Presentation
Hematuria. Blood investigation reveals hypercalcemia.
Patient Data
There is an isodense lobulated mass measuring 47.1 x 44.8 x 48.6 mm involving the lower pole of the left kidney with an area of dense amorphous central calcification.
Post contrast (nephrogenic phase) demonstrates heterogeneous enhancement of the mass (lesser than that of the normal parenchyma). There is indistinct interface with the surrounding parenchyma and minimal perinephric fat stranding.
There are multiple peripheral ring enhancing hypodense nodules of various sizes involving both lobe of the liver.
There is also a dilated left renal vein with a filling defect within it.
This is a case of Robson stage IV renal cell carcinoma
There is evidence of hepatic metastasis and renal vein tumor thrombus
Case Discussion
Stage I Confined within renal capsule
Stage II Perinephric stranding, perinephric collateral or soft tissue mass in perinephric space
Stage III
A Filling defect within a distended vein; direct continuity of thrombus with primary mass
B Lymph nodes ≥1 cm
Stage IV-
A Obliteration of normal soft tissue planes between tumor and adjacent organs
B Metastases enhance with IV contrast material (hepatic metastases in arterial phase)
Unable to process the form. Check for errors and try again.