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Findings: Multiple contiguous unenhanced axial images were obtained through the abdomen. There is evidence of multiple oval soft tissue densities in the left retroperitoneum in the vicinity of the left renal fossa. The patient has undergone left nephrectomy. Surgical clips are identified in the left renal fossa. The right kidney appears unremarkable.
A 20 gauge Chiba needle was directed into one of the left retroperitoneal soft tissue masses. Sample was sent for analysis.
Diagnosis: Metastatic renal cell carcinoma to para-aortic node.
Differential Diagnosis: Differential diagnosis includes a complicated cyst, an angiomyolipoma. In addition one may see inhomogeneity secondary to hemorrhage, necrosis, or cystic degeneration. MRI is the best modality to assess either Stage III or Stage IV disease. One may see a low to medium signal intensity on the T1 weighted images. Hyperintense areas are usually due to hemorrhage. In addition on the T2 weighted images one may see heterogenous signal intensity. On angiogram, they are typically hypervascular (95%) of the time with puddling of contrast and occasional AV shunting. In addition, one may see enlarged tapering poorly feeding vessels.
Discussion: Renal cell carcinoma usually occurs in the 6th or 7th decade with a peak age of 55 years. It may occur in children. Male to female ratio is 2 to 3 to 1. Pathologically arises from the proximal tubular cells and 30% are found incidentally with imaging. Multiple renal cell carcinomas are commonly found in Von Hippel-Lindau. There are multiple stages to the classification of renal cell carcinoma.
Staging:
The prognosis is a 10 year survival rate for Stage I and II disease of (60 to 70%), for Stage III disease, it is (40%), and for Stage IV disease it is (0%).
References:
Dahnert, W: Radiology Review Manual, Second Edition,
Williams & Wilkins, 1993.
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