A 10-year-old female was referred to our department with complaints of an asymptomatic left flank mass. History was unremarkable with no haematuria, flank pain, fever or episodes of increased urine output associated with pain. There was no history suggestive of hereditary syndrome in the child or family.
On examination the child showed normal developmental milestones with no genito-urinary anomalies and organ asymmetry. There was a large mass palpable in the left flank with the superior border going below the costal margin, medial border towards the umbilicus and inferior border about 9 cm below the costal margin.
Ultrasound abdomen was in concurrence with the examination finding showing a large renal mass about 10 × 9 cm in size.
The patient was then taken up for a contrast-enhanced computed tomography which showed a large circumscribed heterogeneously enhancing solid mass lesion measuring 11.0 × 11 × 9 cm in the upper and midpole of the left kidney with few tiny calcific foci (Fig. 1).
Anteriorly the lesion was compressing the distal transverse colon and abutting the abdominal wall. Dilated gonadal vein was present on the left side. There was no evidence of tumour extension in the renal vessels. There was no lymphadenopathy.
CT chest was normal with no evidence of any metastatic lesions.
In view of the age of the patient, Wilms’ tumour was kept as a differential diagnosis. Wilms’ tumour of this size would have needed neo-adjuvant chemotherapy. Therefore, FNAC was done which was suggestive of clear cell RCC.
The patient was taken up for left radical nephrectomy with regional lymphadenectomy. Intra-op the renal capsule was intact with no renal vein or IVC thrombus. There was no regional lymphadenopathy (Fig. 2).
Histopathological analysis revealed a 10 × 10 × 5.5 cm renal clear cell carcinoma in the upper and midpole of the kidney (Fig. 3). Ureteric and pelvicalyceal system margins were free of tumour with no lymphovascular or perineural invasion. There was, however, sarcomatoid differentiation of the tumour (Fig. 4).
Ten lymph nodes were sampled, none of which showed involvement with tumour.
The pathological staging of the tumour was T2aN0M0 according to AJCC 8th edition.
Post-op the patient did well. Drain and catheter were removed on post-op days 2 and 4, and the patient was discharged on post-op day 6.
On follow-up after 2 months, the patient was well with a normal kidney function and no abnormality on abdominal ultrasound.