血液透析患者之出血性腎臟嗜伊紅細胞瘤擬似破裂性腎細胞癌：病例報告

黃上瑋、卓育慶

三軍總醫院 外科部 泌尿外科

Hemorrhagic Renal Oncocytoma Mimicking Ruptured Renal Cell Carcinoma in a Hemodialysis Patient: A Case Report

Shang-Wei Huang, Yu-Cing Juho

Division of Urology, Department of Surgery, Tri-Service General Hospital, Taiwan

Abstract

Background:

Renal oncocytoma is a benign epithelial neoplasm that may closely resemble renal cell carcinoma (RCC) on imaging. In patients with end-stage renal disease (ESRD), the pretest probability of renal malignancy is often considered high, which may further bias clinical decision-making toward surgical treatment. When a renal mass presents with spontaneous hemorrhage, the suspicion for RCC becomes even stronger, potentially increasing the risk of overtreatment.

Case Summary:

An 81-year-old woman with ESRD on maintenance hemodialysis, Parkinson disease, and hypertension presented with abdominal pain and vomiting. Initial imaging revealed acute/subacute hemorrhage with hematoma over the right kidney, marked perirenal fat stranding, and a 4.4-cm enhancing soft-tissue mass in the lower pole of the right kidney, highly suspicious for RCC. A second 1.1-cm exophytic nodule was also noted in the right kidney, and the clinical stage was considered at least cT3aN0Mx if malignancy was confirmed. Because of concern for ruptured RCC with perirenal hematoma, the patient underwent laparoscopic right radical nephrectomy. However, final pathology demonstrated renal oncocytoma with chronic pyelonephritis and organized hematoma rather than RCC.

Conclusion:

This case highlights how ESRD background risk and hemorrhagic presentation may jointly anchor the diagnosis toward RCC, even when the underlying lesion is benign. In frail dialysis patients, in whom renal function preservation is no longer the primary consideration, avoidance of non-beneficial surgery becomes particularly important. Although acute hemorrhagic presentation may limit diagnostic options, this case underscores the need to reconsider the role of preoperative tissue diagnosis and individualized risk stratification in selected hemodynamically stable patients with hemorrhagic renal masses.