Presentation
Anemia
Patient Data
There is a large heterogenous solid mass arising from the upper pole of the left kidney with shows heterogenous post-contrast enhancement with areas of central necrosis. No fat content or calcification.
The tumor extends into the peri-renal fascia pushing on the capsule and local structures (spleen, left adrenal and stomach) without direct CT evident invasion.
Tumor does invade the left renal vein with tumor thrombus extending to the origin at the IVC but not into the IVC.
The venous invasion results in a number of local collateral vessels and left gonadal vein causing a left sided varicocele.
Although borderline in size there are some local abnormal appearing nodes.
Simple right renal cyst and benign right adrenal adenoma. No metastatic disease.
Case Discussion
This case illustrates a T3a renal tumor extending into the left renal vein. If tumor extended into the IVC it would be T3b and if it extended into the IVC above the diaphragm it would be T3c. T3a tumor classification also includes tumors that invade peri-renal fascia and renal sinus fat 1.
It also demonstrated normal venous anatomy by obstructing the left gonadal vein as it drain drains directly into the left renal vein whereas the right gonadal vein usually, as in this case, drains into the IVC. This explains the ultrasound teaching that the kidneys should be imaged especially if you detect a unilateral left varicocele on testicular ultrasound.
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