Renal cell carcinoma with renal vein thrombus and hepatic metastases
Hematuria. Blood investigation reveals hypercalcemia.
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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
Stage I Confined within renal capsule
Stage II Perinephric stranding, perinephric collateral or soft tissue mass in perinephric space
A Filling defect within a distended vein; direct continuity of thrombus with primary mass
B Lymph nodes ≥1 cm
A Obliteration of normal soft tissue planes between tumor and adjacent organs
B Metastases enhance with IV contrast material (hepatic metastases in arterial phase)
- 1. Sheth S, Scatarige JC, Horton KM et-al. Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector ct and three-dimensional CT. Radiographics. 2001;21 Spec No: S237-54. Pubmed citation