What is the diagnosis? Follow us and come back next week for | Figure 1

Diagnosis Overview

What is the diagnosis? Follow us and come back next week for the answer!

Presented by Sanhong Yu MD, Ph.D, under the supervision of Qiusheng Si MD, Ph.D, while on the Genitourinary rotation.

Clinical History:

A 61-year-old male presented for renal masses and gross hematuria while on dialysis. Patient has a history of ESRD status post right kidney transplant that failed two years later. CT noted cystic kidneys with multiple enhancing renal masses. Patient underwent left and right robotic-assisted laparoscopic radical nephrectomy.

Radiographic Description:

Both kidneys have innumerable cysts, several of which are enhancing, ranging from 1.9 to 4.7 cm.

Gross Description:

The tumor is composed of multiple cysts and well-circumscribed fleshy yellow tan solid masses with gelatinous material.

Ancillary Tests:

CK7 and CA9 positive; CD10, AMARCA, CD117, and GATA-3 negative.

Case Images

Similar Cases


#Nephrectomy for large, cystic #Renal-cell-carcinoma. 1st pic - blue arrow shows normal-appearing kidney, black arrow shows obvious tumor visible from the outside. 2nd pic - bivalved view of "normal" looking portion of kidney. Blue arrow points to uninvolved kidney tissue and black arrow is the mass which takes up the vast majority of the kidney. 3rd pic - cut surface of cystic aspect of mass. You can see the tissue is all necrotic inside of the cystic space. Arrow shows that all of the tissue is involved by tumor and if you look closely, you can see the thin, white renal capsule running along the outer edge. It appears this mass started in the lower pole and grew outward in both directions. Unsure how long this has been growing but it is >20cm and, surprisingly, the patient is only in her 40s.


55-year-old patient with findings of a right renal mass. A radical laparoscopic nephrectomy was performed without complications.


78 y.o. male patient with 65 mm right renal mass on CT imaging. Underwent laparoscopic radical #Nephrectomy, during surgery grossly enlarged hilar lymph nodes were visible and renal pelvis was dislocated/infiltrated. Most likely #Renal-cell-carcinoma, differential with #Transitional-cell-carcinoma of the upper urinary tract. Still waiting on final pathology.


CLINICAL HISTORY: 47 Male presents with Gross Hematuria. History of kidney stones. History of smoking.
TECHNIQUE: Axial 5 mm images were obtained from the lung bases to the pubic symphysis prior to and following administration of 100 cc Optiray 350 intravenously.
Believe to be several left renal cysts. Subcentimeter probable hemorrhagic cyst in the left kidney.
Thoughts?

Conclusion

This case provides insights into the diagnosis and management of renal masses, demonstrating complex clinical histories and diverse presentations of renal pathologies.