Korean J Urol.  2011 Dec;52(12):865-867.

Spontaneously Ruptured Renal Cell Carcinoma During Hemodialysis in Two Patients with End-Stage Renal Disease

• Kim WB
• Lee ES
• Doo SW
• Yang WJ
• Song YS
• Noh H

Abstract

Spontaneously ruptured renal cell carcinoma (RCC) in end-stage kidney disease is very rare. Preoperative diagnosis is difficult because of the relatively small tumor size, associated hematoma, and surrounding acquired cysts. Two middle-aged men who were maintained on hemodialysis (HD) for over 10 years suddenly developed flank pain during HD. Computed tomography scans revealed an enhancing ruptured renal mass in one patient, and no obvious tumor lesion except for a hematoma in the other, both of which were later confirmed as RCCs by pathologic specimens.

Keyword

Renal cell carcinoma; Rupture; Spontaneous

MeSH Terms

Carcinoma, Renal Cell
Flank Pain
Hematoma
Humans
Kidney Failure, Chronic
Male
Renal Dialysis
Rupture

Figure

• 

  FIG. 1 Case 1. Enhanced Computed tomography scan revealed a 3.2×2.5 cm sized ill-defined enhanced mass in the lower pole of the left kidney (arrow), which had acute extravasation of contrast material.

• 

  FIG. 2 Gross section. (A) Case 1. A partially ruptured yellowish mass in the lower pole of the kidney (arrow). (B) Case 2. Massive intrarenal hematomas without visible solid mass.

• 

  FIG. 3 Case 2. (A) Enhanced Computed tomography (CT) scan showed a 10×7.2×13 cm hyperdense hematoma in the left retroperitoneum; however, no solid tumor could be identified in the area of contrast material extravasation. (B) 2 weeks after follow-up enhanced CT scan displayed increased size (8.7×12×13 cm) of hematoma with improved prominent tortuous vascular structure.

Reference

1. Koh DH, Kim SJ, Ahn HS. Clinical analysis of spontaneous renal rupture with perirenal hemorrhage. Korean J Urol. 2004. 45:64–68.

2. Goto T, Sengiku A, Sawada A, Shibasaki N, Ishitoya S, Okumura K. Bilateral renal cell carcinoma of dialysis patient manifesting as spontaneous renal rupture. Hinyokika Kiyo. 2009. 55:707–710.

3. Zhang JQ, Fielding JR, Zou KH. Etiology of spontaneous perirenal hemorrhage: a meta-analysis. J Urol. 2002. 167:1593–1596.

4. Polky HJ, Vynalek WJ. Spontaneous nontraumatic perirenal and renal hematomas. Arch Surg. 1933. 26:196–218.

5. Koo V, Duggan B, Lennon G. Spontaneous rupture of kidney with peri-renal haematoma: a conservative approach. Ulster Med J. 2004. 73:53–56.

6. Skinner DG, Colvin RB, Vermillion CD, Pfister RC, Leadbetter WF. Diagnosis and management of renal cell carcinoma. A clinical and pathologic study of 309 cases. Cancer. 1971. 28:1165–1177.

7. Novicki DE, Turlington JT, Ball TP Jr. The evaluation and management of spontaneous perirenal hemorrhage. J Urol. 1980. 123:764–765.

8. Denton MD, Magee CC, Ovuworie C, Mauiyyedi S, Pascual M, Colvin RB, et al. Prevalence of renal cell carcinoma in patients with ESRD pre-transplantation: a pathologic analysis. Kidney Int. 2002. 61:2201–2209.

9. Bosniak MA. Spontaneous subcapsular and perirenal hematomas. Radiology. 1989. 172:601–602.

10. Truong LD, Krishnan B, Cao JT, Barrios R, Suki WN. Renal neoplasm in acquired cystic kidney disease. Am J Kidney Dis. 1995. 26:1–12.