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Last visited 12-08-2010 T1 N0 M0/ ROBSON STAGE 1/ AJCC STAGE 1 PAPILLARY RENAL CELL CARCINOMA IN 60 Y/O US, CT AND MRI RENAL
Contributed by: alex maclennan, Radiologist, Royal Alexandra Hospital, Paisley, United Kingdom.
Patient: 60 year old male
History: 3.5cm left renal mass incidentally discovered during US for possible gallstones.
Images:[small]larger

Fig. 1: US

Fig. 2: US

Fig. 3: US

Fig. 4: Non contrast CT

Fig. 5: Non contrast CT

Fig. 6: Arterial phase post contrast CT

Fig. 7: Arterial phase post contrast CT

Fig. 8: Nephrographic phase post contrast CT

Fig. 9: Nephrographic phase post contrast CT

Fig. 10: Coronal T2

Fig. 11: Coronal T2

Fig. 12: Axial T2

Fig. 13: Axial T2

Fig. 14: Arterial phase enhancement

Fig. 15: Early nephrographic phase enhancement

Fig. 16: Late nephrographic phase enhancement
Findings: Fig 1 to Fig 3 US Hypovascular cortical mass. Adjacent typical simple renal cyst. Fig 4 and Fig 5 Plain CT Hypodense simple renal cyst and isodense solid tumour Fig 6 and Fig 7 Arterial CT Hypodense non enhancing simple renal cyst. Mildly enhancing solid tumour Fig 8 and Fig 9 Nephrographic phase Hypodense non enhancing simple renal cyst. Mildly enhancing solid tumour Fig 10 to fig 13. Coronal and axial T2 show hyperintense simple renal cyst and heterogenous mildly hyperintense solid tumour Fig 14 to fig 16 Arterial, early and late nephrographic phase mild enhancement of solid tumour. Simple renal cyst not shown Fig 8 and Fig 9 Nephrographic CT Hypodense non enhancing simple renal cyst. Mildly enhancing solid tumour CT & MRI Staging is T1 N0 M0/ Robson Stage 1/ AJCC Stage 1
Diagnosis: Papillary renal cell carcinoma on percutaneous biopsy. Subsequent nephrectomy.
Discussion: Staging * The Robson modification of the Flocks and Kadesky system is uncomplicated and is used commonly in clinical practice. This system was designed to correlate stage at presentation with prognosis. The Robson staging system is as follows: o Stage I - Tumor confined within capsule of kidney o Stage II - Tumor invading perinephric fat but still contained within the Gerota fascia o Stage III - Tumor invading the renal vein or inferior vena cava (A), or regional lymph-node involvement (B), or both (C) o Stage IV - Tumor invading adjacent viscera (excluding ipsilateral adrenal) or distant metastases * The tumor, nodes, and metastases (TNM) classification is endorsed by the American Joint Committee on Cancer (AJCC). The major advantage of the TNM system is that it clearly differentiates individuals with tumor thrombi from those with local nodal disease. In the Robson system, stage III disease includes both inferior vena caval involvement (stage IIIA) and local lymph node metastases (stage IIIB). Although patients with Robson stage IIIB renal carcinoma have greatly decreased survival rates, the prognosis for patients with stage Robson IIIA renal carcinoma is not markedly different from that for patients with Robson stage I or II renal carcinoma. The TNM classification system is as follows: o Primary tumor (T) + TX - Primary tumor cannot be assessed + T0 - No evidence of primary tumor + T1 - Tumor 7 cm or smaller in greatest dimension, limited to the kidney + T2 - Tumor larger than 7 cm in greatest dimension, limited to the kidney + T3 - Tumor extends into major veins or invades adrenal gland or perinephric tissues but not beyond the Gerota fascia + T3a - Tumor invades adrenal gland or perinephric tissues but not beyond the Gerota fascia + T3b - Tumor grossly extends into the renal vein(s) or vena cava below the diaphragm + T3c - Tumor grossly extends into the renal vein(s) or vena cava above the diaphragm + T4 - Tumor invading beyond the Gerota fascia o Regional lymph nodes (N) - Laterality does not affect the N classification + NX - Regional lymph nodes cannot be assessed + N0 - No regional lymph node metastasis + N1 - Metastasis in a single regional lymph node + N2 - Metastasis in more than 1 regional lymph node o Distant metastasis (M) + MX - Distant metastasis cannot be assessed + M0 - No distant metastasis + M1 - Distant metastasis o AJCC stages + AJCC stage I - T1, N0, M0 + AJCC stage II - T2, N0, M0 + AJCC stage III - T1-2, N1, M0 or T3a-c, N0-1, M0 + AJCC stage IV - T4; or any T, N2, M0; or any T, any N, M1
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Case Number: 48796102Last Updated: 12-17-2010
Anatomy: Genitourinary (GU)   Pathology: Neoplasm
Modality: CT, MR, USAccess Level: Readable by all users

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