Presentation
Weak urinary stream, passage of blood clots in the urine, suprapubic pain, and fever for 1 day. History of dysuria for a few weeks. Known diabetic with past history of recurrent UTIs
Patient Data
An isoechoic mass measuring 6 x 7 cm is seen at the upper pole of the left kidney. A cystic component measuring 3 x 4 cm is seen in it. No vascularity is seen in it on color Doppler ultrasound examination.
A mildly enhancing heterogeneous mass having mixed solid and cystic components measuring 7 x 7 cm, is seen at the upper pole of the left kidney. Mass effect is seen on the adjacent renal parenchyma causing inferior displacement of the collecting system. There are inflammatory changes in the surrounding Gerota's fascia that could be due to superadded urinary tract infection rather than infiltration. Renal arteries, renal veins and IVC are patent. No significant lymphadenopathy or distant metastases are seen. The contralateral kidney is normal. A few tiny radiopaque gallstones without any CT features of acute cholecystitis are noted. Hepatomegaly.
Case Discussion
Laboratory investigations showed elevated acute inflammatory markers and urinary tract infection with positive urine culture for klebsiella pneumoniae. However, in addition to the radiological features of UTI, the CT scan showed a malignant left renal mass, for which the patient underwent left radical nephrectomy.
Histopathology: Chromophobe renal cell carcinoma. Greatest dimension: 10 cm. Additional dimensions: 7 x 5 cm. Tumor focality: Unifocal. Sarcomatoid/Rhabdoid features: Not identified. Histologic grade (WHO/ISUP Grade): Not applicable. Tumor necrosis: Present (10%). Tumor extension: Tumor extension into renal sinus. Margins: Uninvolved by invasive carcinoma. Lymphovascular invasion: Not identified. Regional lymph nodes: No lymph nodes submitted or found. Pathologic stage classification (pTNM, AJCC 8th Edition): pT3a, pNX. Pathologic findings in non-neoplastic kidney: Acute suppurative nephritis with abscess formation.
The special stain with Hale's colloidal iron was uniformly positive in the tumor. The immunostain with the antibody anti-CK7 was also positive in the tumor cells. CD117, CD10 and vimentin were negative.
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