PMC3785371_01
CT images of the abdomen with contrast medium shows a heterogeneously enhancing exophytic mass projecting posteriorly from the upper pole of the right kidney.
ccrep-2-2009-001f1.jpg
PMC3785371_01_ccrep-2-2009-001f1.jpg
f1-ccrep-2-2009-001
Therefore he underwent an abdominal CT with contrast medium which incidentally showed a heterogeneously enhancing exophytic mass projecting posteriorly from the upper pole of the right kidney (Fig. 1).
MR images with contrast showed a 4-cm complex enhancing mass at the projecting from the posterolateral aspect of the upper pole (indicating arrows) of the right kidney; the complex mass demonstrated heterogeneous signal internally including a focal hypointense signal on precontrastT1 weighted sequences; and these areas also showed hyperintense signal postcontrast suggesting hemorrhage, necrosis, and scar formation components.
ccrep-2-2009-001f2.jpg
PMC3785371_01_ccrep-2-2009-001f2.jpg
f2-ccrep-2-2009-001
Three weeks later, an MRI with contrast medium showed a 4-cm complex enhancing mass projecting from the posterolateral aspect of the upper pole of the right kidney; the complex mass demonstrated heterogeneous signal internally including a focal hyperintense signal on precontrastT1 weighted sequences; and these areas also showed hyperintense signal postcontrast suggesting hemorrhage, necroses, and scar formation (Fig. 2).
F-18 FDG PET images.. I. Maximal intensity image shows a photon-deficient area in the upper pole of the right kidney as indicated by an open-arrowhead.. II. Coronary slices show a photon-deficient area in the upper pole posterior-laterally as indicated by open-arrowheads.. III. Transverse slices show a photon-deficient area in the upper pole posterior-laterally as indicated by opnen-arrowheads.
ccrep-2-2009-001f3.jpg
PMC3785371_01_ccrep-2-2009-001f3.jpg
f3-ccrep-2-2009-001
F-18 FDG PET images showed two small areas of faintly increased activity in the larynx (not shown); in addition, a photon-deficient area was also seen in the upper border of the right kidney (Fig. 3).
Tumor is composed of clear cells.
ccrep-2-2009-001f4a.jpg
PMC3785371_01_ccrep-2-2009-001f4a.jpg
f4A-ccrep-2-2009-001
Subsequently, a right nephrectomy using hand-assisted laparoscopic nephrectomy directed laparocopy with biopsy and direct laryngoscopy with biopsy were same day resulted in clear renal cell carcinoma with focal papillary features (Figs. 4A and B) an focal capsular invasion approxmimal one-two cell layers short of true transcapular involvement us present.