Renal cell carcinoma originating in a renal cyst in a 12-year-old girl

We report a 12-year-old girl with renal cell carcinoma originating in a cyst of the left kidney. Ultrasonography revealed 2 small hyperechoic masses in the luminal side of a cyst. Although hypervascularity was not detected in the cyst by computed tomography, the possibility of malignancy could not be ruled out because of the presence of 2 solid masses. Therefore, partial left nephrectomy was performed. On histopathologic examination, the 2 solid masses within the cyst were found to be renal cell carcinoma. This patient remains disease-free at 4 years after partial nephrectomy.     

Bilateral renal cell carcinoma associated with polycystic kidney disease: case report and literature review

A 56-year-old Japanese man consulted a urologist because of urethral bleeding. He had been undergoing hemodialysis for the past 15 years due to polycystic kidney disease. Computed tomography revealed an irregular cyst wall in the left kidney. Since a neoplasm could not be ruled out, we removed the left kidney, by laparoscopic radical nephrectomy after obtaining the patient's consent. Histopathologic diagnosis was renal cell carcinoma. Fourteen months after the operation, urethral bleeding recurred. Further examination of the bladder and the urethra revealed no significant abnormalities. The patient insisted on right nephrectomy. Therefore, laparoscopic radical nephrectomy was performed. Histopathologic diagnosis was also renal cell carcinoma. Renal cell carcinoma in patients with end-stage renal disease is fairly common and is associated with acquired cystic kidney disease. However, renal cell carcinoma associated with polycystic kidney disease is extremely rare.     

Surgical exploration for renal cyst: two-case report]

A 59-year-old male was admitted to our clinic for further examination of the calcified renal cyst discovered incidentally on medical workup elsewhere. CT showed a left renal cyst associated with calcification. Ultrasound-guided puncture of the renal cyst was not successful because of thickness of the cystic wall. Renal angiography showed hypervascularity of the cystic wall. Association of renal cell carcinoma could not be ruled out, therefore the exploration was performed. Histological examination revealed benign renal cyst with calcification. A 27-year-old male presented with the chief complaint of left flank pain. Following examinations by US, CT and MRI, a renal cyst associated with renal cell carcinoma was highly suspected. Subsequent exploration revealed cluster of cysts with a yellowish lesion a few mm in diameter. Frozen section revealed no malignancy, and cystic fluid was not hemorrhagic. Therefore as many cystic walls as possible were removed without nephrectomy. Histological examination of the permanent specimen revealed renal cell carcinoma. Renal cyst associated with renal cell carcinoma was regarded as rare clinical entity, but such cases are reported in increasing number in recent years. We report such cases and review the pertinent literature in this paper.     

Collecting duct carcinoma with acquired cystic disease of the kidney in a long-term hemodialysis patient

Abstract:   We report a very rare case of collecting or Bellini duct carcinoma (CDC) found in a 60-year-old male who had received hemodialysis therapy for 21 years. Screening with ultrasonography revealed a solid tumor originating from the cyst wall in the right kidney with acquired cystic disease of the kidney. Subsequent computed tomography (CT) and angiography could not detect another renal tumor. Right radical nephrectomy was performed. The tumor detected preoperatively was composed of papillary renal cell tumor (RCC) and multiple clear cell carcinoma, pathologically. In addition to the tumors, CDC was revealed in the central medulla with the involvement of regional lymph nodes. Three months later, left nephrectomy was performed because left RCC was suspected during CT. The histological diagnosis was multiple clear cell carcinomas. Peritonitis carcinomatosa appeared and the patient died 13 months later.     

Renal cell carcinoma presenting high serum level of CA19-9 due to hydronephrosis: a case report

A 58-year old female was referred to our hospital due to left renal cyst that was pointed out at her health check-up. Abdominal CT scan showed left hydronephrosis with a 20 x 12 x 11cm tumor. The serum CA19-9 level elevated to 4,400 U/ml. Urinary cytology in the left renal pelvis was negative, therefore we could not diagnose whether the mass was renal cell carcinoma or renal pelvic tumor before surgery. She underwent left radical nephrectomy, and frozen section revealed renal cell carcinoma. Immunohistological stain clarified CA19-9 was limited to epithelium lining the renal pelvis and was not contained in carcinoma cells. After the surgery, the serum CA19-9 decreased to the normal range. Serum CA19-9 is known to be sometimes elevated in patients with urothelial carcinoma, but rarely elevated in those with renal cell carcinoma. We thought that hydronephrosis by tumor occlusion caused CA19-9 elevation in our case.     

