Renal medullary carcinoma: beware of diagnosing a urinary tract infection in a young sickle cell patient

Abstract

An 18-year-old Afro-Caribbean woman presented to her GP with a 2-week history of intermittent abdominal pain and was found to have microscopic haematuria. Her medical history was notable only for sickle cell trait. Examination was unremarkable and she was diagnosed as having a urinary tract infection. She re-presented with similar bouts of abdominal pain 2 months later and on clinical examination a large left supraclavicular lymph node was present. Excision biopsy of the lymph node raised the possibility of a metastatic renal tumour. Subsequent computed tomography imaging demonstrated a large 6 × 7 cm mass involving the upper part of the right kidney with extensive paracaval lymphadenopathy and encasement of the renal artery with metastasis to the liver, lung and ovaries (Figure 1). A laparotomy was carried out to make a definitive diagnosis before the start of chemotherapy. The tumour was found at multiple sites and was invading the inferior vena cava extending to the hepatic veins. Excision biopsy of the ovarian mass was performed and histology confirmed a metastatic renal medullary carcinoma. Following a trial of chemotherapy the patient died 4 weeks later.