Presentation
Work up for acute right lower quadrant pain. No other past medical history.
Patient Data
The appendix is markedly distended and shows a thick enhancing wall with surrounding fat stranding. A small appendicolith is also noted in the proximal portion of the appendiceal lumen.
An 86×72×82 mm partially exophytic hetero-enhancing mass is noted at the upper pole of the left kidney. There is no sign of local invasion, no vascular extension or regional enlarged lymph node.
A few small ill-defined hypo-attenuating masses are seen in the liver less than 13 mm, which show delayed enhancement.
The gallbladder is not seen at the anatomical location due to prior resection.
In imaged portions of the lower thorax, a 28 mm nodule is seen at the right lower lobe, highly suggestive of metastasis. A small volume of pericardial effusion is also present.
The prostate gland is enlarged.
Case Discussion
The patient underwent an urgent appendecectomy and elective left nephrectomy. The histopathology evaluation of the left renal mass confirmed papillary renal cell carcinoma, the second most common histological subtype of renal cell carcinoma (RCC).
On CT images, papillary renal cell carcinoma is characteristically less vascularized than the clear cell subtype, showing overall hypo-enhancement compared to the adjacent normal renal cortex.