LETTER TO THE EDITOR
Year : 2010 | Volume
: 21 | Issue : 6 | Page : 1147--1148
Renal cell carcinoma in a horse-shoe kidney
Suresh Kumar, Aman Gupta, Punit Bansal, Punit Tiwari, Anup K Kundu
Department of Urology, IPGMER, Kolkata, India
Correspondence Address:
Suresh Kumar
Department of Urology, IPGMER, Kolkata
India
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;21:1147-1148
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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 Oct 21 ];21:1147-1148
Available from: https://www.sjkdt.org/text.asp?2010/21/6/1147/72312 |
Full Text
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}{Figure 2}
Discussion
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
| 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. |
| 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. |
| 3 | Jones L, Reeves M, Wingo S, Babanoury A. Malignant tumor in a horseshoe. Kidney Urol J (Tehran) 2007;4:46-8. |
| 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. |
| 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. |
| 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. |
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