Renal cell carcinoma: clear cell

Case contributed by Dr Karim Hussein

Presentation

Right flank pain and haematuria.

Patient Data

Age: 60 years
Gender: Male

There is a 8 cm mass in the middle to lower pole of right kidney which avidly enhances with arterial phase contrast.

A tumour thrombus is seen invading and dilating the entire length of the right renal vein, but does not extend to the IVC.

Photo

Histology report post-radical nephrectomy

Confirmed clear cell renal cell carcinoma and tumour thrombus.

Case Discussion

The patient presented with macroscopic haematuria and right flank pain. These are two of the classic presentation triad of renal cell carcinoma, consisting of haematuria, flank pain and a palpable mass.

Correlated with the imaging findings, the patient was diagnosed with renal cell carcinoma.

Radical nephrectomy was performed.

Histopathology confirmed the diagnosis of renal cell carcinoma.

Tumour thrombus is classically associated with renal cell carcinoma. In some cases, it may be difficult to differentiate between a bland thrombus and a tumour thrombus in the renal vein on a non-contrast or venous phase CT, as both are seen as a filling defect in the renal vein. However, an arterial phase CT will show enhancement of a tumour thrombus due to neovascularisation of the tumour, as in this case.

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Case information

rID: 53545
Case created: 23rd May 2017
Last edited: 5th Jul 2017
Inclusion in quiz mode: Included

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