Tag Archive for: retroperitoneal haematoma

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Highlights from #BAUS15

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#BAUS15 started to gain momentum from as early as the 26th June 2014 and by the time we entered the Manchester Central Convention Complex well over 100 tweets had been made. Of course it wasn’t just Twitter that started early with a group of keen urologists cycling 210 miles to conference in order to raise money for The Urology Foundation.

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Monday 15th June 2015

By the time the cyclists arrived conference was well under way with the andrology, FNUU and academic section meetings taking place on Monday morning:

  • The BJU International Prize for the Best Academic Paper was awarded to Richard Bryant from the University of Oxford for his work on epithelial-to-mesenchymal transition changes found within the extraprostatic extension component of locally invasive prostate cancers.
  • Donna Daly from the University of Sheffield received the BJUI John Blandy prize for her work on Botox, demonstrating reductions in afferent bladder signaling and urothelial ATP release.

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  • Professor Reisman’s talk on ‘Porn, Paint and Piercing’ as expected drew in the crowds and due to a staggering 44% complication rate with genital piercings it is important for us to try to manage these without necessarily removing the offending article as this will only serve to prevent those in need from seeking medical attention.
  • With the worsening worldwide catastrophe of antibiotic resistance, the cycling of antibiotics for prevention of recurrent UTIs is no longer recommended. Instead, Tharani Nitkunan provided convincing evidence for the use of probiotics and D-Mannose.

The afternoon was dominated by the joint oncology and academic session with Professor Noel Clarke presenting the current data from the STAMPEDE trial. Zolendronic acid conferred no survival benefit over hormones alone and consequently has been removed from the trial (stampede 1). However, Docetaxal plus hormones has shown benefit, demonstrated significantly in M1 patients with disease-free survival of 65 months vs. 43 months on hormones alone (Hazard ratio 0.73) (stampede 2). This means that the control arm of M1 patients who are fit for chemotherapy will now need to be started on this treatment as the trial continues to recruit in enzalutamide, abiraterone and metformin arms.

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The evening was rounded off with the annual BAUS football tournament won this year by team Manchester (obviously a rigged competition!), whilst some donned the

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lycra and set out for a competition at the National Cycle Centre. For those of us not quite so energetic, it was fantastic to catch up with old friends at the welcome drinks reception.

 

Tuesday 16th June 2015

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Tuesday kicked off bright and early with Professor John Kelly presenting results from the BOXIT clinical trial, which has shown some benefit over standard treatment of non-muscle invasive bladder cancer, but with significant cardiovascular toxicity.

The new NICE bladder cancer guidelines were presented with concerns voiced by Professor Marek Babjuk over discharging low-risk bladder cancer at 12 months given a quoted 30-50% five-year recurrence risk. Accurate risk stratification, it would seem, is going to be key.

The President’s address followed along with the presentation of the St. Peter’s medal for notable contribution to the advancement of urology, which was presented to Pat Malone from Southampton General Hospital. Other medal winners included Adrian Joyce who received the BAUS Gold Medal, and the St. Paul’s medal went to Mark Soloway.

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A plethora of other sessions ensued but with the help of the new ‘native’ BAUS app my programme was already conveniently arranged in advance:

  •     ‘Heartsink Conditions’ included pelvic and testicular pain and a fascinating talk by Dr Gareth Greenslade highlighted the importance of early and motivational referral to pain management services once no cause has been established and our treatments have been exhausted. The patient’s recovery will only start once we have said no to further tests: ‘Fix the thinking’
  • Poster sessions are now presented as ‘e-posters’, abolishing the need to fiddle with those little pieces of Velcro and allowing for an interactive review of the posters.

 

Photo 22-06-2015 22 36 07Pravisha Ravindra from Nottingham demonstrated that compliance with periodic imaging of patients with asymptomatic small renal calculi (n=147) in primary care is poor, and indeed, these patients may be better managed with symptomatic imaging and re-referral as no patients required intervention based on radiograph changes alone.

