PMC9691311_01
Axial CT scan showing posterior upper pole left enhancing renal mass concerning for malignancy.
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The patient presented with a CT scan of the abdomen and pelvis with and without intravenous contrast that demonstrated the tumor and, per the radiology report, no evidence of vascular invasion on portal venous phase imaging (Figure 1).
Coronal CT arterial phase showing two left renal arteries and early venous filling of contrast in renal vein and vena cava concerning for AVM in addition to multiple collateral vessels.
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Subsequent findings of early venous filling and multiple engorged collateral vessels with arterialized blood flow raised concern for the presence of a cortical AVM (Figure 2).
Selective angiography of main renal artery showing early filling of enlarged left renal vein with arterialized flow within the renal vein.
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The patient subsequently underwent a selective arterial angiography with embolization by interventional radiology (Figures 3 and 4) followed by an open radical nephrectomy within 24 hours.
Status post selective coil embolization of the main renal artery at the level of the AVM with absence of early venous filling.
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The patient subsequently underwent a selective arterial angiography with embolization by interventional radiology (Figures 3 and 4) followed by an open radical nephrectomy within 24 hours.
Gross pathology showing left kidney with upper pole renal mass, perinephric fat, and proximal ureter en bloc.
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Final pathology revealed clear-cell renal-cell carcinoma grade 2 with renal vein tumor thrombus, AVM within renal cortex, and tumor invasion of the renal sinus (pT3a) with negative surgical margins (Figures 5 and 6).
Gross pathology showing coil within the renal artery and tumor thrombus in the main renal vein.
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Final pathology revealed clear-cell renal-cell carcinoma grade 2 with renal vein tumor thrombus, AVM within renal cortex, and tumor invasion of the renal sinus (pT3a) with negative surgical margins (Figures 5 and 6).