Extensive metastases in young patient: probable renal cell carcinoma
This 22 year old woman presented with a feeling of fullness in the left flank, which has been there since she gave birth 3 years ago. No haematuria. No GIT symptoms. Ultrasound abdomen revealed a large renal renal mass and another separate mass in the epigastrium. No respiratory symptoms were recorded. CT scan abdomen and chest was done.
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Very large mildly enhancing left renal mass that is involving almost the whole kidney. A separate mass which is non enhancing is evident in the epigastrium, partially displacing the stomach to the left. No pelvic masses. No intra-abdominal lymphadenopathy. No focal liver or osseous lesions.
Multiple well defined pulmonary masses which are predominantly located in the peripheral aspect of the lungs. This is consistent with pulmonary metastatic spread.
This is a late presentation scenario with widespread pulmonary metastatic lesions. This patient refused any biopsy and she said she "believed she doesn't have cancer". She was however referred to the oncology service. As a result there is no histological confirmation.
Renal cell carcinoma in young adults has been documented and the majority are papillary renal cell carcinoma. The differential diagnosis given the chest findings includes choriocarcinoma, breast cancer, colorectal carcinoma and uterine leiomyosarcoma.
- Renshaw AA, Granter SR, Fletcher JA et-al. Renal cell carcinomas in children and young adults: increased incidence of papillary architecture and unique subtypes. Am. J. Surg. Pathol. 1999;23 (7): 795-802. Pubmed citation