Abstract: SA-PO0234
A Unique Case of Renal Cell Carcinoma Mimicking Renal Infarction
Session Information
- Onconephrology: MGRS, HSCT, Electrolytes, RCC, and More
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Haque, Fatima, The Ohio State University, Columbus, Ohio, United States
- Bhatt, Udayan Y., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Thakkar, Asish, Veterans Health Administration, Columbus, Ohio, United States
Introduction
Renal cell carcinoma (RCC) is a very common cancer. It typically presents with flank or abdominal pain, hematuria, or a palpable mass. More advanced disease can present with all three findings. Despite this, incidental finding of RCC on imaging is quite common. On imaging, typical findings include a renal mass or an atypical cyst. We describe a rare presentation of RCC as a wedge-shaped defect that presented as a likely renal infarct.
Case Description
A 69yo male presented to his primary care physician with flank pain. He had a history of controlled hypertension on low dose ACEI but no history of tobacco use, chronic kidney disease, or occupational exposure. Because of his pain, the patient underwent CT imaging that showed a wedge-shaped defect that was likely consistent with a renal infarction. The patient subsequently underwent vascular and cardiac imaging. No source of emboli was found. The patient underwent an MR urogram that demonstrated a perfusion abnormality with hypoperfusion that was felt to be consistent with a renal infarction. However, the patient experienced progressive pain over the course of months. Repeat imaging showed no growth in the wedge-shaped defect. Because of no resolution of the defect over months and continued pain, the patient underwent a transcutaneous renal biopsy of that area. The biopsy did not reveal malignancy. The patient continued to have pain. Repeat imaging showed new onset hydronephrosis. Because of this, a cystoscopy revealed friable masses in the ureter. This led to a guided biopsy that demonstrated poorly differentiated RCC. The patient underwent a nephrectomy, confirming the diagnosis. Unfortunately, the patient began manifesting evidence of metastatic disease and progressive symptoms of malignancy. Because of this the patient elected to pursue hospice care.
Discussion
RCC is the sixth most common malignancy. When diagnosed early with only local disease, it is potentially curable with resection. However, once metastases occur, treatment consists of surgery, radiation, and/or chemotherapy/immunotherapy. In this unique presentation, the patient did not have growth or changes to the presumed area of infarction but began manifesting evidence of ureteral disease. Based on the trajectory of this case, lack of resolution in an area of presumed renal infarction should lead to an evaluation potentially including cystoscopy and guided biopsy.