Archana Fernando from Guy’s presented a prospective study demonstrating the value of CTPET in the diagnosis of malignancy in  patients with retroperitoneal fibrosis (n=35), as well as demonstrating that those with positive PET are twice as likely to respond to steroids.

 

Wednesday 17th June 2015

Another new addition to the programme this year was the Section of Endourology ‘as live surgery’ sessions. This was extremely well received and allowed delegates to benefit from observing operating sessions from experts in the field whilst removing the stressful environment and potential for risk to patient associated with live surgery. This also meant that the surgeon was present in the room to answer questions and talk through various steps of the operation allowing for a truly interactive session.
Wednesday saw multiple international speakers dominating the Exchange Auditorium:

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  • The BJU International guest lecture was given by Professor Hendrik Van Poppel: a heartfelt presentation describing what he believes to be the superiority of surgery over radiotherapy for high-risk localised prostate cancer.
  • The Urology Foundation presented the Research Scholar Medal to Ashwin Sachdeva from Freeman Hospital, Newcastle for his work on the ‘Role of mitochondrial DNA mutations in prostate carcinogenesis’. This was followed by an inspiring guest lecture by Inderbir Gill on ‘Robotic Urologic Oncology: the best is yet to come’ with the tag line ‘the only thing that should be open in 2015 is our minds’
  • Robotic Surgery in UK Urology: Clinical & Commissioning Priorities was a real highlight in the programme with talks from Jim Adshead and Professor Jens-Uwe Stolzenburg focussing on the fact that only 40% of T1a tumours in the UK were treated with partial (as opposed to radical) nephrectomy, and that the robot really is the ‘game-changer’ for this procedure. Inderbir Gill again took to the stage to stress that all current randomised trials into open vs. robotic cystectomy have used extracorporeal reconstruction and so do not reflect the true benefits of the robotic procedure as the dominant driver of complications is in the open reconstruction.

These lectures were heard by James Palmer, Clinical Director of Specialised Commissioning for NHS England who then discussed difficulties in making decisions to provide new technologies, controlling roll out and removing them if they show no benefit. Clinical commissioning policies are currently being drafted for robotic surgery in kidney and bladder cancer. This led to a lively debate with Professor Alan McNeill having the last word as he pointed out that what urologists spend on the robot to potentially cure cancer is a drop in the ocean compared with what the oncologists spend to palliate!

 

Thursday 18th June 2015

The BJU International session on evidence-based urology highlighted the need for high-quality evidence, especially in convincing commissioners to spend in a cash-strapped NHS. Professor Philipp Dahm presented a recent review in the Journal of Urology indicated that the quality of systematic reviews in four major urological journals was sub-standard. Assistant Professor Alessandro Volpe then reviewed the current evidence behind partial nephrectomy and different approaches to this procedure.

Another fantastic technology, which BAUS adopted this year, was the BOD-POD which allowed delegates to catch-up on sessions in the two main auditoria that they may have missed due to perhaps being in one of the 21 well designed teaching courses that were available this year. Many of these will soon be live on the BAUS website for members to view.

The IBUS and BAUS joint session included a lecture from Manoj Monga from The Cleveland Clinic, which led to the question being posed on Twitter: ‘Are you a duster or a basketer?’The audience was also advised to always stent a patient after using an access sheath unless the patient was pre-stented.

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The updates session is always valuable especially for those studying for the FRCS (Urol) exam with far too many headlines to completely cover:

