Renal cell carcinoma

Case contributed by Yesid Cardozo Vélez
Diagnosis almost certain


Abdominal pain.

Patient Data

Age: 70 years
Gender: Male

In the upper pole of the left kidney, a solid, exophytic lesion with irregular contours and heterogeneous density is identified, which enhances after the administration of contrast medium (35 HU in the simple phase, 60 HU in the corticomedullary phase and 84 HU in the nephrographic phase).

Adjacent to this lesion, a satellite nodule is identified that contacts the ipsilateral adrenal gland, which also enhances after the administration of contrast medium.

Inside the left renal vein, hypodense content is identified that enhances after the administration of the contrast material. However, there is no involvement of the inferior vena cava.

In the lower pole of the right kidney, a nodule with irregular morphology is identified, but it does not present significant enhancement.

Multiple nodules with soft tissue density are identified in the lung parenchyma, which are randomly distributed, enhance after contrast administration and, in some of them, the "feeder artery" sign is observed.

The prostate gland is enlarged, reaching an estimated volume of 113 cm³. This protrudes the posteroinferior wall of the bladder.

At the level of the soft tissues of the abdominal wall and the gluteal region, multiple subcutaneous nodules with soft tissue density were identified.

Case Discussion

The most likely diagnosis, in this case, is renal cell carcinoma (RCC) with locoregional and distant (lung) metastases, which could be categorized as stage IV. The nodule in the lower pole of the contralateral kidney is of indeterminate type due to its size and lack of significant enhancement.

Renal cell carcinoma (RCC) is a malignant neoplasm that arises from the renal tubular epithelium and represents 90% of solid renal tumors 1,2,3.

The clear cell tumor represents 70%, the papillary cell tumor between 10-15%, the chromophobe 5% and the collecting duct tumor less than 1% 1,3.

The typical appearance of clear cell renal cell carcinomas on computed tomography is that of an exophytic mass projecting from the renal cortex, heterogeneous, multilobulated, with infiltrative behavior and, in most cases, hypervascular 3,4.

RCC compromises the renal vein in 23% and the inferior vena cava in 7% of cases 3,4.

The organs to which it usually metastasizes are the lung (75%), liver (40%), bone (40%), adrenal gland, contralateral kidney and brain 3,4.

Its main differential diagnoses are renal oncocytoma, renal angiomyolipoma, urothelial carcinoma, renal metastases, lymphoma, renal abscess and hemorrhagic renal cysts 3,4.


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