Chromophobe renal cell carcinoma

Case contributed by Dr Ammar Ashraf

Presentation

Left loin pain, dysuria and hematuria. No fever, anorexia or weight loss.

Patient Data

Age: 60 years
Gender: Male

No radiopaque renal/ureteric calculi or hydroureteronephrosis is seen. Multiple small phleboliths are seen in the pelvis. Small isodense exophytic lesion along the posteromedial aspect of the upper pole of the left kidney and a large hypodense lesion in the right hepatic lobe; both these lesions need further evaluation with contrast-enhanced CT abdomen.  

A large hypodense lesion measuring 7.5 x 5.5 cm is seen in segment VIII of the liver. It shows early peripheral discontinuous nodular enhancement on the arterial phase, progressive centripetal fill-in on portal venous phase and becoming isodense to the liver parenchyma on delayed phase, this is likely a giant hepatic hemangioma. Another lesion measuring 1.4 x 1.1 cm, showing enhancement on the arterial phase and becoming isodense to the liver on the venous phase is noted in segment II of the liver; this is likely a flash filling hepatic hemangioma. The rest of the liver is unremarkable.

A well-defined enhancing solid exophytic lesion measuring 1.5 x 1.6 cm is seen along the posteromedial aspect of the mid pole of the left kidney, which is suspicious for a primary renal malignancy. A few small retro-aortic lymph nodes are noted at the level of the renal hilum. Renal vessels and IVC are patent and well-opacified. Multiple small well-defined non-enhancing hypodense lesions (suggestive of benign cysts) are noted in both kidneys. 

Case Discussion

Procedure: Left partial nephrectomy (wedge resection).

Diagnosis: Chromophobe renal cell carcinoma. Fuhrman nuclear grade: Grade II. Maximum tumor size 1.5 cm. Renal capsule attenuated but no definite capsular invasion seen. Resection margin clear. No evidence of peritumoral lymphovascular space invasion identified. Pathological stage: pT1a, pNx, pMx. Non-neoplastic renal tissue shows focal interstitial chronic nephritis and periglomerular fibrosis and focal global glomerular sclerosis.

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Case information

rID: 84337
Published: 22nd Nov 2020
Last edited: 23rd Nov 2020
Inclusion in quiz mode: Included
Institution: Ministry of national guard health affairs

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