Renal cell carcinoma - atypical appearance

Case contributed by Ian Bickle
Diagnosis certain


Left flank pain and weight loss. Left renal angle mass. Tumor?

Patient Data

Age: 40 years
Gender: Male


2 cm mass in the right lobe of the thyroid.

The lungs contain multiple nodules/masses, up to 3.4 cm. These are 'cannonball' in appearance.

No abnormal mediastinal nodes.


The left kidney is diffusely enlarged with abnormal morphology and attenuation. The tumor extends into the left renal vein. No normal residual left renal tissue.

Multiple enlarged left renal hilum and left para-aortic nodes.

Porcelain gallbladder.

Case Discussion

Ultrasound guided biopsy was performed on the renal mass.

HISTOLOGY:  renal cell carcinoma.  Furhmans Grade 2

The lung lesions are somewhat typical for cannonball metastases from a renal cell carcinoma.

Both the young age of presentation (38-years-old) and imaging appearance are atypical for an RCC.  The whole left kidney is occupied with tumor with no discerable residual renal tissue, but a reniform morphology remains. The differential diagnosis based on this appearance and prior to biopsy included lymphoma.   

An ultrasound several month prior reported an enlarged but normal appearing left kidney.

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