Presentation
Painless hematuria and pelvic pain. US examination showed a large mass along with the left kidney lower pole.
Patient Data
Large intermediate signal (T1/T2) solid soft tissue mass lesion measuring about 60*65*88mm along with left kidney mid to lower pole with invasion to the pelvicalyceal system and outward extension
No evidence of left renal main artery and vein invasion
A large abnormal intermediate signal infiltrated bone marrow lesion along with S2-S4 vertebrae and left sacral ala next to the sacroiliac joint
Mildly enlargement of prostrate measuring about 42*50 mm and shows heterogeneous signal intensity
Large solid nodule (low on T1 and high on T2) measuring about 15*20 mm originated from prostate left lobe central zone with exophytic extension and stretching of the prostate capsule
Neurovascular bundles are unremarkable.
Case Discussion
The classic presentation of renal cell carcinoma consisting of hematuria, flank pain, and a palpable mass. However, these presentations only found in 10-15% of patients 1,2.
With regarding the imaging findings, RCC with bone metastasis is the probable diagnosis.