| Abstract|| |
Renal cell carcinoma (RCC) of the transplanted kidney is rare. In Iran, until 2004, 15000 kidney transplantations were performed, mostly from living donors. We report the first case of renal cell carcinoma in transplanted kidney, four years after transplantation, which was treated with nephron sparing or partial nephrectomy.
Keywords: Renal cell, Carcinoma, Transplantation, Kidney, Surgery.
|How to cite this article:|
Amirzargar M, Yavangi M. Nephron Sparing Surgery in a Transplanted Kidney Renal Cell Carcinoma. Saudi J Kidney Dis Transpl 2004;15:494-6
|How to cite this URL:|
Amirzargar M, Yavangi M. Nephron Sparing Surgery in a Transplanted Kidney Renal Cell Carcinoma. Saudi J Kidney Dis Transpl [serial online] 2004 [cited 2019 Oct 20];15:494-6. Available from: http://www.sjkdt.org/text.asp?2004/15/4/494/32883
| Introduction|| |
Cancer is more common in transplant recipients than in the general population. However, renal cell carcinoma (RCC) of the transplanted kidney is rare. ,, In Iran, until 2004, 15000 kidney transplantations were performed, mostly from living donors. We report the first case of renal cell carcinoma developing in a transplanted kidney, four years after transplantation, which was treated with nephron sparing.
| Case Report|| |
A 49-year-old woman with glomerulopathy that progressed to end-stage renal disease underwent preemptive renal transplantation from unrelated living donor in October 1999. Post transplantation, the function of the transplanted kidney was normal with serum creatinine ranging from 0.7 to 1.4 mg/dl (79 to 158 µmol/L). Immunosupression consisted of 10 mg prednisolone once daily, 100 mg cyclosporine twice daily and 100 mg azathioprine once daily. In December 2003, the patient developed microscopic hematuria that was detected by a routine urinalysis without any pain or discomfort. The ultrasound of the transplanted kidney detected a 4-4.5 centimeters (cm) solid mass at the lower pole of the kidney, [Figure - 1]. Computerized tomography (CT) scan and magnetic resonance tomography (MRI) confirmed the ultrasound findings, [Figure - 2]. Needle aspiration of the solid mass was performed under sonography control but pathological report was unspecific because the mass was solid and the hematuria continued. The mass was resected with a one centimeter margin of apparently normal tissue. The microscopic examination revealed a poorly differentiated RCC, but the margins were not involved. At two weeks after operation, creatinine was 0.7 mg/dl. Blood biochemical examination, monthly sonography and urinalysis were normal, [Figure - 3].
| Discussion|| |
The indication for nephron sparing includes bilateral renal cell carcinoma and renal cell carcinoma in a solitary kidney. ,, It is an effective treatment for single localized tumors less than 4 cm. Regular sonography of the transplanted kidney every 3-6 months may detect the development of tumor at early stage, when it is less than 4 cm. Accordingly, we may be able to save the transplanted kidney with nephron sparing or partial nephrectomy and keep its function normal. Moreover, it is necessary to reduce the amount of immunosuppression after resection of the tumor. ,,
Thus we believe that routine sonography may detect tumors in the transplanted kidney of less than 4 cm and enables treatment with nephron sparing or partial nephrectomy without the need for radical nephrectomy.
| References|| |
|1.||Roupret M, Peraldi M, Thaunat O, et al. Renal cell carcinoma of grafted kidney: how to improve screening and graft tracking. Transplantation 2004;77:146-8. |
|2.||Leonardou P, Semelka R, Mastropasqua M, Kanematsu M, Woosley JT. Renal cell carcinoma in transplanted kidney: MR imaging findings. Magn Reson Imaging 2003;21:691-3. |
|3.||Mindrup S, Rayhill S, Fallon B. Renal cell carcinoma in a transplanted kidney. J Urol 2001;165:1990. [PUBMED] |
|4.||Kim JY, Ruckle HC, Ramin SA. Partial nephrectomy for renal cell carcinoma in an allograft kidney 15 years after transplantation. J Urol 2001;165:1205. [PUBMED] |
|5.||Tyden G, Wernersson A, Sandberg J, et al. Development of renal cell carcinoma in living donor kidney grafts. Transplantation 2000;70:1650-6. |
|6.||Lasaponara F, Catti M, Ferraris C, Volpe A, Ferrando U. Nephron sparing treatment of kidney neoplasms in transplanted kidney. Our experience. Minerva Urol Nefrol 2000; 52:179-81. |
|7.||Ghasemian SR, Guleria AS, Light GA, Sasaki TM. Multicenter renal cell carcinoma in a transplanted kidney. Transplantation 1997; 64:1205-6. |
|8.||Penni. Cincinnati transplant tumor registry. Cincinnati: CTTR, 1990. |
|9.||Pfister C, Etienne I, Cobet F, et al. Adenocarcinoma of renal allograft as a complication at 5 years. Transplantation 1999;68:1608-10. |
Mohammad Ali Amirzargar
Department of Urology and Kidney Transplantation, Ekbatan Hospital, Hamadan University of Medical Sciences, Hamadan
[Figure - 1], [Figure - 2], [Figure - 3]