterogenous echogenicity
  • The mass is vascular with few vessels seen within it
  • No hydronephrosis
Contrast-enhanced CT scan in axial plane

CT scan findings:

  • A huge soft tissue density mass at lower pole of left kidney
  • Areas of central necrosis seen (yellow arrow)
  • Soft tissue density extension seen into the left renal vein (red arrows)
  • No extension into the IVC
  • No involvement of ipsilateral adrenal gland

Diagnosis: Renal cell carcinoma 

Discussion:

  • Renal cell carcinomas are the most common malignant renal tumour
  • Patient usually 50-70 years of age at presentation
  • Risk factors include smoking, dialysis-related cystic disease, obesity, chemotherapy agent and hypertension
  • Clinical triad of macroscopic hematuria, flank pain and palpable flank mass occurs in only 10-15% of patients
  • The most common sites of metastasis are lungs, bones, lymph nodes, liver, adrenals and brain
  • Renal cell carcinoma has a widely varying sonographic appearance. It may appear solid or partially cystic, and may be hyper, iso, or hypoechogenic to the surrounding renal parenchyma
  • On non-contrast CT the lesions are soft tissue attenuation between 20-70 HU.¬†Larger lesions frequently have areas of necrosis.
  • Approximately 30% demonstrate some calcification
  • Intraluminal growth into the venous circulation, in particular, the renal vein, occurs in 4-15% of cases

Progress of patient:

  • Patient was diagnosed as Stage IV disease with lung metastasis (images not shown)
  • Patient refused any intervention or further treatment
  • Patient died 2 months after the diagnosis

 

Author: radhianahassan