Six cases (men ranging in ages from thirty-seven to seventy-seven years) illustrate the varied characteristics of avascular renal adenocarcinoma. These tumors frequently simulate benign lesions. All modalities including intravenous pyelography, nephrotomography, ultrasonography, cyst puncture with cystic fluid assessment, angiography, and operation with tissue specimens submitted for pathologic examination may be required before diagnosis is established. An orderly approach to the evaluation of lesions will allow accurate diagnosis approaching 100 per cent with minimum morbidity. Attention to the finer details of vascular patterns on angiography has proved to be a most helpful diagnostic aid. Cyst puncture with histochemical, cytologic, and radiographic examinations appears to offer additional help in diagnosing these elusive lesions.
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