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DOI: 10.1148/rg.276075013
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Metastatic Renal Cell Carcinoma1

Shao-Pow Lin, MD, PhD, Andrew J. Bierhals, MD, MPH, and James S. Lewis, Jr, MD

1 From the Mallinckrodt Institute of Radiology (S.-P.L., A.J.B.) and Department of Pathology and Immunology (J.S.L.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110. Received January 30, 2007; revision requested March 13 and received April 30; accepted May 9. All authors have no financial relationships to disclose.

Figure 1A
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  		Figure 1a.  Posteroanterior (a) and lateral (b) radiographs of the chest in a 59-year-old man with flu-like symptoms demonstrate a lingular nodule approximately 3 cm in diameter (arrow).

 

Figure 1B
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  		Figure 1b.  Posteroanterior (a) and lateral (b) radiographs of the chest in a 59-year-old man with flu-like symptoms demonstrate a lingular nodule approximately 3 cm in diameter (arrow).

 

Figure 2A
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  		Figure 2a.  (a, b) PET/CT scans do not show increased FDG uptake in either the dominant pulmonary nodule (a) or in a nodule in the pancreatic tail (b). (c) PET/CT scan obtained at a lower level shows mildly increased FDG uptake within a 4-cm-diameter lesion arising from the left kidney (arrow).

 

Figure 2B
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  		Figure 2b.  (a, b) PET/CT scans do not show increased FDG uptake in either the dominant pulmonary nodule (a) or in a nodule in the pancreatic tail (b). (c) PET/CT scan obtained at a lower level shows mildly increased FDG uptake within a 4-cm-diameter lesion arising from the left kidney (arrow).

 

Figure 2C
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  		Figure 2c.  (a, b) PET/CT scans do not show increased FDG uptake in either the dominant pulmonary nodule (a) or in a nodule in the pancreatic tail (b). (c) PET/CT scan obtained at a lower level shows mildly increased FDG uptake within a 4-cm-diameter lesion arising from the left kidney (arrow).

 

Figure 3A
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  		Figure 3a.  Axial (a), coronal (b), and sagittal (c) CT images acquired during the cortical phase of contrast material enhancement show a left renal mass. The mass was well-defined, exophytic (appearing to arise from the cortex), and heterogeneously and avidly enhancing.

 

Figure 3B
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  		Figure 3b.  Axial (a), coronal (b), and sagittal (c) CT images acquired during the cortical phase of contrast material enhancement show a left renal mass. The mass was well-defined, exophytic (appearing to arise from the cortex), and heterogeneously and avidly enhancing.

 

Figure 3C
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  		Figure 3c.  Axial (a), coronal (b), and sagittal (c) CT images acquired during the cortical phase of contrast material enhancement show a left renal mass. The mass was well-defined, exophytic (appearing to arise from the cortex), and heterogeneously and avidly enhancing.

 

Figure 4A
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  		Figure 4a.  (a, b) Cortical (a) and nephrographic (b) phase CT images demonstrate the left renal lesion. (c, d) Cortical (arterial) phase images reveal the pancreatic tail nodule (c) and one of numerous pulmonary nodules (d). All lesions demonstrated the characteristic hypervascularity expected from clear cell renal cell carcinoma.

 

Figure 4B
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  		Figure 4b.  (a, b) Cortical (a) and nephrographic (b) phase CT images demonstrate the left renal lesion. (c, d) Cortical (arterial) phase images reveal the pancreatic tail nodule (c) and one of numerous pulmonary nodules (d). All lesions demonstrated the characteristic hypervascularity expected from clear cell renal cell carcinoma.

 

Figure 4C
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  		Figure 4c.  (a, b) Cortical (a) and nephrographic (b) phase CT images demonstrate the left renal lesion. (c, d) Cortical (arterial) phase images reveal the pancreatic tail nodule (c) and one of numerous pulmonary nodules (d). All lesions demonstrated the characteristic hypervascularity expected from clear cell renal cell carcinoma.

 

Figure 4D
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  		Figure 4d.  (a, b) Cortical (a) and nephrographic (b) phase CT images demonstrate the left renal lesion. (c, d) Cortical (arterial) phase images reveal the pancreatic tail nodule (c) and one of numerous pulmonary nodules (d). All lesions demonstrated the characteristic hypervascularity expected from clear cell renal cell carcinoma.

 

Figure 5
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  		Figure 5.  Gross photograph of the laparoscopically excised and bisected left kidney shows a heterogeneous, yellow-red mass in the upper pole. The mass expanded, but did not penetrate, the renal capsule.

 

Figure 6A
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  		Figure 6a.  (a) Photomicrograph (original magnification, x4; hematoxylin-eosin [H-E] stain) demonstrates sheets of clear cells with intervening vasculature and a well-circumscribed fibrous capsule (arrows). (b, c) Higher power photomicrographs (b, original magnification, x20; H-E stain) show prominent nucleoli within the tumor cells (arrows) and (c, original magnification, x40; H-E stain) hyperchromatic nuclei with multinucleated giant cells (arrows). (d) Photomicrograph (original magnification, x10; H-E stain) also reveals areas of necrosis (N) within the tumor.

 

Figure 6B
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  		Figure 6b.  (a) Photomicrograph (original magnification, x4; hematoxylin-eosin [H-E] stain) demonstrates sheets of clear cells with intervening vasculature and a well-circumscribed fibrous capsule (arrows). (b, c) Higher power photomicrographs (b, original magnification, x20; H-E stain) show prominent nucleoli within the tumor cells (arrows) and (c, original magnification, x40; H-E stain) hyperchromatic nuclei with multinucleated giant cells (arrows). (d) Photomicrograph (original magnification, x10; H-E stain) also reveals areas of necrosis (N) within the tumor.

 

Figure 6C
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  		Figure 6c.  (a) Photomicrograph (original magnification, x4; hematoxylin-eosin [H-E] stain) demonstrates sheets of clear cells with intervening vasculature and a well-circumscribed fibrous capsule (arrows). (b, c) Higher power photomicrographs (b, original magnification, x20; H-E stain) show prominent nucleoli within the tumor cells (arrows) and (c, original magnification, x40; H-E stain) hyperchromatic nuclei with multinucleated giant cells (arrows). (d) Photomicrograph (original magnification, x10; H-E stain) also reveals areas of necrosis (N) within the tumor.

 

Figure 6D
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  		Figure 6d.  (a) Photomicrograph (original magnification, x4; hematoxylin-eosin [H-E] stain) demonstrates sheets of clear cells with intervening vasculature and a well-circumscribed fibrous capsule (arrows). (b, c) Higher power photomicrographs (b, original magnification, x20; H-E stain) show prominent nucleoli within the tumor cells (arrows) and (c, original magnification, x40; H-E stain) hyperchromatic nuclei with multinucleated giant cells (arrows). (d) Photomicrograph (original magnification, x10; H-E stain) also reveals areas of necrosis (N) within the tumor.

 




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