Research Day
INCIDENTAL DIAGNOSIS OF AN ASYMPTOMATIC PAPILLARY RENAL CELL CARCINOMA
Document Type
Abstract
Date
2021
Abstract
Background: The United States Preventive Services Task Force has recommended lung cancer screening in high-risk adults with low-dose computed tomography (LDCT) since 2013. This screening protocol has reduced lung cancer mortality by 20%, but incidental findings are common, and the cost of investigating these findings, which are often benign, is significant. However, as many as 15% of patients undergoing LDCT screening have a clinically significant incidental finding, most commonly cardiovascular or pulmonary disease, or extrapulmonary neoplasm.
Case History: A 70-year-old man with a 45-pack-year smoking history underwent LDCT for lung cancer screening, during which an incidental indeterminate right renal mass was discovered. The patient had no complaints of hematuria or flank pain. He subsequently underwent renal ultrasound, which showed an exophytic, solid-appearing, anterior upper pole mass of the right kidney. Right partial nephrectomy was performed excising a 5.6cm mass. Pathology confirmed the diagnosis of papillary renal cell carcinoma, a cancer with a ten-year survival rate as low as 41% if discovered after invasion of the urinary collecting system. This patient's tumor was confined to the renal capsule without renal vein or collecting system invasion. Follow-up abdominal CT scans over the subsequent 5 years have shown no evidence of metastasis or recurrence.
Conclusion: Early detection of "incidentalomas" can enable detection and treatment of carcinoma before symptomatic presentation, improving outcomes for patients. However, not all incidental findings are worthy of follow-up. Physicians are advised to carefully consider screening procedures to ensure that the benefits outweigh the risks for their patient.