Renal Cell Carcinoma Mimicking Adrenal Tumor

There are a variety of causes of adrenal pseudotumors on computerized tomography (CT) scan, including upper-pole renal mass, gastric diverticulum, prominent splenic lobulation, pancreatic mass, hepatic mass, and periadrenal varices. We present a case of a large subhepatic mass that discrimination of its origin from neighborhood organs was difficult preoperatively. Our patient was a 58 years old man, that three months after an unsuccessful operation in another center for a pseudoadrenal mass underwent a very difficult subcapsular tumorectomy in our center.

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Preoperative differentiation of chromophobe renal cell carcinoma from oncocytoma: Aorta-lesion-attenuation difference on multiphasic multidetector computed tomography.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.627 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 627-627

Author(s):

Melina Hosseiny ◽

Justin Ching ◽

Soheil Kooraki ◽

Steven Raman

Keyword(s):

Renal Cell Carcinoma ◽

Ct Scan ◽

Cell Carcinoma ◽

Renal Cell ◽

Renal Mass ◽

Multidetector Ct ◽

Hounsfield Unit ◽

Chromophobe Renal Cell Carcinoma ◽

Imaging Biomarker ◽

The Difference

627 Background: Differentiation of benign oncocytoma from chromophobe renal cell carcinoma (chRCC) remains a challenge. This study aimed to investigate whether Aorta-lesion-attenuation difference (ALAD) on multiphasic multidetector CT scan (MDCT) can aid to distinguish oncocytoma from chRCC. Methods: This IRB-approved, HIPAA-compliant study consisted MDCT of 111 patients with pathologically proven chRCC (N: 37) or oncocytoma (N: 74). Regions of interest (ROIs) were placed over the renal mass and Aorta on the same axial MDCT slice of un-enhanced (UE), corticomedullary (CM), nephrographic (NP) and excretory (EX) phases. ROIs were devoid of calcification, necrosis and hemorrhage in lesion or atherosclerotic plaque in Aorta. The difference between Aorta and renal mass Hounsfield unit was calculated in all available phases. SPSS v.18 was used to draw receiver-operating characteristic (ROC) curve to calculate accuracy and optimal cutoff values for differentiation of chRCC from oncocytoma. Results: Mean ALAD was significantly higher in chRCC compared to oncocytoma in CM(P: 0.04), NP (P<0.01) and EX (P<0.01) phases. The area under the curves for ALAD in UE, CM, NP and EX phases were 0.47 (95% CI: 0.36- 0.59, p: 0.68), 0.64 (95% CI: 0.51-0.77, p: 0.03), 0.87 (95% CI: 0.79- 0.95, p< 0.01) and 0.80 (0.70-0.90, P<0.001), respectively. ALAD threshold of 19 in nephrographic phase had sensitivity and specificity of 79% and 78%, respectively, for differentiation of chRCC from oncocytoma. Conclusions: ALAD measured in the nephrogenic phase showed the highest accuracy for differentiation of chRCC from oncocytoma on multidetector CT scan. If validated prospectively, ALAD may act as a useful imaging biomarker to distinguish chRCC from oncocytoma.

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Paraneoplastic Hypercalcemia as the Initial Presenting Sign of Metastatic Renal Cell Carcinoma

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.428 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A210-A211

Author(s):

Salem Gaballa ◽

Armen Malkhasian

Keyword(s):

