Presentation
Left flank pain and hematuria.
Patient Data
Normally sited average size left kidney. A well-defined exophytic solid lesion measuring 5.7 x 5.8 x 6.3 cm is seen along the anterior inferior pole of the left kidney. This lesion has an average density of 44, 63, 70 and 57 HU on plain, arterial, portovenous and 15 minutes delayed renal excretory phase imaging respectively. A small linear non-enhancing hypodensity is noted within the center of this lesion which is suspicious for a scar. No calcifications are seen within this mass lesion. The lesion has clear surrounding fat planes and has no radiological features of invasion into the surrounding structures. No significant loco-regional lymphadenopathy is seen. Patent and well-opacified single left renal artery. Left renal vein is also patent and well-opacified.
Malrotated right ectopic kidney visualized in the midline pelvis. A simple cortical cyst (Bosniak type 1)measuring 17 x 19 mm is seen along the anterior mid pole of the right kidney. No radiopaque renal/ureteric calculi are seen. No significant hydroureteronephrosis or perinephric fat stranding/collection is noted.
Status post cholecystectomy. Surgical sutures are seen along the stomach which are related to the history of previous sleeve gastrectomy.
Histopathology and immunohistochemistry reports of the left radical nephrectomy.
Case Discussion
Exophytic mass lesion along the anterior aspect of the lower pole of the left kidney; possible differentials include renal cell carcinoma and oncocytoma. The patient was planned for laparoscopic partial left nephrectomy; however, due to technical issues and bleeding (from injury to the left renal vein), he ended up in a laparotomy with radical nephrectomy. Histopathology and immunohistochemistry showed chromophobe renal cell carcinoma.
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