Multilocular cystic renal cell carcinoma: report of a case

We report a case of multilocular cystic renal cell carcinoma seen in a 54-year-old man. At the annual health check he was found to have numerous cysts of various sizes in the lower pole of the left kidney. Plain CT scan disclosed a mass in the lower pole of the left kidney. On enhanced CT scan septa were visible, suggesting a multilocular cyst. Left renal arteriography disclosed a hypervascular mass in the lower pole of the left kidney. Radical nephrectomy was performed. The gross appearance of the cut surface showed a feature of multilocular cyst. The histopathological diagnosis was clear cell carcinoma. We describe the clinical features of multilocular cystic renal cell carcinoma and discuss the differential diagnosis.     

Renal oncocytoma with synchronous contralateral renal cell carcinoma

A 60-year-old male was admitted with bilateral renal masses with a diameter of 50 mm (right kidney), and 15 mm (left kidney) found incidentally by computed tomography. Renal angiography demonstrated neovascularization in the lower pole of the right kidney, but no remarkable findings in the left kidney. We could not deny the possibility of bilateral renal cell carcinoma. Right radical nephrectomy and left partial nephrectomy were performed. The histopathological finding revealed diagnosis of right papillary renal cell carcinoma and left oncocytoma. To our knowledge, this is the third case of renal oncocytoma with synchronous contralateral renal cell carcinoma reported in Japan.     

Renal cell carcinoma in a renal cyst--observation of changes during the year: report of a case]

We report a case of renal cell carcinoma within a renal cyst. A 45-year-old man visited our hospital with the chief complaint of left back pain. Ultrasonography was examined by a physician, and it revealed a right renal cyst by chance. Computed tomography demonstrated a thick wall in the cyst which showed enhancement of density with contrast medium. The physician followed the cystic lesion periodically, by ultrasonography and computed tomography. The cyst on volume did not change, but the thick wall had a tendency to develop to inner space. The patient was referred to our department. Angiography was performed, and it showed neovascularity and tumor staining. We diagnosed the renal tumor in a renal cyst. Transabdominal right radical nephrectomy was performed on 18 June, 1991. The resected specimen involved a mall tumor (2.5 x 2.0 cm) in the cyst. Histological examination of the tumor was renal cell carcinoma which was well capsulated by connective tissue without invasion to normal parenchyma and perirenal fat. We speculated that the renal cell carcinoma originated from the cyst wall and it developed to inner cystic space. The natural history of the renal cell carcinoma in a renal cyst is not clear. Our case shows a type of its history. We reviewed and discussed the types and diagnosis of the renal cell carcinoma in a renal cyst.     

A case of leiomyosarcoma of the kidney

Leiomyosarcoma of the left kidney seen in a 58-year-old man is reported. On April 10, 1982, he complained of left flank pain. He visited our hospital and left solitary renal cyst was suspected. He had been treated as an outpatient, but left flank pain became exacervated. On May 18, he was admitted to our hospital. On June 7, radical nephrectomy was done under the diagnosis of left renal cell carcinoma. At operation, the tumor invased directory to the psoas muscle and abdominal wall, and could not be completely resected. Pathological diagnosis was renal cell carcinoma with sarcomatoid change. On July 1, he was discharged from the hospital. In December, left flank distention appeared and back pain became exacervated. On February 8, 1983, he was readmitted to our hospital. Low density area was found in left psoas muscle by CT scanning and recurrence of renal cell carcinoma was suspected. alpha-Interferon therapy had been done, but tumor increased remarkably and caused ileus. He died on June 14, 1983. The autopsy revealed a child head-sized cystic tumor in the upper retroperitoneal space, a 5 X 5 X 5 cm metastasis of the left lobe of the liver, a 3 X 3 X 4 cm tumor to the left upper lobe with cavity formation and direct invasion into the spleen, diaphragma and gastric serosa. These metastatic lesions were leiomyosarcoma. Retrospectively, the primary tumor of kidney revealed primary leiomyosarcoma of kidney.     

Renal cell carcinoma in a giant renal cyst

A case of renal carcinoma in a giant solitary renal cyst is reported. Ultrasonography and CT showed an apparently benign left renal cyst except for wall irregularity. Cytological examination and fat analysis of the cyst content were negative but the fluid was haemorrhagic in nature. Frozen section of the cyst wall revealed malignancy and further histopathologic examination indicated renal cell carcinoma.     