  • Endourology: The SUSPEND trial published earlier this year was a large multi-centre RCT that showed no difference in terms of rates of spontaneous passage of ureteric stone, time to stone passage or analgesic use between placebo, tamsulosin and nifedipine. There was a hot debate on this: should we be waiting for the meta-analysis or should a trial of this size and design be enough to change practice?
  • Oncology-Prostate: The Klotz et al., paper showed active surveillance can avoid over treatment, with 98% prostate cancer survival at 10 years.
  • Oncology-Kidney: Ellimah Mensah’s team from Imperial College London (presented at BAUS earlier in the week) demonstrated that over a 14-year period there were a higher number of cardiovascular-related admissions to hospital in patients who have had T1 renal tumours resected than the general population, but no difference between those who have had partial or radical nephrectomy.
  • Oncology-Bladder: Arends’s team presented at EAU in March on the favourable results of hyperthermic mitomycin C vs. BCG in the treatment of intermediate- and high-risk bladder cancer.
  • Female and BPH: The BESIDE study has demonstrated increased efficacy with combination solifenacin and mirabegron.
  • Andrology: Currently recruiting in the UK is the MASTER RCT to evaluate synthetic sling vs. artificial sphincter in men with post-prostatectomy urinary incontinence.

 

Overall BAUS yet again put on a varied and enjoyable meeting. The atmosphere was fantastic and the organisers should be proud of the new additions in terms of allowing delegates to engage with new technologies, making for a memorable week. See you all in Liverpool!

 

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Rebecca Tregunna, Urological Trainee, West Midlands Deanery @rebeccatregunna

 

Dominic Hodgson, Consultant Urologist, Portsmouth @hodgson_dominic

 

Papillary Cell Carcinoma in Post transplant Dialysis dependent patient – presenting as retroperitoneal hematoma

We present the case of a middle age male with ESRD with post transplant graft rejection, who presented with fever and left flank pain. Histopathology revealed a papillary cell carcinoma. Papillary cell carcinoma presenting as haemorrhage has not been previously reported in literature.

 

Authors: Nadeem, Mehwash; Ather, M Hammad; Sulaiman, M Nasir

Corresponding Author: Nadeem, Mehwash

For Correspondence and reprint requests

Dr Mehwash Nadeem
Dept of Surgery
Aga Khan University
P O Box 3500, Stadium Road
Karachi 74800, Pakistan
E mail [email protected]

 

Abstract
Renal cell carcinoma (RCC) is one of the known complications of end stage renal disease (ESRD) but these patients have favourable outcome in comparison to the general population. Spontaneous bleeding in renal tumours is a rare presentation and reported only anecdotally. We present the case of a middle age male with ESRD with post transplant graft rejection, who presented with fever and left flank pain. On investigation he was found to have a left perinephric collection. Initially he was managed conservatively, but subsequently underwent surgical exploration due to persistent flank pain. At operation, he was found to have a retroperitoneal hematoma. Histopathology revealed a papillary cell carcinoma. Papillary cell carcinoma presenting as haemorrhage has not been previously reported in literature.

Key Messages
Patients with ESRD on haemodialysis (HD) have a 100 times greater risk of developing RCC so these patients should be screened annually. There should be a high index of suspicion to diagnose these tumours and more specifically identifying these tumours as a cause of haemorrhage.

Introduction

Renal cell carcinoma (RCC) in patients with dialysis dependant end stage renal disease (ESRD) is about 100 times more common than in the general population. The histopathological type and features are distinct with a clear relation to the duration that a patient has remained haemodialysis (HD) dependent. Clear cell carcinoma is the most common renal tumour in the in general population as well as in patients with ESRD, papillary cell carcinoma represents a small fraction of cases and has not previously been reported in literature to present as haemorrhage.

