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Case 99

Hypernephroma of the Kidney

Imad Azouka

Clinical History:

A middle aged male patient complaining of pain in the right flank with general tiredness and ill health for the last one year.

Findings

Ultrasound Scan Findings:

Large solid well encapsulated mass is seen in the upper pole of the right Kidney. The lesion displays heterogeneous texture with echogenicity similar to the normal renal parenchyma.

CT scan Findings:

There is evidence of a large solid mass measuring 5.8 x 5.2cm seen in the posterior aspect of the upper portion of the right kidney with higher attenuation that the normal renal parenchyma. The mass appears heterogeneous showing thick and irregular rim. Tiny faint calcification is also noted in the mass. The mass is causing distortion of the renal parenchyma, collecting system and sinus fat.

After bolus i.v contrast, a central enhancement with perceptible thick irregular rim was seen. Note is made of transient increased enhancement with unsharp parenchyma interface and focal necrotic changes. There is evidence of mass extension to the perinephric space in the same side with focal thickening of Gerota's fascia and an apparent dilated I.V.C.

Diagnosis

Hypernephroma (Renal adenocarcinoma)

Discussion

Hypernephroma (Renal adenocarcinoma) is the most common primary malignant tumour in adults, 80% of all malignant renal tumours. It usually affects people between 40 and 60 years of age. Male to female ratio is 2:1. Aetiology is unknown. 20-50% of hypernephromas are associated with Von Hippel-Lindau disease. These tumours account for 2 to 3 % of all neoplasms and mostly spread by direct extension into the renal pelvis and the blood stream, thus early spread to the lungs is expected. The tumor involves the soft tissues of the renal sinus. Secondary deposits to the bones, liver and opposite kidney are commonly seen. CT scan is the preferred imaging modality for patients suspected of having renal neoplasia.

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