Renal medullary carcinoma
Renal medullary carcinoma is a rare variant of renal cell cancer, which is a highly aggressive malignant tumour of the kidney.
Renal medullary carcinoma occurs almost exclusively in adolescent and young adult blacks with sickle cell trait or haemoglobin SC disease but not with homozygous haemoglobin SS sickle cell disease. Typically it affects patients around the age of 20 years with a range of 10-39 years 1.
Presenting symptoms include gross hematuria, abdominal or flank pain, and, less commonly, weight loss, palpable mass, or fever.
Renal medullary carcinoma is of epithelial origin and is thought to arise at the renal pelvic-mucosal interface 1.
The tumour quickly grows to fill the renal pelvis and invade vascular and lymphatic structures. Intraparenchymal satellite nodules are frequently present.
Imaging demonstrates a centrally located infiltrative lesion invading the renal sinus with peripheral caliectasis, reniform enlargement, and smaller peripheral satellite nodules.
There is heterogeneous enhancement at CT, and US shows heterogeneous echotexture.
The differential diagnosis of renal medullary carcinoma includes: