American Board of Pathology (ABPath) Practice Test 2026 - Free Pathology Exam Practice Questions and Study Guide

The presence of calcifications in a renal mass is particularly concerning for malignancy. Calcifications can appear in several forms within renal tumors, such as in renal cell carcinoma, where they may indicate necrosis, a higher tumor grade, or increased vascularity—factors often associated with more aggressive behavior.

In contrast, a homogeneous echo pattern typically suggests a benign lesion, as malignant tumors often exhibit heterogeneous appearances due to necrosis or cystic changes. Regular borders are also more characteristic of benign masses, as malignant tumors tend to have irregular, infiltrative margins. Small size may lend itself to a lower likelihood of malignancy, as many malignant tumors present at relatively larger sizes. Therefore, calcifications stand out as a red flag for malignancy in the evaluation of renal masses.