Renal cell carcinoma

Case contributed by Devandiran Sandra Sagaran
Diagnosis certain


Presented with frank hematuria for 2 weeks and history of lower abdominal pain for 6 months. She had loss of weight (5kg) during the past 2 months.

Patient Data

Age: 55 years old
Gender: Female

Ultrasound Abdomen


Heterogenous lobulated mass in the right suprarenal region with infiltration into the right kidney.


Well defined lobulated heterogenously enhancing mass which is infilitrating the upper and midpole of right kidney. Superiorly, the mass is compressing the inferior border of the liver. The inferior vena cava is compressed and displaced medially. Soft tissue density within the inferior vena cava and right renal vein may represent tumor thrombosis.

Case Discussion

Considering the anatomical location of the adrenal glands which are adjacent to the liver, spleen, bowels, kidneys and adjacent vessels, the diagnosis of an extra adrenal lesion or an adrenal lesion itself based on imaging only is proven to be difficult. Patients with adrenal gland disorders can present with endocrine syndromes such as Cushing syndrome, hyperaldosteronism and pheochromocytoma.

In this patient the vital signs, renal function tests, blood electrolytes, serum cortisone, and urinary catecholamines were within the normal range. Intraoperatively the right adrenal gland was normal, and only part of the adrenal gland was removed along with the mass. There was clear plane between the mass and the liver surface, gallbladder, small bowels, large bowels and inferior vena cava. Intraoperative pathological consultation is important. 

In this case, the histopathological result confirmed renal cell carcinoma.

Differentiation between an adrenal tumor and a metastatic renal cell carcinoma is difficult. Frozen sections can be requested to further aid in differential of a malignant renal or adrenal tumors. 

Possible adrenal pseudotumors are exophytic upper pole renal mass, abundant suprarenal fat, retroperitoneal tumor localized in the area of adrenal gland, hepatic tumor or prominent lobation of the hepatic lobe, redundant gastric funds, gastric divertivculum, fluid filled duodenum or colon, tortuous or dilated splenic vessels, splenic lobulation, pancreatic tail in an unusual location or pancreatic tail mass, and focal thickening of adjacent diaphragmatic crus.

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