Papillary renal cell carcinoma

Case contributed by Dr Andrew Lawson

Presentation

Incidental finding during CT abdomen for epigastric pain.

Patient Data

Age: 60
Gender: Male
Ultrasound

Initial US abdomen: echogenic lesion in the left lower pole. A second lesion was demonstrated retrospectively in the right upper posterior pole.

Please see MR report.

A well circumscribed, 31mm diameter, lesion is identified along the supero-posterior cortical pole of the right kidney. It extends deep towards the calyceal system. The lesion returns predominantly low T2 signal with focal eccentric high T2 and T1 signal which does not suppress during fat saturation. No signal drop-off is identified on opposed phase imaging to support a fat-containing lesion.

An ill-defined enhancing component is demonstrated along the most posterior aspect of the lesion occupying at least half the volume of the lesion.

No hypervascularity is visible and there is no extension into the peri-renal fat.

A second lesion in the left kidney is identified. On T2 weighted imaging, ill-defined low grade signal is best visualized on the axial imaging of this lesion centered deep within the medulla of the inferior pole measuring 32mm in diameter.

There is no evidence of fat within the lesion. A poorly enhancing, rounded component is visible deep within the lesion measuring approximately 24mm.

On CT, the lesion also demonstrates low grade enhancement, but is less defined and seems to arise from the urothelial surface and extend peripherally. There is no associated vascularity.

Ultrasound

18G biopsy needle in the left renal mass.

Case Discussion

It was felt that, particularly the left lesion, could not be confidently diagnosed on the imaging. A biopsy was considered the best course of action since only a left nephrectomy would otherwise yield an answer.

This showed a papillary cell carcinoma. The patient is being prepped for a left nephrectomy and right partial nephrectomy.

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