Renal cell carcinoma
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There is a large heterogenous soft tissue mass arising in the posterior left kidney, with surrounding fat stranding. There mass appears to involve the left renal vein which is indistinct from surrounding structures at its distal end. There is relative hypoenhancement and of the left kidney compared to the right. The mass does not invade through Gerota's fascia. No lymphadenopathy. Appearances are consistent with a renal cell carcinoma, invading the left renal vein.
There is a small cortical cyst, anterior aspect of the lower pole of the left kidney. A larger cyst is also present at the posterior aspect of the superior pole, left kidney. The right kidney shows a tiny cortical cyst at the inferior pole. The left renal pelvis and ureter cannot be identified on renal excretory phase.
Degenerative changes of the imaged lumbar and thoracic spine are noted. The remaining imaged abdominal viscera are normal in appearance, with no evidence of metastasis, however distal metastasis is not excluded given the limited imaging.
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This patient went on to have a radical nephrectomy. The pathology report reads as follows:
Sections show a multinodular tumour consistent with clear cell renal cell carcinoma. There is direct extension of tumour into the renal vein. Surrounding lymph nodes are normal. The left adrenal gland is normal.