Renal Cell Carcinoma ◽

Ct Scan ◽

Cell Carcinoma ◽

Renal Cell ◽

Renal Mass ◽

Lung Nodule ◽

Pet Ct ◽

Tnf Α ◽

Paraneoplastic Hypercalcemia ◽

Pet Ct Scan

Abstract Introduction: Malignant hypercalcemia can occur in patients with renal cell carcinoma as part of a paraneoplastic syndrome. The suggested mechanisms of malignant hypercalcemia include overproduction of parathyroid hormone-related peptide (PTHrP), interleukin-6 (IL-6), prostaglandins, and tumor necrosis factor-alpha (TNF-α). This report describes an unusual case of paraneoplastic hypercalcemia as the initial manifestation of metastatic renal cell carcinoma (RCC). Case presentation: A 44-year-old Caucasian male with no past medical history who presented to his PCP complaining of unintentional weight loss of 25 lbs, increasing fatigue, occasional right flank pain, and nausea. His family history is significant for multiple myeloma of his mother. The physical exam was unremarkable. Labs were remarkable for serum calcium of 11.5 mg/dL, Albumin of 4.5 g/dL, intact parathyroid hormone (PTH) of 9 pg/mL, undetectable PTHrP, 25 hydroxy VitD of 26.4 ng/mL, and 1, 25 hydroxy VitD of 18 pg/mL. Serum and urine protein electrophoresis and PSA were unremarkable. CXR revealed the right lower lobe noncalcified nodule of 15×11×7 mm. CT abdomen/Pelvis revealed a right renal mass of 13×14×12 cm without lymphadenopathy or local metastasis. The patient was referred to a medical oncologist and further workup including PET/CT scan that demonstrated increased uptake in right lung nodule of SUV 6, right renal mass uptake of SUV 72, and MRI brain without metastasis. The patient treated with right total nephrectomy that revealed a sarcomatoid renal cell carcinoma. Right lung nodule biopsy revealed a clear cell renal carcinoma. The patient further treated with two cycles of Gemcitabine/oxaliplatin and four cycles of nivolumab/ipilimumab. A repeated PET/CT scan showed a complete resolution of a right lung nodule. Repeated labs were unremarkable, including serum calcium of 8.7 mg/dL. Discussion: Hypercalcemia is a frequent occurrence in patients with RCC, but it is an unusual presenting symptom. The initial evaluation should focus on whether the hypercalcemia is parathyroid-dependent or medication-related. Basic laboratory investigations for hypercalcemia include PTH, PTHrP, and 1, 25(OH)2D. Bone-resorbing cytokines may be present in those patients in which the cause of the hypercalcemia is unclear. In our case, we could not determine the specific cytokine that caused hypercalcemia, as IL-6 and TNF-α were unavailable. If laboratory tests are unavailable, bone scan, CT scan, or PET-CT should be considered to evaluate for lytic bone lesions or underlying malignancy. Evaluation for carcinoma should be persistently pursued in a patient who has symptoms suggestive of paraneoplastic hypercalcemia. Finally, symptomatic malignant hypercalcemia can be treated with IV fluids and bisphosphonates. Approximately 50% of patients who undergo nephrectomy and/or tumor debulking will revert to normocalcemia.

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An Atypical Case of Renal Mass - A Case Study

Bangladesh Journal of Urology ◽

10.3329/bju.v15i2.45921 ◽

2020 ◽

Vol 15 (2) ◽

pp. 56-58

Author(s):

Shafiqur Rahman ◽

B Ahmed ◽

ATM Mowladad Chowdhury ◽

Mirza M Hasan ◽

Sayedul Islam

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Clinical Diagnosis ◽

Renal Cell ◽

Renal Mass ◽

Clinical Presentation ◽

Atypical Case ◽

Renal Tuberculosis

A forty eight year old woman with the clinical diagnosis of renal mass due to renal cell carcinoma was found to have renal tuberculosis. The clinical presentation and management are being discussed. Bangladesh Journal of Urology, Vol. 15, No. 2, July 2012 p.56-58

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Histologic Heterogeneity of Extirpated Renal Cell Carcinoma Specimens: Implications for Renal Mass Biopsy

Journal of Kidney Cancer and VHL ◽

10.15586/jkcvhl.v7i3.134 ◽

2020 ◽

Vol 7 (3) ◽

pp. 20-25

Author(s):

Lauren Nahouraii ◽

Jordan Allen ◽

Suzanne Merrill ◽

Erik Lehman ◽

Matthew Kaag ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Renal Mass ◽

Tumor Stage ◽

High Grade ◽

Renal Masses ◽

Histologic Heterogeneity ◽

Adequate Sampling ◽

Renal Mass Biopsy

Pathologic characteristics of extirpated renal cell carcinoma (RCC) specimens <7 cm were reviewed to get better information on technical nuances of renal mass biopsy (RMB). Specimens were stratified according to tumor stage, nuclear grade, size, histology, presence of lymphovas-cular invasion (LVI), necrosis, and sarcomatoid features. When considering pT1 (0–7 cm) tumors pT1b (4–7 cm), RCC masses were more likely to have necrosis (43% vs 16%, P < 0.001), LVI (6% vs 2%, P = 0.024), high-grade nuclear elements (29% vs 17%, P < 0.001), and sarcomatoid features (2% vs 0%, P = 0.006) compared with pT1a (0–4 cm) tumors. Additionally, pT3a tumors were more highly associated with necrosis (P = 0.005), LVI, sarcomatoid features, and high-grade disease (P for all < 0.001) when compared to pT1 masses. For masses <4 cm, pT3a cancers were more likely to demonstrate necrosis (38% vs 16%, P < 0.001), LVI (10% vs 2%, P = 0.037), high-grade nuclear elements (31% vs 17%, P = 0.05), and sarcomatoid features (3% vs 0%, P = 0.065) compared to pT1a tumors. Similarly, for masses 4–7 cm, pathologic T3a tumors were significantly more likely to have sarcomatoid features (16% vs 2%, P < 0.001) and LVI (28% vs 6%, P < 0.001) compared to pT1b tumors. In summary, pT3a tumors and those RCC masses >4 cm exhibit considerable histologic heterogeneity and may harbor elements that are not easily appreciated with limited renal sampling. Therefore, if RMB is considered for renal masses greater than 4 cm or those that abut sinus fat, a multi-quadrant biopsy approach is necessary to ensure adequate sampling and characterization of the mass.

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