Renal cell carcinoma with renal vein thrombus and hepatic metastases

Case contributed by Dr Subash Thapa

Presentation

Hematuria. Blood investigation reveals hypercalcemia.

Patient Data

Age: 40-45 years
Gender: Female

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

Robson Stage for RCC 1

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)

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