Clear cell renal cell carcinoma located in sinus renalis confused with renal pelvis mass in image

摘要

A 58-year-old Chinese woman presented with a mass in right renal pelvis incidentally detected by ultrasonography (Fig. 1A). No positive signs were found by physical examination, and urinalysis was also normal. Enhanced computed tomography (CT) of abdomen displayed a polycystic mass of 2.3 cm × 2.1 cm × 1.6 cm in right sinus renalis (Fig. 1B and C) with ample blood perfusion in arterial phase (Fig. 1B) and less perfusion in venous phase (Fig. 1C). CT images of excretory phase were not obtained. A retrograde pyelography was then performed and did not find a defined mass image in the pelvis (Fig. 1D). Urinary cytology was negative from three urine samples including one pelvic urine sample. Our preliminary diagnosis was renal cell carcinoma (RCC) in right renal pelvis. We decided to perform laparoscopic nephroureterectomy for radical incision of the tumor. During operation we ligated the ureter first to prevent the dissemination of transitional cell carcinoma. Incision of the removed kidney displayed a polycystic tumor with a complete psuedocapsule near the fat tissue in renal pelvis (Fig. 1E and F). Intraoperative findings supported the diagnosis of RCC. Pathological diagnosis was clear cell RCC (Fig. 1G), which invaded renal sinus (peripelvic) fat but not beyond the Gerota's fascia.