Case History
The patient is a 48 year old man with co morbidities of hypertension, Hepatitis C, Crohn’s disease and ESRD (on thrice weekly haemodialysis). He underwent renal transplant in 2003 after remaining on haemodialysis (HD) for one year. Four years later he had graft rejection and again become dialysis dependent. He presented complaining of a high grade intermittent fever responding to antipyretics and vague left flank pain which was non-radiating and aggravated on movement. On examination he had a blood pressure of 100/60 mmHg, pulse of 68 beats/minute and he was afebrile. On abdominal examination, there was a scar in the right iliac fossa, the graft was palpable but not tender and there was mild tenderness in the left flank. His haemoglobin was 12gm/dl with a total leukocyte count of 12.3. A non contrast enhanced CT scan (CT KUB) showed extensive fat stranding around the left kidney with an area of high density representing a collection, the corticomedullary differentiation was lost in all three kidneys and there were small calculi in the renal graft (Figure 1 and 2). The patient was admitted with a probable diagnosis of acute pyelonephritis. The possibility of drain placement was discussed, but due to multi-focality and the small size of the collection, the decision was made for conservative management. He was started on Imipenim to which his fever responded but his haemoglobin dropped to 4gm/dl without any obvious source of bleeding. His CT scan was discussed with a radiologist and they raised suspicion of small areas of haemorrhage in the left kidney rather than a collection, along with a mixed density mass in the upper pole of the right kidney which could represent a complex cyst. A contrast enhanced CT scan of his abdomen was performed which demonstrated similar findings without any evidence of ongoing bleeding. His haemoglobin stabilized at 8gm/dl after the transfusion of 2 units of packed cells but he continued to have left flank pain despite epidural analgesia. Due to persistent pain, the drop in haemoglobin and his contralateral kidney showing a solid mass highly suspicious of a cancer an elective surgical exploration was planned. Per-operatively, the patient was found to have a huge retroperitoneal hematoma on left side crossing the mid line, from which approximately 2 litres of blood clots were evacuated. The graft kidney was small and shrunken with a stone in the renal pelvis. The right kidney contained an upper pole mass. Bilateral native and graft nephrectomy was done. The patient’s post operative course was uneventful. He was discharged home on the 6th post operative day with advice on alternate day HD. Histopathology showed a papillary renal cell carcinoma in right kidney, with foci of similar tumour seen in the left kidney as well. Extensive infarct in the left kidney was seen, the margins of the graft kidney as well as the ureteric margins of both kidneys were tumour free. Since the disease was organ confined, no further treatment was given to the patient. The patient was last seen three months ago and was well.

Discussion
End stage renal disease (defined in the Framingham Study as a GFR that is < 60% of the normal level) developed in about 9% of the subjects in the Framingham Study cohort during an 18-year follow-up period(1). The data of National Health and Nutrition Examination Surveys of 1988 to 1994 and 1999 to 2004 suggest that the prevalence of chronic kidney disease increased from 10 to 13% over the 10-year period from 1994 to 2004(2). The rate of renal replacement therapy over the 5-year observation period in a study was 1.1%, 1.3%, and 19.9%, respectively (3).
Patients with end-stage renal disease (ESRD) on dialysis have more than a 100 times greater risk of RCC than age-matched healthy controls, (4-5) and the risk is considered to be progressively higher in patients with a longer duration of dialysis (6-7). A multicenter retrospective study of more than 1200 patients by Neuzillet et al has reported that RCC occurring in patients with ESRD has many favourable clinical, pathologic, and outcome features compared with those diagnosed in patients from the general population. In the ESRD group, RCC occurred in younger patients (55+/-12 yrs vs. 62+/-12 yrs; p < 0.0001) and more often in male patients (3.2 men vs.1.6 women; p < 0.0001). Tumours were more frequently discovered incidentally in the ESRD group (87% vs.44%; p < 0.0001) (8). In this series, the incidental RCC diagnosis rate was in 87% compared with 44% in the general population. Such a high rate (75-100%) of incidental diagnosis had already been reported (9-10). This may be due to either to the constitutional low aggressiveness of ESRD tumours, related in part to their favourable histological phenotype, or to early diagnosis of renal tumours in the ESRD setting (due to screening) (8).
The spectrum of histological types of RCC arising in ESRD is distinct from that of sporadic RCC. Tumours arising in the setting of ESRD show microscopic features that are either similar to sporadic cases (clear cell, papillary and chromophobe RCC) or unique to ESRD, including acquired cystic disease (ACD)-associated RCC, and clear cell-papillary RCC (11). Clear cell carcinomas are less frequent (59% vs. 89%) and papillary carcinomas are more frequent (37%) than in the general population (7%) but with clear cell still being the most common (8).
A spontaneous retroperitoneal haemorrhage (SRH) is defined as a retroperitoneal haemorrhage that occurs without proceeding trauma or any underlying pathology. The majority of the patients respond to conservative treatment, with stopping of the offending agent (anticoagulants), judicious resuscitation with fluids and blood products and other supportive care. Surgery or radiological intervention is performed if there is evidence of continued bleeding, but these two modalities have some disadvantages. Spontaneous rupture of a renal neoplasm is a rare entity. Most commonly reported are angiomyolipomas. Other renal tumours reported in literature presenting as retroperitoneal hematoma are leiomyosarcoma (12-13) and metastatic gestational trophoblastic tumour (14). Papillary cell carcinoma of renal origin has not yet been reported in the literature presenting as retroperitoneal hematoma.
In our patient triple nephrectomy was dictated by three different indications. The left kidney was removed because it was the source of pain, bleeding and relative hemodynamic instability, the right kidney was removed as it was harbouring a solid mass suspicious of malignancy and the graft was removed as it had been rejected and also contained a calculus.

