Presentation
Past medical history of end stage renal disease secondary to hypertension and status - post left lower quadrant kidney transplant presents for routine follow-up.
Patient Data
Grey-scale and color doppler images of the native right kidney demonstrates a new 1.8 cm solid appearing exophytic mass arising from the posterior interpolar region. This did not demonstrate significant color doppler flow.
Subsequent MRI demonstrates a 1.8 cm exophytic mass arising from the posterior interpolar region of the right kid. The mass demonstrates decreased signal on T2WI and isointense signal on T1WI. On post contrast substraction images, the mass demonstrates minimal arterial phase hyperenhancemnt with progressive increased enhancement on delayed images. No fat or restricted diffusion was seen associated with the mass.
There are multiple bilateral simple and hemorrhagic renal cysts.
Case Discussion
Patient underwent right nephrectomy. Pathology revealed a papillary renal cell carcinoma.
Key points:
papillary RCC typically shows an expansile pattern of growth
papillary RCC tend to be hypoechoic on ultrasound
they typically show iso- to hypointense signal on T1-WI and hypointense signal T2-WI on MRI
on post contrast images, papillary RCC tend to enhance less than clear cell RCC, particularly on corticomedullary or renal cortical phase
second most common subtype of RCC
less aggressive than Clear Cell RCC
associated with hereditary papillary renal carcinoma, an autosomal dominant syndrome
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