M/39

C/C:
Incidentally found renal mass

Assessment
Probably, renal cell carcinoma
DDx

Oncocytoma
Metastasis from an extra-renal primary neoplasm
Renal lymphoma
Renal parenchymal sarcoma
Transitional cell cancers of the renal pelvis
(more centrally located, involvement of the
collecting system)
Angiomyolipomas
(fat density usually visible by CT)

R EV IEW O F D ISEA SE

Renal Cell Carcinoma


Essentials of Diagnosis
Gross or microscopic hematuria
Flank pain or mass in some patients
Systemic symptoms
such as fever, weight loss may be prominent
Solid renal mass on imaging

More commonly, these lesions are being discovered inciden

tally before symptoms have developed
Imaging Studies
Renal mass on intravenous urography, ultrasound, CT or MRI scan

Diagnostic Procedures
CT scanning
for 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 v
ein or vena cava in selected patients

Radiologic characters
On ultrasound
nonspecific renal mass
these lesions may be hyperechoic, isoechoic
central necrosis mimicking the central scar of oncocytomas

By CT
rounded, soft-tissue masses
enhancing after the administration of intravenous contrast ag
ent
often homogeneous on small lesion
heterogeneous frequently with necrosis and often with calcifi
cations on large lesion

Reference
pollack, mcclennan: clinical urography 2nd volume 2, p.14131641
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 ~