Conclusion
Annual screening of patients with ESRD should be done for RCC and ACKD. Although spontaneous rupture of renal neoplasm is a rare entity, there should be a high index of suspicion for bleeding when patients with ESRD present with flank pain in order to avoid a fatal outcome. Presentation of papillary cell carcinoma as a ruptured renal neoplasm has not been reported in literature as yet.

 

Abstract
Renal cell carcinoma (RCC) is one of the known complications of end stage renal disease (ESRD) but these patients have favourable outcome in comparison to the general population. Spontaneous bleeding in renal tumours is a rare presentation and reported only anecdotally. We present the case of a middle age male with ESRD with post transplant graft rejection, who presented with fever and left flank pain. On investigation he was found to have a left perinephric collection. Initially he was managed conservatively, but subsequently underwent surgical exploration due to persistent flank pain. At operation, he was found to have a retroperitoneal hematoma. Histopathology revealed a papillary cell carcinoma. Papillary cell carcinoma presenting as haemorrhage has not been previously reported in literature.

Key Messages
Patients with ESRD on haemodialysis (HD) have a 100 times greater risk of developing RCC so these patients should be screened annually. There should be a high index of suspicion to diagnose these tumours and more specifically identifying these tumours as a cause of haemorrhage.

Introduction

Renal cell carcinoma (RCC) in patients with dialysis dependant end stage renal disease (ESRD) is about 100 times more common than in the general population. The histopathological type and features are distinct with a clear relation to the duration that a patient has remained haemodialysis (HD) dependent. Clear cell carcinoma is the most common renal tumour in the in general population as well as in patients with ESRD, papillary cell carcinoma represents a small fraction of cases and has not previously been reported in literature to present as haemorrhage.

Case History
The patient is a 48 year old man with co morbidities of hypertension, Hepatitis C, Crohn’s disease and ESRD (on thrice weekly haemodialysis). He underwent renal transplant in 2003 after remaining on haemodialysis (HD) for one year. Four years later he had graft rejection and again become dialysis dependent. He presented complaining of a high grade intermittent fever responding to antipyretics and vague left flank pain which was non-radiating and aggravated on movement. On examination he had a blood pressure of 100/60 mmHg, pulse of 68 beats/minute and he was afebrile. On abdominal examination, there was a scar in the right iliac fossa, the graft was palpable but not tender and there was mild tenderness in the left flank. His haemoglobin was 12gm/dl with a total leukocyte count of 12.3. A non contrast enhanced CT scan (CT KUB) showed extensive fat stranding around the left kidney with an area of high density representing a collection, the corticomedullary differentiation was lost in all three kidneys and there were small calculi in the renal graft (Figure 1 and 2). The patient was admitted with a probable diagnosis of acute pyelonephritis. The possibility of drain placement was discussed, but due to multi-focality and the small size of the collection, the decision was made for conservative management. He was started on Imipenim to which his fever responded but his haemoglobin dropped to 4gm/dl without any obvious source of bleeding. His CT scan was discussed with a radiologist and they raised suspicion of small areas of haemorrhage in the left kidney rather than a collection, along with a mixed density mass in the upper pole of the right kidney which could represent a complex cyst. A contrast enhanced CT scan of his abdomen was performed which demonstrated similar findings without any evidence of ongoing bleeding. His haemoglobin stabilized at 8gm/dl after the transfusion of 2 units of packed cells but he continued to have left flank pain despite epidural analgesia. Due to persistent pain, the drop in haemoglobin and his contralateral kidney showing a solid mass highly suspicious of a cancer an elective surgical exploration was planned. Per-operatively, the patient was found to have a huge retroperitoneal hematoma on left side crossing the mid line, from which approximately 2 litres of blood clots were evacuated. The graft kidney was small and shrunken with a stone in the renal pelvis. The right kidney contained an upper pole mass. Bilateral native and graft nephrectomy was done. The patient’s post operative course was uneventful. He was discharged home on the 6th post operative day with advice on alternate day HD. Histopathology showed a papillary renal cell carcinoma in right kidney, with foci of similar tumour seen in the left kidney as well. Extensive infarct in the left kidney was seen, the margins of the graft kidney as well as the ureteric margins of both kidneys were tumour free. Since the disease was organ confined, no further treatment was given to the patient. The patient was last seen three months ago and was well.

