Contributed by Peter Christakos, MD and Paul S Dickman, MD
Published on line in June 1999
The patient was a previously healthy 19 month old boy born at 38 weeks gestational age who was referred to a pediatric surgeon for evaluation of a groin mass. Workup revealed a left varicocele; ultrasound examination confirmed the varicocele and demonstrated a large left renal mass. An abdominal CT scan showed an 11 cm mass arising in the left kidney and extending into the left renal vein ( Image 01). The inferior vena cava was not involved and no lesions were seen in the contralateral kidney. Metastatic workup, including abdominal and chest CT, bone marrow biopsy and bone scan, wasl negative. A left nephrectomy was performed.
The left kidney weighed 580 grams. Approximately 80% of the kidney was replaced by a 9.5 cm well circumscribed, lobulated, white firm mass centered in the medulla (Image 02). The mass was grossly confined by the renal capsule and Gerota's fascia was intact. Tumor was present in the renal vein but not at the resection margin. The attached adrenal gland, renal artery and ureter were uninvolved by tumor. Hilar lymph nodes were not enlarged.