1. 高雄義大醫院泌尿科; 2. 病理科
Laparoscopic partial nephrectomy for multilocular cystic renal cell carcinoma in the isthmus part of a horseshoe kidney
Richard C. Wu1, Chung-Hsien Chen1, Yu-Chi Chen1, I-Wei Chang2, Victor C. Lin1, 3
1. Department of Urology and 2. Pathology, E-Da Hospital, Kaohsiung, Taiwan;
3. School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
Horseshoe kidney is the most common renal fusion disease has an incident rate from 1 in 1000 up to 1 in 400. Patients with this disease are often asymptomatic until incidental image finding for other reason. ＭMeanwhile, the incidence of renal cell carcinoma and the correlation to horseshoe kidney disease remains unclear and there were only few case reports to date. Partial nephrectomy has becoming gold standard treatment for renal tumors and the most important issue during surgery is the variable blood supplies of the horseshoe kidney. We reported a case that was diagnosed with renal cell carcinoma confined in the isthmus of a horseshoe kidney and treated by laparoscopic partial nephrectomy.
A 48-year-old woman presented epigastralgia and a solid renal tumor with calcification confined in the isthmus, close to the right moiety, of a horseshoe kidney was incidentally detected by computed tomography. Followed angiography of kidney revealed there were one renal artery and one lower polar artery at both sides and the tumor was supplied by a branch from right lower polar artery. Laparoscopic partial nephrectomy was performed under left lateral decubitus surgical position. Right lower polar artery was controlled by bulldog and feeding artery of the tumor was ligated before tumor resection. The left border of the tumor was also resected with isthmusectomy procedure without pedicle control. The laparoscopic procedure time was 178 minutes with selective artery clamping 32 minutes and the estimated blood loss was 100 ml. The final pathology revealed a pT1a multilocular cystic renal cell carcinoma, a rare subtype. The patient was discharged on post-operative day without complications and there was no evidence of recurrence at one-year follow-up.