Renal Cell Carcinoma

A 64-year-old male smoker with hypertension presents with microscopic hematuria detected on routine urinalysis. Ultrasound of the abdomen reveals a 5.5 cm heterogeneous hyperechoic solid mass arising from the upper pole of the right kidney, with internal vascularity on color Doppler. An adjacent simple anechoic cyst with smooth walls is also noted. Contrast-enhanced triphasic CT confirms the mass shown as **A** in the diagram, demonstrating heterogeneous enhancement of 18 Hounsfield units above baseline, without renal vein involvement, regional lymphadenopathy, or distant metastases. Based on the imaging characteristics of the mass marked **A**, what is the most appropriate management strategy for this patient?

A 65-year-old male smoker with hypertension presents with painless gross hematuria for 3 weeks, right flank discomfort, and 6 kg unintentional weight loss over 3 months. Examination reveals a palpable right flank mass and a non-reducing left varicocele. Renal ultrasound demonstrates a 7 cm **solid, heterogeneous, predominantly hypoechoic mass** arising from the upper pole of the right kidney with internal echoes, areas of cystic necrosis, and distortion of the cortico-medullary architecture. Color Doppler shows internal vascularity. The contralateral kidney is normal. The structure marked **A** in the diagram represents this solid heterogeneous renal mass. Which of the following is the most likely histologic subtype and its associated genetic abnormality?