Renal Cell Carcinoma

Clinical History: A woman in her mid-60s presented with right upper quadrant abdominal pain. An abdomen complete exam was ordered to rule out gallbladder disease. The patient had no history of smoking or diabetes.

[[{"type":"media","view_mode":"media_crop","fid":"22958","attributes":{"alt":"","class":"media-image","id":"media_crop_2083429693258","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1734","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

Image 1: This is an image of the gallbladder with the patient in a supine position. It appears remarkable, with no indication of a thickened wall, sludge, or stones.

[[{"type":"media","view_mode":"media_crop","fid":"22959","attributes":{"alt":"","class":"media-image","id":"media_crop_8540611166848","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1735","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

Image 2: This is an image of the lateral portion of the right kidney in a longitudinal plane. There is a solid, round mass on the superior pole of the kidney. It appears isoechoic to slightly hyperechoic compared to the renal cortex

[[{"type":"media","view_mode":"media_crop","fid":"22960","attributes":{"alt":"","class":"media-image","id":"media_crop_1991903931659","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1736","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

Image 3: This image was taken to show that the mass was located on the lateral, superior portion of the kidney. Measurements were taken and the mass was 7.0cm in the longest plane.

[[{"type":"media","view_mode":"media_crop","fid":"22961","attributes":{"alt":"","class":"media-image","id":"media_crop_3135173908817","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1737","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

Image 4: There is intravascular flow seen in this image with the use of Color Doppler. It proves that the renal mass is hypervascular

From these imaging findings, no definitive diagnosis could be made. However, due to the appearance and hypervascularity of the mass extending exophytically off the superior pole of the right kidney, it was reported as suspicious for renal cell carcinoma (RCC).

A differential diagnosis could have been an angiomyolipoma, which is also a well-defined solid mass, but it contains a fat component unlike RCC (Ahuja, 2007). Since there was no way of determining the components of the mass, the patient was scheduled for surgery several weeks later. Because the mass was suspicious for RCC, a right nephrectomy was performed. A microscopic examination was performed and confirmed the mass to be renal cell carcinoma, clear cell pattern. It was grade 1, meaning it was confined to the kidney, with no invasion of the Gerota’s fascia surrounding the kidney.

Since the patient was not experiencing any of the signature signs for renal cell carcinoma, this was more of an incidental finding. The classic triad for renal cell carcinoma is flank pain, gross hematuria, and a palpable flank mass; however less than 10% of affected patients actually experience this triad. Other symptoms include fever, anorexia, weight loss, malaise, nausea, vomiting, and constipation. If the mass was not found at this time, it is possible it may have spread to the renal vasculature and IVC which is very common for renal cell carcinoma (Ahuja, 2007).

References
Ahuja, A. T. (2007). Diagnostic imaging ultrasound. (1st ed., pp. 5:86-88). Salt Lake City, UT: Amirsys Inc.