0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1
Renal Masses and Tumors 1285RENAL MASSES AND TUMORS
BENJAMIN N. HENDIN, MD
history & physical
■Classic triad in Renal Cell Carcinoma (RCC)
■Gross hematuria, flank pain, and palpable mass
■Triad was previously found in 10–15% of patients
■Now less common due to earlier detection with increasing incidence
of “incidentally detected” tumors
Paraneoplastic Syndromes
■Erythrocytosis
➣up to 3–10% of patients
➣consequence of increased erythropoietin production
■Stauffer’s syndrome:
➣reversible hepatic dysfunction associated with non-metastatic
RCC
➣Abnormalities include elevated Alk Phos and Bili, hypoalbumine-
mia, prolonged PTT, hypergammaglobulinemia. Fever, fatigue,
weight loss occur in association
➣Resolves following nephrectomy
■Hypertension
■Hypercalcemia
tests
Blood Tests
■CBC to detect anemia, in late-stage RCC
■Serum Creatinine to assess global renal function
■Hepatocellular enzymes – elevated levels with either Stauffer’s syn-
drome or hepatic metastases.
■Alkaline Phosphatase – to detect bone metastases
Radiographic
■Ultrasound
■CT Scan with and without IV contrast, renal imaging protocol
■MRI with Gadolinium
■CXR to evaluate for metastases.differential diagnosis
Key is to Differentiate Cystic vs. Solid
■CT or MRI essential to evaluate indeterminate lesions
■Ultrasound may aid in diagnosis