Clear cell renal cell carcinoma

Case contributed by Ammar Ashraf
Diagnosis certain


Known case of diabetes mellitus, hypertension and benign prostatic hyperplasia (BPH).

Patient Data

Age: 60 years
Gender: Male

Enlarged heterogeneous prostate gland (BPH) measures 5.3 x 5.2 x 5.3 cm with an average volume of 75 ml. Incidental finding of a well-defined, isoechoic, rounded mass lesion measuring approximately 3.6 x 4.0 cm at the lower pole of left kidney. Some internal vascularity is appreciable in it on color Doppler ultrasound examination. 

Findings: An enhancing exophytic mass lesion measuring about 3.7 x 4.7 cm is seen at the lower pole of the left kidney. A few small necrotic areas are seen in it. Patent renal vessels and IVC. No evidence of metastases is noted. A few simple bilateral renal cortical cysts. Fat stranding & subcentimeter lymph nodes around the mesenteric vessels, suggestive of mesenteric panniculitis. A calcified nodule measuring 10 mm is seen in the left upper lobe which is likely an old pulmonary granuloma. Bilateral pars interarticularis fracture (spondylolysis) at L5 level with grade I spondylolisthesis at L5/S1 level. Enlarged prostate gland. Impression: Enhancing exophytic left renal mass lesion suspicious of renal cell carcinoma. 

Case Discussion

Pre-operative diagnosis: Left renal mass.

Procedure: Laparoscopic left radical nephrectomy.

Diagnosis: Histologic type:  Clear cell renal cell carcinoma. Tumor size: Tumor size:  4 x 3.6 x 1.5 cm. Histologic grade:  grade 1 (Fuhrman nuclear grade). Tumor focality: Unifocal. Macroscopic extent of tumor: Tumor limited to kidney. Sarcomatoid features: Not identified. Tumor necrosis:  Present. Microscopic tumor extension: Tumor limited to kidney. Margins: Uninvolved by invasive carcinoma. Lymphovascular invasion: Not identified.

Pathologic staging:  pT1a, pNx, pMx

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