Adenocarcinoma, Renal cell carcinoma

Adenocarcinoma or Renal cell carcinoma is derived from the cells which should have made the renal tubules and comprises about 80% of all renal tumours. Because of Grawitz's theory of adrenal origin, the erroneous name of Hypernephroma survives in common usage. It occurs in late middle age and is unusual before 40, but can occur at any age above 20. The condition is roughly twice as common in men. Clinical presentation may include flank pain, haematuria and a mass. The blood picture varies. About a quarter of cases may have anaemia, but up to 5% may have polycythaemia. The erythrocyte sedimentation rate is often elevated. Metastasis is local and blood-borne remote. It is one of the causes of expanding lytic bone metastases. The incidence is of up to 20% microscopic renal vein invasion in operative specimens.

Radiological demonstration is firstly to demonstrate the lesion. The tumour is often diagnosed during Ultrasound investigation of haematuria or the incidental displacement of calyces in an IV Urogram. Typically the kidney is enlarged with separation of the calyces. Some form of sectional imaging is needed to assess the location, size and extent of the lesion. Vascular invasion into the renal veins and inferior vena cava is fairly common. Lymph nodes are also involved. Ultrasound gives a good indication of extent, but is often supplemented with CT or MRI. While assessing the images, it is worth remembering the possibility of two tumours, which is roughly 3%, but some retrospective series give results indicating this incidence to be much higher.