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Early-detection demo · Kidney · Renal-cell carcinoma

Bosniak IV cystic mass in a VHL-surveillance patient

Right renal Bosniak IV cystic mass · 2.8 cm · with avid arterial enhancement of mural nodule.

Patient: Tomás · 38 · VHL syndromeModality: MRIRisk: high · 84/100
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01

Risk profile

What OCTON knew before the scan
Risk
84
high
Tier
high
Confirmed VHL c.499C>T · prior cerebellar hemangioblastoma at 24 · annual MRI abdomen + brain.
Contributing factors
  • VHL pathogenic variant+45
  • Prior CNS hemangioblastoma+18
  • Multifocal renal cysts on prior imaging+12
  • Age 38+4
  • Family history (paternal)+8
Narrative

VHL-driven clear-cell RCC manifests as multifocal cystic + solid renal lesions. Annual contrast MRI catches Bosniak III/IV transition early — when nephron-sparing partial nephrectomy preserves function.

02

Scan + AI report

What MRI found · Multiphase contrast MRI abdomen (T1+C, T2, DWI)
MRI · DEMO
Bosniak v2019 IV
OCTON · scanning · live
conf 0.85
OCTON Impression · 83% confidence

Right upper-pole renal mass 2.8 cm — predominantly cystic with avid arterial enhancement of a 9 mm mural nodule. Bosniak v2019 IV.

Findings
  • 2.8 cm cystic mass · upper-pole · right kidney · Right kidney upper pole28 mm
  • 9 mm enhancing mural nodule (arterial > 70 HU) · Mural nodule
  • Multifocal smaller Bosniak II cysts bilaterally · Bilateral kidneys
Differential diagnosis
  • Clear-cell RCC (VHL-driven)78%
  • Cystic papillary RCC10%
  • Multilocular cystic neoplasm of low malignant potential8%
  • Mixed-epithelial-and-stromal tumor4%
Recommended actions
  • ▸Robotic / open partial nephrectomy within 4 weeks (nephron-sparing per AUA 2021)
  • ▸MRI brain + spine annually (CNS-hemangioblastoma surveillance)
  • ▸Pancreatic surveillance MRCP (NET / cystadenoma risk)
Caveats
  • VHL-driven RCC is multifocal AND bilateral — staged nephron-sparing approaches favored.
  • Lifelong surveillance is required.
03

360° Preventative plan

Drugs · surveillance · diet · exercise · lifestyle — generated for this case
Clinical anchors
Drugs · labs · imaging · surveillance
Medical
Ophthalmology dilated fundoscopy
FrequencyAnnual
Startsage 1
VHL Alliance 2020
Medical
Plasma + urinary metanephrines
FrequencyAnnual
Startsage 5
VHL Alliance 2020
Monitoring
Contrast MRI abdomen (renal + pancreas)
FrequencyAnnual
Startsage 16
VHL Alliance 2020
Monitoring
MRI brain + spine
FrequencyAnnual
Startsage 11
VHL Alliance 2020
04

What changed

The early-detection win

Annual VHL surveillance caught a Bosniak IV mass at 2.8 cm — partial nephrectomy preserves the kidney and the patient's lifetime renal function.

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