Review Question - QID 103529

Given the patient’s presentation (flank pain, hematuria) and history of smoking, the most likely diagnosis is renal cell carcinoma.

Renal cell carcinoma most commonly presents with a combination of hematuria, an abdominal mass, and flank discomfort, although many patients are asymptomatic and are diagnosed incidentally. Patients may also have an elevated hematocrit from elevated erythropoietin production. Risk factors for renal cell carcinoma include smoking, hypertension, obesity, acquired cystic kidney disease, and genetic factors such as von Hippel Lindau.

Higgins and Fitzgerald discuss the differential diagnosis of renal and adrenal masses. They broadly categorize renal masses as cysts, tumors, or inflammatory lesions, and suggest ultrasound and/or abdominal CT with contrast as an initial diagnostic step.

Cohen and McGovern review the diagnosis and management of renal cell carcinoma. They suggest that the standard of care has traditionally involved radical nephrectomy, although small tumors may be treated with partial nephrectomy. They also mention recent investigation into percutaneous ablative approaches, which may require further trials to determine its appropriate use in management.

Incorrect answers:
Answer 2: Polycystic kidney disease typically presents with bilateral complaints.
Answer 3: Abdominal aortic aneurysm is less likely as the complaint appears to be renal in nature.
Answer 4: The patient does not have evidence of infection.
Answer 5: Renal oncocytoma is much less common than renal cell carcinoma, and is a benign tumor.