Renal cell carcinoma vs renal pelvic transitional cell carcinoma

Case contributed by Dr Ian Bickle

Presentation

Incidental right renal mass observed on CT performed for an alternative indication. Patient asymptomatic.

Patient Data

Age: 55
Gender: Female

Heterogenous mass in the central right kidney - either derived from central renal parenchyma tissue or the renal pelvis.

Case Discussion

Incidental heterogenous mass centered on the central right kidney.  The differential is between a centrally placed renal cell carcinoma or a renal pelvis transitional cell carcinoma. 

This study was performed for an alternative indication and hence only a single portal venous phase.  If the clinical indication pertained to the renal tract a multiphase study would have been performed making the diagnosis more straightforward.

Discussed at a clinico-radiological meeting as to whether it was a renal cell carcinoma or a pelvic transitional cell carcinoma.

Multi-phase imaging offered, in particular a excretory phase study to delineate of this mass is renal parenchymal derived or within the pelvis - in which case it would be clearly elucidated as a filling defect in the renal pelvis. Urologists decided to perform a retrograde study in theater - no collecting system abnormality (images not available). 

Final diagnosis was of a renal cell carcinoma.

The case highlights the value of:

  • good referral practices
  • importance of robust vetting and protocol selection
  • value of clinico-radiological discussion
  • holistic approach to imaging with multi-modality studies

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