Translocation renal cell carcinoma

Case contributed by Dr Hazem M Almasarei

Presentation

Previously healthy, complained of flank pain, then he has abdominal trauma, the patient developed vomiting and went to the outpatient doctor who asked for an abdominal ultrasound which was suspicious of renal mass so was referred to a urologist who asked for abdomen and pelvis CT. The first impression was Wilms tumour.

Patient Data

Age: 5 years
Gender: Male

There is well-defined relatively homogeneous soft tissue mass and the involving the posterior aspect of the upper pole of the right kidney reaching to the supra-hilar area. A tiny dot of calcification is seen at its posterior aspect. There an evidence of right renal pelvis invasion. The renal vessels are preserved. The reniform contour of the involved kidney was preserved. Another similar density and enhancement soft tissue mass is seen at right infra-hilar, which is highly suggestive of lymph node metastasis.

Unremarkable left kidney. Unremarkable liver, spleen and the pancreas. No ascites.

Renal cell carcinoma and lymphoma are to be considered more than the diagnosis of Wilms tumor. 

Photo

This is a pathology report from an ultrasound-guided renal biopsy.

Pathology

Gross pathology

Pathology

Pathology slides.

Pathology

Para-aortic lymph node

Photo

Pathology report.

Case Discussion

The most common renal mass in children is Wilms tumor, but in this case; it does not meet the radiological classic features of Wilms tumor, despite the patient age.

The presence of lymph node enlargement may raise the possibility of lymphoma.

The imaging diagnosis of renal cell carcinoma and subtypes are a challenge in a pediatric age. So accurate histologic and imaging characterization of renal cell carcinoma is important for prognosis and management.

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Case information

rID: 57750
Published: 6th Feb 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: King Hussein Cancer Center

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