Extensive metastases in young patient: probable renal cell carcinoma

Case contributed by Dr Arthur Daire

Presentation

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.

Patient Data

Age: 22
Gender: Female

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.

Case Discussion

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.

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Case information

rID: 30158
Case created: 22nd Jul 2014
Last edited: 4th Oct 2015
Systems: Chest, Urogenital
Inclusion in quiz mode: Included

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