Bilateral renal cell carcinoma in a patient receiving long-term dialysis

Bilateral renal cell carcinoma developing in a 55-year-old male receiving long-term dialysis is reported. The patient, who had undergone maintenance hemodialysis for 12 years, was admitted in July, 1986 for the purpose of extensive examination of a right renal mass. CT scan and ultrasonography demonstrated an enlarged bilateral kidney associated with multiple cysts, containing a solid mass in the right upper pole. The patients underwent right nephrectomy under the diagnosis of right renal tumor. The solid tumor 4 x 3 cm in size revealed a grade 1 to 2 renal cell carcinoma pathologically. Two small tumors were recognized in other portions of the kidney. Multiple cysts of varying sizes, the largest 2 cm in diameter, replaced the renal parenchyma. The cyst walls frequently contained hyperplastic changes. The patient has been subsequently followed up for 2 years and 9 months and underwent left nephrectomy for suspected left renal tumor. The surface of the left kidney was covered by numerous cysts. The result of pathological examination was renal cell carcinoma, which was recognized in a total of 7 regions of the left kidney. The patient remains well on hemodialysis, with no evidence of recurrence or metastasis.     

Bilateral multilocular cystic renal cell carcinoma]

A case of bilateral renal cell carcinoma with multilocular cysts is described. A 42-year-old female was admitted to our hospital for the purpose of further examination or right renal cystic mass discovered incidentally by ultrasonography. After she was examined by CT-scan and angiography, right nephrectomy was performed under the diagnosis of right renal cancer. Histological diagnosis was multilocular cystic renal cell carcinoma. One year later a small cystic legion was found in the left kidney. Under the diagnosis of left renal cancer, left partial nephrectomy was performed. Histological diagnosis was multilocular cystic renal cell carcinoma same as the right kidney. Multilocular renal cyst is classified into several classes by its style of development. This case of bilateral renal cell carcinoma which grew to be multilocular cysts is the first case in Japan as far as we can search.     

A case of acute renal failure due to parapelvic cyst in a solitary kidney

A 79-year female patient had undergone right radical nephrectomy for renal cell carcinoma (pT3b, grade 1) in October 2000. Three years later, she complained of left back pain and anuria. The ultrasonography and computed tomographic scanning showed a left hydronephrosis and parapelvic cyst. It was thought that the postrenal renal failure was caused by parapelvic cyst in a solitary kidney. An indwelling ureteral stent was placed for temporary relief of obstruction. Percutaneous cyst puncture was performed. Thereafter, she has been well, with no recurrent ureteral obstruction. To our knowledge, this is the third case of acute renal failure due to parapelvic cyst in a solitary kidney reported in the literature in Japan.     

A case of renal cell carcinoma with the complication of a giant cyst difficult to distinguish from xanthoma

A case of renal cell carcinoma accompanied by a giant cyst in a 69-year-old male patient is reported. The patient consulted a physician in our Hospital for bellyache on the left abdomen. Because giant cyst in the left kidney and intracystic hemorrhage were suspected by computed tomography diagnosis, the patient was transferred to the Department of Urology, As a tumor-like mass was detected in the cyst by ultrasound echo diagnosis, transperitoneal extirpation of the left kidney was conducted on May 8, 1985. At operation, a giant unilocular cyst covered with hypertrophic fibrous capsule including much coagula was observed. The inner wall of the cyst was covered with many deeply yellow torous lesions of sizes ranging from those of a wheat grain to thumb. Histologically, the lesions consisted of a cell group supposedly of histiocyte origin accompanied by cellular infiltration of lymph cells, and xanthoma was deeply suspected. However, as it was difficult to distinguish from the clear cell subtype of renal cell carcinoma, examination by an electron microscope was conducted and the final diagnosis of renal cell carcinoma was made. The post-operative course of the patient was good and no recurrence or cancer metastasis was observed as of January, 1986.     

Ipsilateral synchronous renal pelvic transitional cell carcinoma and renal cell carcinoma: a case report and review of the literature

A case of ipsilateral transitional cell carcinoma of left renal pelvis and left-renal cell carcinoma is presented. A 75-year-old male consulted our hospital with the complaint of painless gross-hematuria which had persisted for four years. Excretory urography revealed left non-visualized kidney. Retrograde pyelography demonstrated the filling defect, which had an irregular border, in the left renal pelvis. The selective left renal arteriography revealed the hypervascular region in the left renal cortex. Intraarterial chemotherapy with CDDP, MTX and ADR was performed preoperatively. Then, total left nephroureterectomy and segmental resection of the bladder was done. The surgical specimen was pathologically diagnosed as transitional cell carcinoma of the renal pelvis and renal cell carcinoma of the left kidney. This case is the 23rd reported case of ipsilateral synchronous renal malignancy in Japan.     

