Papillary Renal Cell Carcinoma in the Horseshoe Kidney

Sa Ying-Long, MD; Xu Yue-Min; Xie Hong; Xu Xiao-Lin

Disclosures

South Med J. 2010;103(12):1272-1274. 

In This Article

Case Report

A 54-year-old woman presented for left flank pain and gross hematuria. History was relevant for diabetes mellitus, which was well controlled pharmacologically. Physical examination showed a palpable mass in the left flank. Urine examination confirmed gross hematuria and urine culture was sterile. Ultrasonography revealed a tumor encroaching upon nearly the entire left portion of a horseshoe kidney with a parenchymatous isthmus (Fig.). Intravenous urography (IVU) revealed a filling defect of the left renal lower calices. Upper abdominal computed tomography (CT) revealed an enhanced, well-defined large mass of 8.0 cm × 8.0 cm originating from the left renal lower pole. Pathological examination found no distant metastasis.

Figure.

Transverse renal sonogram demonstrating a heterogeneous solid renal mass, 8.0 cm × 8.0 cm, connected with the isthmus (arrow).

During surgery, a left lateral rectus incision plus a subcostal incision were used in order to offer clear exposure to the tumor and the major vessel. The tumor was oriented from the left renal lower pole and extended into the isthmus. The ureter may insert high on the renal pelvis and lie medially, probably as the result of incomplete renal rotation. The two left renal arteries and three renal veins were ligated. After division of the isthmus of the horseshoe kidney, the tumor and the left kidney were removed en bloc. Bleeding from the right parenchyma was controlled by selective ligation of small arteries and electrical coagulation. The surface of the parenchyma was covered with a free peritoneal patch. The final pathologic examination of the kidney revealed papillary renal cell carcinoma (RCC). The pathological subtype of this papillary RCC is II, without tumor infiltration microscopically over these areas.

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