Fact-sheet: Renal cell carcinoma


Updated on 04/18/2017 at 7:08 AM

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Definition

Most common primary malignant Kidney tumor in adults, generally occurring after 40 years of age. Risk factors: - Von Hippel-Lindau syndrome - Hemodialysis - Acquired cystic kidney disease - Smoking - Phenacetin

Clinical features

Hematuria,
flank pain, weight loss, fever
Palpable mass
Varicocele
Stauffer syndrome (nephrogenic hepatopathy) = Hepatosplenomegaly and liver function impairment in the absence of Metastasis fo liver.

Laboratory findings

Normochromic normocytic anemia
Liver function impairment (Stauffer syndrome)
Paraneoplastic syndromes: Erythrocytosis, Hypercalcemia

Ultrasound

Nodule generally hyperechoic when small, otherwise iso- or hypoechoic, possibly surrounded by a hypoechoic capsule and showing a heterogeneous cystic or hemorrhagic component
Vascularized on color Doppler
Typically hypervascular on contrast-enhanced ultrasound

CT

Homogeneous or heterogeneous solid lesion (necrosis, hemorrhage, calcification), showing enhancement >12 HU post-injection. Generally hypodense relative to normal parenchyma on the venous phase Perirenal infiltration Look for: - Enhancing nodule in the perirenal fat - Renal vein thrombosis - IVC thrombosis - Lymphadenopathy - Metastases

MRI

Nodule of variable signal depending on the hemorrhagic or cystic component
On opposed-phase imaging, a slight signal drop indicates low intracellular fat
On delayed sequences, hypoT1 relative to normal renal parenchyma

Classification

T1 Tumor
T2 Tumor 7 cm or greater
T3 Extension into the perirenal fat, contained by Gerota's fascia
T3a Extension into the renal vein or perirenal fat
T3b Thrombus in the inferior vena cava below the diaphragm
T3c Thrombus in the inferior vena cava above the diaphragm or invasion of the inferior vena cava wall
T4a Extension into adjacent organs, excluding the ipsilateral Adrenal gland
T4b Extension into the ipsilateral Adrenal gland
N Regional lymphadenopathy
M Metastases: lung (55%), lymph node (34%), liver (33%), bone (32%), adrenal glands (4.3-19%), contralateral Kidney (11%), brain, Heart, Spleen, gastrointestinal tract, skin, ureter.