A case report of renal cell carcinoma in a renal cyst]

We report a case of renal cell carcinoma within a simple renal cyst in the upper pole of the right kidney. The renal cyst was found incidentally by ultrasonography. During the 3 years of follow-up, the cyst size was increasing and a small solid mass was arising from the cyst wall. Angiography revealed a hypervascular tumor stain in the renal cyst. At operation a 15 mm tumor arose from the wall of the cyst. Histopathological examination showed clear cell type renal cell carcinoma and "cyst" with sheets of carcinoma within the cyst wall. The coexistence of renal cyst and tumor is considerably rare. Fifty two cases were collected from the Japanese literature including this, and they are reviewed briefly.     

囊性肾癌5例报告并文献复习

目的:探讨囊性肾癌的早期诊断及治疗方法。方法:回顾性分析2008年1月~2012年8月间收治的5例囊性肾癌患者的临床资料,1例术前影像学检查提示双侧肾脏占位病变,一侧为囊性占位病变;4例显示单侧肾脏单发囊性占位病变,左肾3例,右肾1例;其中男3例,女2例;年龄46~68岁,平均56.4岁;肿瘤体积21.84~208ml,平均101.96ml。按照Bosniak分类,Ⅱ类1例,Ⅲ类2例,Ⅳ类2例;T1期2例,T2期2例,T3期1例。3例术前诊断为囊性肾癌,1例为肾脏囊肿,1例为肾嗜酸性细胞瘤合并囊性肾癌。2例行肾癌根治术,2例行肾部分切除术,1例行囊肿去顶减压术后2周行肾癌根治术。并结合相关文献复习进行分析讨论。结果:5例患者术后病理检查报告证实为透明细胞癌2例,乳头状细胞癌1例,多房囊性肾癌1例,嗜酸细胞腺瘤伴囊性变1例。平均随访34.4个月(10~66个月),1例发生骨骼及肺部转移,余4例均无复发转移。结论:囊性肾癌是一种广义上的肾癌分类,有四种分型;与其他类型肾癌相比,大部分恶性程度较低。囊性肾癌的术前诊断主要依赖于影像学检查,对于可疑病例,术中需行快速冷冻病理检查。对此类肿瘤,建议行保留肾单位手术。     

Cystic local recurrence of renal cell carcinoma after laparoscopic radical nephrectomy in a hemodialysis patient

Although local recurrence of renal cell carcinoma after laparoscopic radical nephrectomy is sometimes reported, cystic local recurrence of renal cell carcinoma has rarely been reported. We report the case of a 59‐year‐old man with hemodialysis who developed cystic local recurrence of renal cell carcinoma accompanied by acquired cystic disease of the kidney in the retroperitoneal space after laparoscopic radical nephrectomy. A cystic tumor of 5.1 cm in diameter occurred in the left retroperitoneal space 15 months after left laparoscopic radical nephrectomy, and enlarged to 7.2 cm in diameter with enhanced mass along the wall of the cyst 36 months after surgery. The cystic tumor was removed and showed local recurrence of renal cell carcinoma on pathological examination.     

A case of small simple renal cyst associated with renal cell carcinoma

A 61-year-old male was admitted to our clinic for the purpose of further examination of the small renal mass discovered incidentally by ultrasonography. Subtraction angiography disclosed a small renal cell carcinoma of the upper-lateral margin of the left kidney dramatically. Enucleating surgery of the tumor was performed successfully (about 2 cm in diameter). Histological examination revealed a small simple renal cyst associated with renal cell carcinoma. The patient is well without evident metastasis 1 year postoperatively. Since this is a very rare case in the literature, we report this case and discuss the preoperative diagnosis of small renal cell carcinoma. We believe that ultrasonography is a simple and very useful method for mass screening of small urological malignancies.     

A case of renal cell carcinoma in a horseshoe kidney]

We report a 68-year-old man with renal cell carcinoma in a horseshoe kidney. Abdominal computed tomography revealed a left renal tumor in a horseshoe kidney, and we carried out left radical nephrectomy. Histopathological diagnosis was renal cell carcinoma. Only 19 cases of renal cell carcinoma in a horseshoe kidney have been reported in Japan, and our case was the 20th.