Synchronous renal and colonic carcinomas

Case contributed by Ammar Ashraf

Diagnosis certain

Citation, DOI, disclosures and case data

Citation:

Ashraf A, Synchronous renal and colonic carcinomas. Case study, Radiopaedia.org (Accessed on 02 Dec 2023) https://radiopaedia.org/cases/85383

DOI:

Permalink:

https://radiopaedia.org/cases/85383

rID:

85383

Disclosures:

At the time the case was submitted for publication Ammar Ashraf had no recorded disclosures.

View Ammar Ashraf's current disclosures

Case published:

26 Dec 2020

Revisions:

3 times, by 2 contributors - see full revision history and disclosures

Systems:

Gastrointestinal, Urogenital, Oncology

Institution:

Ministry of National Guard Health Affairs

Quiz mode:

Included

Presentation

History of abdominal pain and constipation for 2 months. Presented to the emergency department with worsening pain & constipation associated with vomiting for two days.

Patient Data

Age: 65 years

Gender: Male

From the case: Synchronous renal and colonic carcinomas

x-ray

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Findings: Dilated large bowel loops with a few air fluid levels are seen. No significant air is seen in the rectum. No pneumoperitoneum is seen. A sizable partly calcified lesion is seen along the lower pole of the left kidney.

Impression: Dilated large bowel loops with a few air fluid levels, likely due to distal large bowel obstruction. Large calcified lesion along the lower pole of the left kidney; possible differential includes malignancy (RCC), hydatid cyst or calcified renal abscess (tuberculous).

From the case: Synchronous renal and colonic carcinomas

A well-defined exophytic lesion measuring 3.5 x 4.0 cm (having an average density of 26, 35, 43 HU on plain, arterial & venous phases respectively) is seen at the upper pole of the left kidney.

An exophytic lesion containing multiple calcifications is seen at the lower pole of the left kidney; this lesion measures approximately 6 x 7 cm and has an average density of 39, 41, 48 HU on plain, arterial & venous phases respectively. A sub-centimeter exophytic hyperdense renal cyst (average density=65HU) is seen at the lower pole of the left kidney. Multiple simple renal cysts are also seen in the left kidney; the largest cyst seen at the mid pole measures 12 x 13 cm. Renal vessels and IVC are patent. No significant para-aortic lymphadenopathy is seen.

Segmental mural thickening in the descending colon, associated with dilatation of the proximal colon. Mild pericolic fat stranding and a few small lymph nodes are also seen along the thickened colonic segment.

A small fat density lesion (average density=-9 HU) is seen in the left adrenal gland which is likely an adrenal adenoma.

A few osseous hemangiomas (polka dot sign) are seen in the lumbar spine.

Impression:

suspicious exophytic lesions at the upper and lower poles of the left kidney; possibility of renal malignancy (like papillary renal cell carcinoma) needs to be considered
segmental thickening of the descending colon with proximal colonic dilatation, highly suspicious of colonic carcinoma

Next day

From the case: Synchronous renal and colonic carcinomas