OBJECTIVE: To investigate the size of renal cell carcinomas (RCCs) when they cause macroscopic hematuria or other symptoms and/or signs. MATERIAL AND METHODS: A retrospective review of 232 patients (136 males, 96 females; mean age 68 +/- 11 years; age range 40-90 years) with a diagnosis of RCC was undertaken. Patients were grouped according to the presenting symptoms and/or signs caused by the RCCs. Tumor size was measured on CT images. RESULTS: Of the RCCs, 29% were found incidentally and 71% caused symptoms and/or signs. The incidentally found RCCs measured 4.9 +/- 2.6 cm (range 2-12 cm) and RCCs causing symptoms and signs measured 8.9 +/- 3.2 cm (range 3-18 cm); this size difference was significant (p < 0.001). None of the RCCs causing macroscopic hematuria were <4 cm in size and only 3/165 (2%) of the symptomatic RCCs were <4 cm in size. DISCUSSION: If small (<4 cm) RCCs do not cause symptoms, patients with them will not be referred for CT or any other imaging modality. Therefore, if a 2-cm RCC is found in a patient presenting with macroscopic hematuria, it is unlikely that this small RCC caused the hematuria and another cause of the hematuria must be ruled out.
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Dahlman et al. (2007) studied this question.