Renal cell carcinoma

Case contributed by Dr Mohammad Taghi Niknejad

Presentation

Right flank pain and hematuria.

Patient Data

Age: 50 years
Gender: Male
CT

Several small cysts are seen at liver less than 12 mm. 
A 32 mm partially exophytic mass is seen in the lower pole of right kidney. The neoplasm has a similar density to normal renal parenchyma on non-enhanced CT scan. After IV contrast media injection, the attenuation value increased from 20 HU to 46 HU. Nephrographic phase CT scan shows that the mass enhances less than normal renal parenchyma. 

Mild to moderate hydronephrosis is present at right side. Two stones 12 mm (1244 HU) and 8 mm (483 HU) are seen at right upper and lower calyces, respectively. Mild hydronephrosis is also observed at left side. 

The prostate gland is enlarged.
Degenerative changes as osteophytosis are seen at the lumbar spine.
Post-operative changes are seen at lumbar spine as CD insertion at L4 and L5 levels.

MRI

A 32 mm T1W low signal mass is seen at anterior aspect of right renal lower pole. It is hypersignal on T2WI. The mass has T2W low signal rim. After contrast injection, it shows heterogeneous enhancement due to cystic components. No evidence of vascular extension or adjacent organs invasion is observed.

A few cortical cysts is seen at right kidney.
An 11 mm cyst is seen at 6t hepatic segment.

Case Discussion

The patient underwent right nephrectomy and histopathology evaluation confirms low grade clear cell renal cell carcinoma.

MRI is not only excellent at imaging the kidneys and locally staging tumors, but is also able to suggest the likely histology, on the grounds of T2 differences (clear cell RCC: hyperintense on T2WI / papillary RCC: hypointense on T2WI)1.

Tumor pseudo capsule, essentially only seen in low-grade renal cell carcinomas, renal adenomas, and oncocytomas appear as a hypointense rim between the tumor and the adjacent normal renal parenchyma2.

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