Question:

Renal cell carcinoma is characterized most commonly by which of the following features on CT?
1. Areas of negative attenuation suggesting adipose elements.
2. Solid mass with a central stellate scar.
3. Solid or complex cystic mass with enhancement (>20 HU).
4. Renal mass that is isodense with the surrounding renal parenchyma on both non-contrast and contrast-enhanced CT.
5. Simple cystic structure without septa, calcifications, or enhancement.





Answer:

The correct answer for the question "Renal cell carcinoma is characterized most commonly by which of the following features on CT?" is:

3. Solid or complex cystic mass with enhancement (>20 HU).



Explanation
a. Areas of negative attenuation suggesting adipose elements are most consistent with angiomyolipoma.  [Table 2]

b. Oncocytomas often have a central stellate scar on CT but this is not definitive and should not be relied upon to make a diagnosis.  [Table 2]

c. This is the typical appearance of RCC on CT, although RCC can occasionally demonstrate a central stellate scar or areas of negative attenuation.  Fat associated with RCC often contains calcifications whereas angiomyolipomas hardly ever contain calcifications.  [Table 2]

d. This description is most consistent with a pseudotumor, which may represent hypertrophied columns of Bertin.  [Table 2]

e. A cystic structure without septa, calcifications, enhancement, or a solid component is virtually always benign. [Bosniak I cysts (cysts with smooth walls without septations, calcifications, or enhancing component) are considered benign and Bosniak II cysts (cysts with very thin septa, fine calcifications, or hyperattenuating cysts) have an exceptionally low likelihood of being malignant.]



From the manuscript:
Co-existing Sarcoidosis Confounds the Staging of Bilateral Renal Cell Carcinoma
Radiology Case. 2011 Jan; 5(1):18-27


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From the manuscript

Co-existing Sarcoidosis Confounds the Staging of Bilateral Renal Cell Carcinoma

Free full text article: Co-existing Sarcoidosis Confounds the Staging of Bilateral Renal Cell Carcinoma

Abstract
We present a case in which the undiagnosed condition of sarcoidosis complicated the staging of bilateral, subtype-discordant renal cell carcinoma. Initially thought to have metastatic renal cell carcinoma based on computed tomography imaging and referred for immunotherapy, a positron emission tomography/computed tomography scan demonstrated different levels of radiotracer activity in the primary site and the presumed pulmonary metastatic sites. The patient underwent bilateral partial nephrectomies and was ultimately diagnosed with stage T1 bilateral renal cell carcinoma and sarcoidosis. This case highlights the need to consider concurrent medical conditions that can lead to false positive results when evaluating for metastatic disease with imaging studies as well as the importance of evaluating the levels of radiotracer activity between different sites.






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