İzmir Üniversitesi Tıp Dergisi İzm Üniv Tıp Derg 2014; 2:32-34 Izmir University Medical Journal Izm Univ Med J 2014; 2:32-34

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Giant kidney tumor: Radiological case report

Dev böbrek tümörü: Radyolojik olgu sunumu

Abstract A 74-year-old man admitted to hospital with abdominal pain and gastrointestinal symptoms. Physical examination was normal except for a large, solid mass lacalized in the right upper quadrant and extending to right lower quadrant. Computed tomography exam revealed a giant kidney tumor; filling right half of the abdominal cavity. In this present case report, we described how the abdominal structures were affected due to this retroperitoneal giant kidney mass. Key words: Abdominal mass, anatomy, kidney tumor. Özet 74 yaşında bir erkek, karın ağrısı ve gastrointestinal sistem belirtileri ile hastaneye başvurdu. Fizik muayene, sağ üst kadranda yerleşmiş ve sağ alt kadrana doğru uzanan büyük, solid kitle dışında normaldi. Bilgisayarlı tomografide, karın boşluğunun sağ yarısını dolduran ve abdominal dev bir böbrek tümörü izlendi. Bu olgu sunumunda, retroperitoneal dev böbrek tümörünün abdominal yapıları nasıl etkilediğini tanımladık. Anahtar kelimeler: Abdominal kitle, anatomi, böbrek tümörü.

Introduction

An abdominal mass is a swelling which

localized in abdomen, and usually detected

during routine physical examination. In

general, abdominal masses develop slowly.

Therefore, patients may have no symptoms

until the mass enlarges and pressurizes on

neighboring anatomical structures (1).

Depending on its’ size, an abdominal mass

may cause change in the shape of the

abdomen (2). Symptoms of abdominal masses

may include abdominal tenderness, pain and

functional disturbances.

The abdomen is divided into four quadrants;

right upper, right lower, left upper and left

lower. Right and left kidneys are located in the

right upper and left upper quadrants,

respectively. Therefore, an abdominal mass

may occur originating from kidney cancer (3).

Papillary renal cell carcinoma (PRCC) is the

second most common histologic type of

kidney cancer (4).

We aimed to present a giant abdominal mass,

originated from the right kidney (PRCC), which

pressurizes on the neighboring anatomical

structures and further changes the anatomical

localization of the abdominal contents.

Case Report

A 74-year-old man presented with a 3-weeks

history of abdominal pain and gastrointestinal

symptoms. In physical examination, a large-

solid mass extending to the right lower

quadrant was detected in the right upper

quadrant (Figure 1).

Gökşin Nilüfer Yonguç1,

Savaş Şahinli2, Esat Adıgüzel

3, Mehmet Bülent Özdemir

3, Şahika Pınar Akyer

3

1Izmir University, Faculty of Medicine, Department of Anatomy, Denizli, Turkey

2Denizli State Hospital, Department of Urology, Denizli, Turkey

3Pamukkale University, Faculty of Medicine, Department of Anatomy, Denizli, Turkey

Sorumlu Yazar/Corresponding Author: Gökşin Nilüfer Yonguç Izmir University, Faculty of Medicine, Department of Anatomy, Denizli, Turkey e-posta: nyonguc@gmail.com

Geliş Tarihi/Received: 15.04.2014 - Kabul Tarihi/Accepted: 07.05.2014

Yonguç ve ark İzmir Üniversitesi Tıp Dergisi Yonguc et al Izmir University Medical Journal

İzm Ünv Tıp Derg 2014; 2:32-34 Izm Unıv Med J 2014; 2:32-34 33

Figure 1 : Picture of the anterior abdominal wall

was taken during physical examination before

the operation. Abdominal swelling (asymmetry)

was seen on the anterior abdominal wall in the

right upper quadrant.

The patient underwent computed tomography

(CT) exam. CT showed a mass in size 235 x 180

x195 mm, originating from the right kidney;

filling right half of the abdominal cavity. The

upper pole of the mass was extending to just

inferior of the diaphragm (Figure 2).

Figure 2: Image of axial section. 1. Aorta 2. Left

lung 3. Spleen 4. Stomach 5. Hiatal hernia 6. Cor

7. Liver 8. Mass 9. Inferior vena cava 10. Right

lung 11. Body of vertebra 12. Rib

The lower pole of the mass was located in

right iliac fossa (Figure 5). The right lobe of the

liver, gallbladder and loops of the small

intestine were dislocated to the left and

pressured to anterior abdominal wall (Figure

2,3,4). Hiatal hernia was detected (Figure 2).

The caput of the pancreas was dislocated to

the left side (Figure 3). The ascending colon

and the inferior vena cava were compressed

by the mass (Figure 4,5). The patient was

treated surgically, right radical nephrectomy

was performed. Histopathological

examination revealed papillary renal cell

carcinoma.

Figure 3: Image of axial section. 1. Left kidney 2.

Spleen 3. Pancreas 4. Left colic flexure 5. Stomach

6. Liver 7. Right kidney 8. Mass 9. Aorta 10. Body

of vertebra 11. Rib

Figure 4: Image of axial section. 1. Aorta 2. Left

kidney 3. Descending colon 4. Small intestine 5.

Pyloric part of the stomach 6. Duodenum 7. Liver

8. Gall bladder 9. Mass 10. Compressed inferior

vena cava 11. Body of vertebra

Yonguç ve ark İzmir Üniversitesi Tıp Dergisi Yonguc et al Izmir University Medical Journal

İzm Ünv Tıp Derg 2014; 2:32-34 Izm Unıv Med J 2014; 2:32-34 34

Figure 5: Image of axial section. 1. Psoas muscle

2. Two common iliac arteries 3. Small intestine 4.

Transverse colon 5. Mass 6. Compressed

ascending colon 7. Inferior vena cava 8. Ilium 9.

Body of vertebra

Discussion

Kidneys are retroperitoneally located lateral to

the vertebral coloumn. They are bean-shaped

and lie in the extraperitoneal connective

tissue of the posterior abdominal region (5).

Our case presented a giant abdominal mass,

caused by PRCC of kidney, with uncommon

clinical condition of filling the right half of the

abdominal cavity; pressurizing and dislocating

abdominal structures.

Papillary renal cell carcinoma (PRCC) is the

second most common histopathologic type of

kidney cancer, and exhibits a large range of

morphologic variants (4,6). Although, PRCC is

one of the common type of kidney cancer,

there is no any case of giant PRCC that leads

dislocation of abdominal structures in the

literature. On the other hand, Taneja and

Singh (7) report a female case of giant renal

angiomyolipoma of the left kidney displacing

the rest of the abdominal contents toward the

other side of the midline. In this

aforementioned case, mass is originited from

left kidney and filling the left abdominal

cavity, hence the abdominal content was

remowed to the right abdominal cavity.

Similarly, Akbulut et al. (8) report a female

case of giant left renal oncocytoma. However,

in these studies, dislocation of anatomical

contents are not explained.

As a conclusion, most of abdominal masses

are determined incidentally during routine

physical examinations. During physical

examination, the clinician must determine the

location of the mass, and describe well its

location (in terms of quadrants). Also clinicians

should be aware of how giant masses can

dislocate the anatomical structures while

performing manipulations.

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