Renal cell carcinoma

Hidden 3

Step 1: View clinicals

A 66-year-old woman presents with painless hematuria for one week. There is no history of blood clots in the urine, dysuria, frequency, urgency, bipedal edema, facial puffiness, abdominal distension, palpitations, or recent excessive physical activity. Her medical history is positive for hypertension for ten years, which is well controlled on Enalapril alone. There is no family history of malignancy, coagulation disorders, or renal disease. Urinalysis demonstrates a field full of red blood cells, with no cell casts or pus cells. Urine cytology reveals no malignant cells. A complete blood count and coagulation profile are within normal parameters.

Step 2: Order all relevant investigations

Contrast CT Abdomen + Pelvis

There is a 10.6 x 6.4 cm enhancing solitary mass in the upper pole of the right kidney. The renal pelvis, perirenal fat, right adrenal gland, and inferior vena cava appear normal, while no locoregional lymphadenopathy is seen. The left kidney, ureters, and urinary bladder appear normal.

Chest X-Ray

The chest X-ray appears normal.

Percutaneous renal biopsy

Analysis of the biopsy specimen reveals cohesive clusters of malignant cells with clear cytoplasm separated by a branching network of vascular tissue. The appearance is suggestive of clear cell renal carcinoma.

Skeletal scintigraphy

There is no evidence of bone metastases.

Step 3: Select appropriate management

Radical nephrectomy
Adjuvant chemotherapy
Arterial embolization

Score: ★★☆