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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 6  |  Page : 1147-1148
Renal cell carcinoma in a horse-shoe kidney

Department of Urology, IPGMER, Kolkata, India

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Date of Web Publication4-Nov-2010

How to cite this article:
Kumar S, Gupta A, Bansal P, Tiwari P, Kundu AK. Renal cell carcinoma in a horse-shoe kidney. Saudi J Kidney Dis Transpl 2010;21:1147-8

How to cite this URL:
Kumar S, Gupta A, Bansal P, Tiwari P, Kundu AK. Renal cell carcinoma in a horse-shoe kidney. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2021 Sep 20];21:1147-8. Available from: https://www.sjkdt.org/text.asp?2010/21/6/1147/72312
To the Editor,

Horse-shoe kidney is a renal fusion anomaly found in about 0.25% of the population. RCC comprises about 50% of tumors arising in the horse-shoe kidney, and occurs no more often than in general population. [1],[2] We report a case of renal cell carcinoma arising in a horse-shoe kidney in a 65-year-old man who presented with intermittent right flank discomfort for two months. There was no history of hematuria or fever, but a recent history of anorexia and weight loss. He was afebrile and physical exa­mination revealed mild pallor and a palpable lump in his right flank, while the rest of the examination was unremarkable. Hematological investigations revealed mild anemia (hemoglo­bin 9.5 gm %). Renal and liver function tests were normal. Urinalysis revealed microscopic hematuria. Urine culture and cytology were normal. X-ray of the chest was normal. Com­puted tomography (CT) of the abdomen and pelvis revealed a horse-shoe kidney with an enhancing lesion measuring 139 Χ 98 mm ari­sing from right kidney with multiple areas of necrosis and calcification within the mass [Figure 1]. The patient underwent a surgical exploration revealing a large mass occupying almost whole of the right kidney. The isthmus and left kidney were grossly normal. Right ra­dical nephrectomy was performed, and Isthmus was divided along with the specimen and re­maining tissue with the opposite kidney was under run with absorbable suture for hemo­stasis followed by replacing the fibrous capsule of the parenchyma at the resection site with a free peritoneal patch, which may prevent blee­ding and urinary fistula formation at the site of isthmus division. There was no evidence of retroperitoneal lymphadenopathy. Pathological examination revealed grade 2 renal cell car­cinoma, clear cell type, with negative surgical margins [Figure 2]. Post operative course was uneventful. Follow up at six months shows pa­tient to be asymptomatic and X-ray chest, liver function tests and USG of KUB and abdomen to be normal.
Figure 1 :CECT showing Horse-shoe kidney with renal tumour (right side) with area of necrosis and enhancement.

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Figure 2 :Histopathology showing clear cell carcinoma (high magnification).

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   Discussion Top

Horse-shoe kidney, by virtue of its embryo­genesis and anatomy, is predisposed to a higher incidence of disease than the normal kidney. The rates of hydronephrosis, stone formation, infection, and certain cancers are higher in horse­shoe kidneys. Increased incidence of certain cancers in horse-shoe kidneys is thought to be due to teratogenic factors present at birth. Ade­nocarcinoma comprises about 50% of tumors arising in the horse-shoe kidney, followed by transitional cell carcinoma and Wilms tumor. [2] The theory that mechanical fusion of meta­nephroi is responsible for the genesis of horse­shoe kidney has been shown to be true in only a minority of cases: those with connective tissue isthmus. [3] Radical nephrectomy with di­vision of isthmus appears to be the treatment of choice in renal tumor in a horse-shoe kid­ney. [4] Regardless of whether the procedure is radical or organ sparing, the division of the isthmus is essential not only to achieve com­plete access to lymph nodes but also to nor­malize the course of the ureters and to prevent potential development of Rovsing's syndrome. [5] Bleeding and urinary fistula formation can be prevented by replacing the fibrous capsule of the parenchyma at the resection site with a free peritoneal patch. [6]

   References Top

1.Rubio Briones J, Regalado Pareja R, Sanchez Martin F, et al. Incidence of tumoural patho­logy in horseshoe kidneys. Eur Urol 1998;33: 175-9.  Back to cited text no. 1
2.Stuart BB. Anamolies of the upper urinary tract. In: Walsh PC, Retik AB, Vaughean ED Jr, et al, eds. Campbell's urology. 8 th ed. Philadelphia: WB Saunders; 2002;1885-924.  Back to cited text no. 2
3.Jones L, Reeves M, Wingo S, Babanoury A. Malignant tumor in a horseshoe. Kidney Urol J (Tehran) 2007;4:46-8.  Back to cited text no. 3
4.Stimac G, Dimanovski J, Ruzic B, Spajic B, Kraus O. Tumors in kidney fusion anomalies-­report of five cases and review of the literature. Scand J Urol Nephrol 2004;38(6):485-9.  Back to cited text no. 4
5.Hohenfeller M, Schultz-Lampel D, Lampel A et al. Tumour in the horse shoe kidney - clinical implications and review of embryo­genesis. J Urol 1992;147:1098-100.  Back to cited text no. 5
6.Bhat S, Muhammed Fassaludeen AS, Thomas A, Cherian J. Horseshoe kidney with renal adenocarcinoma - report of a rare case. Indian J Urol 2002;19:81-2.  Back to cited text no. 6
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Correspondence Address:
Suresh Kumar
Department of Urology, IPGMER, Kolkata
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PMID: 21060194

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