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Case Presentation
M/39C/C: Incidentally found renal mass
3
AssessmentProbably, renal cell carcinoma
DDx
OncocytomaMetastasis from an extra-renal primary neoplasm Renal lymphomaRenal parenchymal sarcomaTransitional cell cancers of the renal pelvis (more centrally located, involvement of the collecting system) Angiomyolipomas (fat density usually visible by CT)
REVIEW of DiseaseRenal Cell CarcinomaEssentials of DiagnosisGross or microscopic hematuriaFlank pain or mass in some patientsSystemic symptoms such as fever, weight loss may be prominentSolid renal mass on imaging
More commonly, these lesions are being discovered incidentally before symptoms have developed
Imaging StudiesRenal mass on intravenous urography, ultrasound, CT or MRI scanDiagnostic ProceduresCT scanningfor character of the mass, stages the lesion
Chest radiographs for pulmonary metastases
Bone scans for large tumors, bone pain, elevated alkaline phosphatase levels
MRI and duplex Doppler ultrasonography for the presence and extent of tumor thrombus within the renal vein or vena cava in selected patientsRadiologic charactersOn ultrasound nonspecific renal massthese lesions may be hyperechoic, isoechoic central necrosis mimicking the central scar of oncocytomas
By CTrounded, soft-tissue massesenhancing after the administration of intravenous contrast agentoften homogeneous on small lesionheterogeneous frequently with necrosis and often with calcifications on large lesionReference pollack, mcclennan: clinical urography 2nd volume 2, p.1413-1641
Judson R. Gash & D. Matthew Bowen: Basic Radiology,Part 4. Abdomen, Chapter 9. Radiology of the Urinary Tract
: , p.323
Maxine A. Papadakis and Stephen J. McPhee: 2007 Current Consult: Medicine
Hope S. Rugo, MD: Current Medical Dx & Tx, Oncology
Thank you ~