Chromophobe renal cell carcinoma

Case contributed by Dr Ammar Ashraf

Presentation

Left flank pain for a few weeks. No fever, hematuria, or dysuria.

Patient Data

Age: 30 years
Gender: Male
Ultrasound

A well-defined heterogeneous slightly hyperechoic mass measuring 9 x 10 cm is seen at the upper pole of the left kidney. No significant internal vascularity is seen in it on color Doppler ultrasound examination.

A large heterogeneous density mass measuring approximately 10.0 x 9.5 cm is seen at the upper/mid pole of the left kidney. Multiple small hyperdense areas (measuring up to 50 HU) are seen in this mass on plain CT scan, which are suspicious for hemorrhage. Multiple hypodense non enhancing areas suggestive of necrosis and multiple tiny calcifications are also seen within the lesion. This mass does not show any significant enhancement on post-contrast images. Mild fat stranding is noted along the upper pole of the left kidney adjacent to the left adrenal gland. Patent and well-opacified renal vessels and IVC. No locoregional lymphadenopathy or distant metastases.  A well-defined hypodense lesion measuring 16 x 22 mm, showing peripheral nodular enhancement on portal venous phase imaging and becoming isodense to the liver parenchyma on delayed phase imaging, is seen in segment V of the liver, which is likely a hemangioma.

Case Discussion

Procedure: Laparoscopic left radical nephrectomy.

Diagnosis: Chromophobe renal cell carcinoma. Maximum tumor size: 8 cm. FUHRMAN nuclear grade=G1. Renal capsular, perirenal fat, pelvicalyceal system & adrenal invasion: Not identified. Vascular and ureteric resection margins are free. No evidence of renal vein invasion seen. No regional lymph nodes are grossly or histologically identified. Pathologic staging:  pT2a, pNx, pMx. The tumor was positive with colloidal iron special staining.

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