renal cell carcinoma RCC case

1. Case presentation
Dr Nawaz Ali

2. History
• A 65 year old female patient ,resident of Tangkhul, Manipur
presented with chief complaint of:
• Passage of blood mixed with urine for last 1 month

3. History of present illnesses:
• The patient has history of 2 episodes of hematuria which was
associated with mild left flank pain, mixed with urine, not associated
with the passage of any blood clots.
• Her flank pain was mild in intensity, dull aching in character, localised
to left flank region ,with no any referral or radiation and gets relieved
by taking medications.

4. History of present illness
• No history of LUTS, burning micturation and fever
• No history of backache /jaundice / hemoptysis / cough / Anorexia /
weight loss
• No history of trauma /prior instrumentation
• No history of taking medications for hematuria locally or intake of
antiplatelets / anticoagulants or any bleeding disorders.

5. Past history:
• No history of DM / TB / Hypertension
• No history of similar illness in the past
• H/o Appendicectomy (1999)
• H/o Hysterectomy (2001)

6. Personal history:
• She is non vegetarian by diet
• She is a regular pan-chewer
• Non alcoholic/ non smoker and her bowel/ bladder habits are normal.
• Family History : not significant.

7. Examinations:

8. General physical examination:
• The patient is conscious ,cooperative and well oriented to time ,place
and person
• ECOG performance status: 1
• Pallor present
• JVP not raised/ pedal edema absent
• No icterus/ cyanosis/ clubbing/ lymphadenopathy
• Patient is thin built with BMI : 18.2
• PR:78/m ,BP:126/76mmHg, RR: 12/m, Temp: 98.4 F

9. • Respiratory system examination:
• Trachea central with b/l symmetrical chest expansion with no added
sounds
• CVS/CNS examination: WNL

10. Abdomen examination:
• Inspection: scaphoid abdomen with all quadrants moving equally with
respiration. Central inverted umbilicus. Two scars were present (linear
scar size of around 4cm along the Macburney point, another
transverse scar present lower abdomen, size of around 5cm) No
dilated veins / sinuses.
• Palpation :no organomegaly/ abdominal lump palpable
• Percussion: tympanic and liver span normal
• Auscultation: normal bowel sounds

11. • Spine: no significant finding
• DRE: no mass palpable ,rectum empty

12. Routine blood investigations:
Hb – 10.2 g/dl
TLC – 5700 /mm3
DLC – 66/30/03/01/00
Na/K/Ca – 140.2/4.64/5.41 mmol /L
Urea/ Creatinine(mg/dl)– 29/0.9
RBS – 108 mg/dl
Total Bilirubin – 0.5 mg/dl
SGOT/PT – 44/32 mg/dl
S. ALP – 172 U/L
PT/INR – 14/1.1

13. • Urine R/M
• Pus cell – occasional
• RBC – plenty /hpf
• Urine C/S: Sterile

14. Imaging

15. USG report:

16. CT Urogram

17. CT Urogram:

18. CT Urogram

19. CT Urogram Report:

20. Postoperative specimen:
• Pat underwent left radical nephrectomy.

21. Thank you