|Print Date:||May 21, 2013, 4:14 pm|
|Title||Renal Cell Carcinoma|
|Text||Hx, 29 y/o male with asymptomatic renal mass found on inferior axial images of chest CT.
Discussion, Renal cell carcinoma is a surgically treated disease with reasonable prognosis if discovered early without extrarenal spread.
Etiology, malignant transformation of proximal renal tubular cells.
Radiologic Findings, The right kidney has a large heterogeneous exophytic mass. It extends superiorly and laterally to Gerota\'s fascia abutting the right lobe of the liver. There is no metastatic extension. No lymph node involvement. No involvement of the inferior vena cava.
Epidemiology, Renal cell carcinoma occurs in the fifth and six decade of life.
Clinical Manifestations, The classic triad of flank pain, palpable mass and hematuria occurs in 20% of patients. Otherwise, RCC may be found serendipitously by other testing.
DDx, cyst, benign neoplasm (adenoma, angiomyolipoma), abscess, transitional cell carcinoma, sarcoma, lymphoma, Wilm\'s tumor.
Diagnosis, Tissue histology of thin film anatomic specimen shows one of eight types. Clear cell carcinoma is the most prevalent subtype. Staging is made via the Robson method. Grade I is lesion within the renal capsule with a 66% five year survival. Stage II extends past the capsule but within Gerota\'s fascia (64% survival). Stage III extends into lymph nodes or the vasculature (42% survival). Stage IV extends to local organs or has metastasis (11% survival). Lymph node involvement conveys a worse prognosis compared to IVC involvement.
Treatment, Surgical removal is the treatment of choice. Radiotherapy has no effect. Interferon may be of benefit. Tumors may spontaneously remit or expand. Watchful waiting may be appropriate in some instances.
|References:||1. Clinical Anatomy, Snell R.S. 1995, little brown and company,
2. Harrison\'s Principles of Internal Medicine, 14th edition, pp-594-596
|Contributor||Gloria Jicha (Tripler Army Medical Center)|
|Author||Dr. Paul Ciminera|
|Peer Reviewer||James L Gee (Uniformed Services University)|
|Record Number||: 3159|
|MedPix® Medical Image Database |
Content Text and Images may be Copyright © 1999 - 2006 by the Original Contributors