Presentation
Lower backache and high blood pressure. Ultrasound to rule out abdominal aortic aneurysm.
Patient Data
Small well defined predominantly isoechoic exophytic solid nodule measuring 2.5 x 3.0 cm at the mid pole of the right kidney. No vascularity is seen in it on color Doppler ultrasound examination. Multiple small cysts in both kidneys and no abdominal aortic aneurysm (not shown).
A well-defined exophytic soft tissue nodule measuring 2.5 x 3.0 cm, is seen at the mid pole of right kidney. It has an average density of 27, 40 and 51 Hounsfield units on plain, arterial and portovenous phases respectively. Patent renal vessels and IVC. No significant locoregional lymphadenopathy or evidence of distant metastasis is seen. Multiple bilateral simple renal cysts (Bosniak I), bilateral tiny non-obstructive renal calculi, mildly enlarged prostate gland and multiple dense gallstones. Atherosclerotic changes of the abdominal aorta; however, no aneurysm is seen. Degenerative changes of the lumbar spine.
Histopathology showing type 1 papillary renal cell carcinoma (pRCC), measuring 3 cm in maximum diameter.
Case Discussion
Well-defined mildly enhancing exophytic right renal lesion, suspicious for malignancy. The patient underwent an uneventful partial right nephrectomy and histopathology showed pRCC.