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73 year male, weight loss, lower Extremity Swelling. Renal US
Left Kidney
DDx? Comments? Further studies?

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Answers
Bilateral Renal Cell CA w/ IVC extension

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  • RCC = hypernephroma; 80-90% of all adult renal malignancies; 6th-7th decade
  • Frequently hyperechoic, especially in tumors <3 cm="" but="" anechoic="" rim="" span="">
  • Mets. To lung, nodes, liver, bone, adrenals, contralateral kidney
  • IVC involvement = stage IIIA, but contralateral mets. Makes this stage IV
  • Associated w/ VHL syndrome, hemodialysis, aquired cystic disease, phenacetin
  • All solid renal masses in adults should be assumed RCC until proven otherwise! (e.g., show the presence of fat in the mass = angiomyolipoma)

Robson Staging Criteria for RCC

Stage I – tumor confined within renal capsule (sharply defined convex interface with peripheral fat)
Stage II – extension into perionephric fat but confined to Gerota’s fascia (irregular interface between tumor and fat)
Stage IIIA – extension into renal vein or IVC
Stage IIIB – regional lymph node metastases
Stage IIIC – extension into renal vein and lymph nodes
Stage IVA – extension of adjacent organs (other than ipsilateral adrenal)
Stage IVB – distant metastases
Staging accuracy: 84-91% for CT, 82-96% for MR, poor for US

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