Discussion
End stage renal disease (defined in the Framingham Study as a GFR that is < 60% of the normal level) developed in about 9% of the subjects in the Framingham Study cohort during an 18-year follow-up period(1). The data of National Health and Nutrition Examination Surveys of 1988 to 1994 and 1999 to 2004 suggest that the prevalence of chronic kidney disease increased from 10 to 13% over the 10-year period from 1994 to 2004(2). The rate of renal replacement therapy over the 5-year observation period in a study was 1.1%, 1.3%, and 19.9%, respectively (3).
Patients with end-stage renal disease (ESRD) on dialysis have more than a 100 times greater risk of RCC than age-matched healthy controls, (4-5) and the risk is considered to be progressively higher in patients with a longer duration of dialysis (6-7). A multicenter retrospective study of more than 1200 patients by Neuzillet et al has reported that RCC occurring in patients with ESRD has many favourable clinical, pathologic, and outcome features compared with those diagnosed in patients from the general population. In the ESRD group, RCC occurred in younger patients (55+/-12 yrs vs. 62+/-12 yrs; p < 0.0001) and more often in male patients (3.2 men vs.1.6 women; p < 0.0001). Tumours were more frequently discovered incidentally in the ESRD group (87% vs.44%; p < 0.0001) (8). In this series, the incidental RCC diagnosis rate was in 87% compared with 44% in the general population. Such a high rate (75-100%) of incidental diagnosis had already been reported (9-10). This may be due to either to the constitutional low aggressiveness of ESRD tumours, related in part to their favourable histological phenotype, or to early diagnosis of renal tumours in the ESRD setting (due to screening) (8).
The spectrum of histological types of RCC arising in ESRD is distinct from that of sporadic RCC. Tumours arising in the setting of ESRD show microscopic features that are either similar to sporadic cases (clear cell, papillary and chromophobe RCC) or unique to ESRD, including acquired cystic disease (ACD)-associated RCC, and clear cell-papillary RCC (11). Clear cell carcinomas are less frequent (59% vs. 89%) and papillary carcinomas are more frequent (37%) than in the general population (7%) but with clear cell still being the most common (8).
A spontaneous retroperitoneal haemorrhage (SRH) is defined as a retroperitoneal haemorrhage that occurs without proceeding trauma or any underlying pathology. The majority of the patients respond to conservative treatment, with stopping of the offending agent (anticoagulants), judicious resuscitation with fluids and blood products and other supportive care. Surgery or radiological intervention is performed if there is evidence of continued bleeding, but these two modalities have some disadvantages. Spontaneous rupture of a renal neoplasm is a rare entity. Most commonly reported are angiomyolipomas. Other renal tumours reported in literature presenting as retroperitoneal hematoma are leiomyosarcoma (12-13) and metastatic gestational trophoblastic tumour (14). Papillary cell carcinoma of renal origin has not yet been reported in the literature presenting as retroperitoneal hematoma.
In our patient triple nephrectomy was dictated by three different indications. The left kidney was removed because it was the source of pain, bleeding and relative hemodynamic instability, the right kidney was removed as it was harbouring a solid mass suspicious of malignancy and the graft was removed as it had been rejected and also contained a calculus.

