Case Study Sonographic features of Renal Cell Carcinoma and importance of operator dependency in ultrasound

ABSTRACT: Background: Renal cell carcinoma (RCC) is a lifethreating condition, it involves not only the oncological outcome but also increased chances of progression into chronic kidney disease because of the large amount of nephron tissue loss. Ultrasound is the first-line modality to suggest the diagnosis of renal cell carcinoma while following more specific sonographic criteria. Indicating the early diagnosis, the better the prognosis of renal cell carcinoma. Ultrasound is therefore recognized to have a fundamental role in the treatment of renal cell carcinoma. OBJECTIVE: To determine the operator dependency of ultrasound modality in the evaluation of renal cell carcinoma. Case presentation: A 40-year-aged woman presented to the University of Lahore Ultrasound Clinic, Green Town with complaints of left flank pain radiating to back (from 6 months) and hematuria (from 2 months). She had her previous ultrasound reports done for the same reason in which hydronephrosis and renal stones were mentioned. On physical examination, the abdomen was soft, non-tender, overlying skin was normal in appearance and mobile over it. Gut sounds were also audible. Ultrasound examination revealed a superior pole left heterogeneous soft tissue renal mass 3.8×4.3cm in size, no vascularity on color and power Doppler. No hydronephrosis or calculi were seen. When this mass was proved as RCC by different scanning modalities like CT, the patient was sent for immediate nephrectomy. The specimen was sent for histopathological examination which excluded clear cell renal cell carcinoma WHO grade III. Conclusions: RCC could be reliably diagnosed with the help of ultrasonography. But the diagnosis depends upon the operator knowledge and ultrasound scanning techniques. KEYWORDS: Renal cell carcinoma; ultrasonography; ultra sonographer; color Doppler; power Doppler; spectral Doppler; computerized tomography