Presentation
Left flank pain.
Patient Data
A 133 × 114 × 122 mm partially exophytic hetero-dense mass is noted in the anterior aspect of the left kidney. After contrast media injection, the mass shows heterogeneous enhancement with a large area of central necrosis. There is no sign of local invasion and no vascular extension.
Two prominent lymph nodes with SAD less than 10mm are seen at the para-aortic level.
A 20 mm thin-walled non-enhanced cyst is noted in the left liver lobe.
A small fat-containing para-umbilical hernia is present.
The prostate gland is enlarged.
Case Discussion
The patient underwent a left nephrectomy, and histopathology evaluation confirmed renal cell carcinoma with a large necrotic component.
It should noted that central necrosis is common in large renal cell carcinomas and may mimic a Bosniak class IV cystic renal mass. So, as a rule, if the enhancing solid component volume of a renal cystic lesion is more than 25% of all mass volume, the Bosniak classification should not be used, and the mass should be instead categorized as a solid renal mass with cystic/necrotic changes; because a solid renal cell carcinoma with cystic/necrotic changes has a poor prognosis compared to the renal cell carcinoma that is arising from a Bosniak class IV cystic renal mass 1.
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