Renal cell carcinoma

Q: What is the likely diagnosis? show answer

A: Renal cell carcinoma is most likely. A renal oncocytoma or benign adenoma may have similar appearances.

Q: Other than an obvious vascular solid mass, what other sonographic finding specifically demarcates a renal tumour? show answer

A: A thin hypoechoic halo seen at the upper margin of mass (tumour pseudocapsule) is relatively specific for renal tumour. Its seen usually in renal cell carcinoma, oncocytoma and, more rarely, in adenomas.

Q: What are the two most common pathological subtypes of renal cell carcinoma, and which is favoured in this case? Why? show answer

A: Clear cell (70-80%) and papillary (15-20%) are most common. Clear cell subtype should be favoured, both because it is far more common and usually show stronger enhancement than papillary subtype.

Q: Considering this is a 10 cm mass, with no locoregional or distant lymph nodes, or any metastases, what should be the stage of renal cell carcinoma? show answer

A: As the renal vein is involved, staging depends on local tumour involvement and whether or not the left adrenal lesion is a metastasis. If it is not extending beyond Gerota's fascia then it would place the tumour as T3. If the adrenal lesion is an incidentaloma then TNM = T3 N0 M0, Robson = stage 3 or 4.

Q: What should be the treatment modality of choice in this case? show answer

A: This depends on the patient's age and co-morbidities, especially the presence of renal impairment. If feasible, radical nephrectomy would be ideal.

Q: Name four other incidental findings on the CT, two of which may require further assessment/treatment. show answer

A: Cholelithiasis. Right adnexal cystic lesion, which in a 72-year-old should be viewed with suspicion. Vertebral haemangioma and liver granuloma require no further assessment.