Slideshow
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Slide
Computed tomography scan demonstrating a large left renal mass that has invaded surrounding structures.
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Slide
Computed tomography scan demonstrating a large left renal mass that has invaded surrounding structures.
A 67-year-old man was found to have a 10 cm left renal mass invading his spleen, the tail of his pancreas, colon, and abdominal wall musculature. Concomitant lung metastases are also identified. Patient’s performance status has declined over the past several months. Your team is planning a renal mass biopsy to rule out sarcomatoid features prior to recommending cytoreductive nephrectomy.
Submit your diagnosis to see full explanation.
This case was prepared by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia.
References
- Abel EJ, Heckman JE, Hinshaw L, et al. Multi-quadrant biopsy technique improves diagnostic ability in large heterogeneous renal masses. J Urol 2015;194:886-891.
- Abel EJ, Carrasco A, Culp SH, et al. Limitations of preoperative biopsy in patients with metastatic renal cell carcinoma: comparison to surgical pathology in 405 cases. BJU Int 2012;110:1742-1746.
Answer: D
Renal biopsy for patients with T2 or greater masses is extremely safe.1 Sensitivity for identification of sarcomatoid features was recently shown to be greater than 85% when quadrant biopsy strategy was employed. This is a marked improvement for detecting sarcomatoid features over using standard biopsy techniques (only 9% to 25% sensitivity).1,2
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