Fig. 4.

A 70-year-old women was evaluated for flank pain and hematuria. A screening ultrasound showed a hypervascular and hyperechoic renal mass of the right kidney. A 3-phase CT scan showed a tumor originating from the upper pole of the right kidney which measured approximately 124 mm×77 mm×95 mm. During the non-contrast phase the tumor showed a heterogeneous aspect with mixed attenuation consistent with parts of central tumor necrosis. (A) Strong enhancement of the solid parts is seen in the corticomedullary phase. (B) The lower pole of the right kidney was unaffected. (C) In the nephrogenic phase, a clear washout effect is seen. (D) Coronal (E) and saggital (F) reconstructions in the nephrogenic phase confirm the tumor to be located mainly in the upper pole with growth toward the liver and centrally towards the renal hilum. Histopathology after open radical nephrectomy confirmed the diagnosis of a 120 mm large, Furhman grade 3, clear cell renal cell carcinoma.