“ Most common renal malignancy. Often incidental, more common in men and peaks from ages 50-70 years . In total, 70% are clear cell adenocar...
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Most common renal malignancy. Often incidental, more common in men and peaks from ages 50-70 years. In total, 70% are clear cell adenocarcinomas. Consider any solid mass in the kidney as RCC until proven otherwise. RCC metastasises to lung, liver, bone, adrenals and pancreas.
US
• Heterogeneous lobulated lesion, either hypo-reflective or mildly hyper-reflective.
• Cystic areas are haemorrhage/necrosis.
• Peripheral vascularity on colour Doppler.
• Check the inferior vena cava (IVC) and renal veins with Doppler—may show low flow or thrombus in lumen.
CT
• Look for a mass with heterogeneous enhancement (triple-phase CT).
• May appear cystic (i.e. Bosniak 3/4).
• A poorly enhancing solid mass could represent a papillary RCC (these are hypovascular).
• Areas of low density are likely to represent haemorrhage or necrosis.
• Nodules in perinephric fat suggest tumour spread (fat stranding does not).
• Invasion of renal veins or IVC indicates T3 disease—look for an enhancing filling defect with expansion of the vessel (‘bland’ thrombus does not enhance).
• Extension beyond Gerota fascia indicates T4 disease.
• Metastases may be hypervascular soft tissue lesions/destructive bone lesions.
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