The Open Urology & Nephrology Journal

ISSN: 1874-303X ― Volume 12, 2019

LEARNING FROM IMAGES : Vascular Extension from an Infiltrating Renal Tumor

Manoj Ketkar* , 1, Tushar J. Vachharajani2, Pramod Gupta1
1 Radiology Department, Dallas VA Medical Center, Dallas, TX, USA
2 Nephrology Section, W. G. (Bill) Hefner VA Medical Center, Salisbury, NC, USA

Article Information

Identifiers and Pagination:

Year: 2012
Volume: 5
First Page: 48
Last Page: 49
Publisher Id: TOUNJ-5-48
DOI: 10.2174/1874303X01205010048

Article History:

Received Date: 24/10/2012
Revision Received Date: 9/11/2012
Acceptance Date: 11/11/2012
Electronic publication date: 14/12/2012

Article Metrics:

CrossRef Citations:

Total Statistics:

Full-Text HTML Views: 821
Abstract HTML Views: 647
PDF Downloads: 259
ePub Downloads: 216
Total Views/Downloads: 1943

Unique Statistics:

Full-Text HTML Views: 510
Abstract HTML Views: 385
PDF Downloads: 173
ePub Downloads: 153
Total Views/Downloads: 1221
Geographical View

Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Radiology Department, Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX -75216, USA; Tel : 214 857 0185; Fax: 214 857 0173;

61-year-old male patient presented with chief complaints of recurrent right renal colic and hematuria.

A ‘stone protocol’ non contrast CT scan of the abdomen and pelvis was performed, which revealed hyperdense blood in the pelvicalyceal system (Fig. 1A) and blood clots in the bladder (not shown). A contrast enhanced CT scan of the abdomen and pelvis (Fig. 1B) revealed an infiltrative lesion involving the pelvicalyceal system of the right kidney with thrombosis of the right renal vein. Coronal T1 weighted post contrast MRI image (Fig. 2) revealed an infiltrative mass involving the right kidney with notable absence of caliectasis or hydronephrosis. Thrombus involving the right renal vein and the inferior vena cava was seen as a filling defect. The microscopic examination of the surgical specimen revealed clear cell type renal cell cancer, with tumor extending into the right renal vein and its walls. On surgical exploration, tumor invasion of the renal capsule with extension into the perinephric fat but restricted to Gerota’s fascia was seen.

Fig. (1)

(A) Non-contrast CT scan of abdomen and pelvis demonstrates slightly enlarged right kidney with mild perinephric fat stranding. Note hyperdense blood in the pelvicalyceal system consistent with hematuria (marked by white arrow). (B) Contrast enhanced CT scan of the abdomen and pelvis reveals an infiltrating mass involving the whole kidney with dilated and thrombosed right renal vein (marked by chevrons).

Fig. (2)

Contrast enhanced fat saturated T1 weighted coronal MRI image demonstrates infiltrative right renal mass with extension of the tumor thrombus into the right renal vein and the inferior vena cava (marked by notched arrow).

Neoplasms account for a significant number of infiltrative renal lesions seen on imaging studies and include a variety of uncommon tumors such as renal medullary carcinoma. However, infiltrative growth is an atypical manifestation (6% of cases) of commonly encountered renal cell carcinoma [1Pickhardt PJ, Lonergan GJ, Davis CJ Jr, Kashitani N, Wagner BJ. From the archives of the AFIP Infiltrative renal lesions: radiologic-pathologic correlation Radiographics 2000; 20(1): 215-43.].

The more common subtypes of renal cell cancer -clear cell, papillary, and chromophobe cell-typically appear as well-defined mass and may form a capsule of connective tissue and compressed atrophic renal parenchyma with tumor proliferation. Occasionally, the tumor appears ill-defined and infiltrative; this appearance is more typical of the uncommon sarcomatoid subtype but may be seen with the other subtypes as well.

Absence of caliectasis is usually a clue to the diagnosis of renal cell cancer over transitional cell cancer. However renal vein invasion can occur in both types of carcinoma.


The authors confirm that this article content has no conflict of interest.


Declared none.


[1] Pickhardt PJ, Lonergan GJ, Davis CJ Jr, Kashitani N, Wagner BJ. From the archives of the AFIP Infiltrative renal lesions: radiologic-pathologic correlation Radiographics 2000; 20(1): 215-43.
Society Affiliation


"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."

Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."

Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."

Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."

Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."

Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."

Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."

Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."

J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."

Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."

Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."

Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."

Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."

Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."

M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."

Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."

Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."

Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."

Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."

Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."

Jih Ru Hwu
(National Central University, Taiwan)

Browse Contents

Webmaster Contact:
Copyright © 2019 Bentham Open