What ultrasound features are typical of renal cell carcinoma?

• A. Isoechoic or hyperechoic, heterogeneous mass with a halo/rim and calcifications.
• B. Anechoic, simple cyst.
• C. Completely solid with uniform echogenicity.
• D. Highly vascular delineation without any halo.

Answer: (A)

Renal cell carcinoma on ultrasound typically shows a solid intrarenal mass that is heterogeneous in texture because of areas of necrosis or hemorrhage. A peripheral capsule or halo and sometimes calcifications are common features, and color Doppler often reveals internal vascularity within the tumor. This combination—solid, variably echogenic mass with a halo and calcifications—best fits RCC.

An anechoic appearance with simple cyst features would not reflect a solid tumor. A mass that is completely solid with uniform echogenicity would be less characteristic, since RCC usually exhibits heterogeneity. Very high vascularity without any halo can occur, but the hallmark pattern includes the halo or capsule with internal heterogeneity and possible calcifications, which helps distinguish RCC from benign lesions.