Conclusion
Annual screening of patients with ESRD should be done for RCC and ACKD. Although spontaneous rupture of renal neoplasm is a rare entity, there should be a high index of suspicion for bleeding when patients with ESRD present with flank pain in order to avoid a fatal outcome. Presentation of papillary cell carcinoma as a ruptured renal neoplasm has not been reported in literature as yet.

Fig 1 050

 

 

 

 

 

 

 

 

 

Figure 1: white arrow showing mixed density mass and red arrow showing extensive perinephric stranding

Fig 2 050

 

 

 

 

 

 

 

 

 

 

Figure 2: Image of right upper pole mixed density mass. Arrow showing area of collection around left kidney References:

References
1. Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D. Predictors of new-onset kidney disease in a community-based population. JAMA. 2004 Feb 18;291(7):844-50.
2. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007 Nov 7;298(17):2038-47.
3. Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004 Mar 22;164(6):659-63.
4. Choyke PL. Acquired cystic kidney disease. Eur Radiol. 2000;10(11):1716-21.
5. Hora M, Hes O, Reischig T, Urge T, Klecka J, Ferda J, et al. Tumours in end-stage kidney. Transplant Proc. 2008 Dec;40(10):3354-8.
6. Vamvakas S, Bahner U, Heidland A. Cancer in end-stage renal disease: potential factors involved -editorial. Am J Nephrol. 1998;18(2):89-95.
7. Peces R. Malignancy and chronic renal failure. Saudi J Kidney Dis Transpl. 2003 Jan-Mar;14(1):5-14.
8. Neuzillet Y, Tillou X, Mathieu R, Long JA, Gigante M, Paparel P, et al. Renal cell carcinoma (RCC) in patients with end-stage renal disease exhibits many favourable clinical, pathologic, and outcome features compared with RCC in the general population. Eur Urol. 2011 Aug;60(2):366-73.
9. Kojima Y, Takahara S, Miyake O, Nonomura N, Morimoto A, Mori H. Renal cell carcinoma in dialysis patients: a single center experience. Int J Urol. 2006 Aug;13(8):1045-8.
10. Neuzillet Y, Lay F, Luccioni A, Daniel L, Berland Y, Coulange C, et al. De novo renal cell carcinoma of native kidney in renal transplant recipients. Cancer. 2005 Jan 15;103(2):251-7.
11. Tickoo SK, dePeralta-Venturina MN, Harik LR, Worcester HD, Salama ME, Young AN, et al. Spectrum of epithelial neoplasms in end-stage renal disease: an experience from 66 tumor-bearing kidneys with emphasis on histologic patterns distinct from those in sporadic adult renal neoplasia. Am J Surg Pathol. 2006 Feb;30(2):141-53.
12. Grasso M, Blanco S, Fortuna F, Crippa S, Di Bella C. Spontaneous rupture of renal leiomyosarcoma in a 45-year-old woman. Arch Esp Urol. 2004 Oct;57(8):870-2.
13. Moazzam M, Ather MH, Hussainy AS. Leiomyosarcoma presenting as a spontaneously ruptured renal tumor-case report. BMC Urol. 2002 Nov 19;2:13.
14. Vijay RK, Kaduthodil MJ, Bottomley JR, Abdi S. Metastatic gestational trophoblastic tumour presenting as spontaneous subcapsular renal haematoma. Br J Radiol. 2008 Sep;81(969):e234-7

 

Date added to bjui.org: 09/10/2012

DOI: 10.1002/BJUIw-2012-050-web

 

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