Urologic Radiology
Urol. Radiol. 1, 173-174 (1980)
Ultrasonographic Demonstration of Renal Cell Carcinoma in a Pelvic Kidney Philip W. Rails, William Boswell, D o n a l d Boger, and J a m e s Halls Department of Radiology, University of Southern California School of Medicine, Los Angeles County-USC Medical Center, Los Angeles, California, USA
Abstract. Renal cell c a r c i n o m a in pelvic kidneys is a surprisingly rare entity. This case report describes the first instance in which the t u m o r was delineated ultrasonographically. N o clear rationale for this apparently lower incidence can be determined.
Key words: Kidney - U l t r a s o u n d - Renal cell carcin o m a - Pelvic kidney.
associated pelvic and peri-aortic l y m p h nodes. P a t h o logic e x a m i n a t i o n showed a mixed clear cell-granular cell renal adenocarcinoma. The resected nodes were free o f tumor. I m m e d i a t e evaluation for metastases showed no lesions. The patient remains t u m o r free after 21/2 years' clinical follow-up.
Discussion Pelvic kidney, resulting f r o m failure of cephalad migration of the m e t a n e p h r o s [1], is an u n c o m m o n a n o m aly with a reported incidence varying f r o m 1/1000 [2] to 1/3000 [3] in p o s t m o r t e m series. Renal cell carcin o m a s in pelvic kidneys are rare, the last reported in 1958 by Bartley [4], whose case was the fifth reported. W e present an additional case, the first case that has been delineated by u l t r a s o n o g r a p h y .
Case Report A 56-year-old agricultural laborer presented with a lower a b d o m i n a l mass after having intermittent hem a t u r i a for 1 year. The patient denied other symptoms. Intravenous and r e t r o g r a d e pyelography revealed a pelvic kidney with distortion f r o m a huge mass (Fig. 1). U l t r a s o n o g r a p h y showed a large solid t u m o r consistent with renal cell carcinoma (Fig. 2). A n g i o g r a p h y confirmed this diagnosis, showing a hypervascular t u m o r with venous invasion (Fig. 3). The t u m o r and involved veins were resected, along with Address reprint requests to ." Philip W. Rails, M.D., Los Angeles
County-University of Southern California Medical Center, 1200 North State Street, Box 631, Los Angeles, CA 90033, USA.
Renal cell c a r c i n o m a comprises a p p r o x i m a t e l y 2% of all malignancies and has an a u t o p s y incidence of 0.3% [5]. Since this report deals with a relatively low incidence lesion in an u n c o m m o n ectopia, precise statistical analysis is difficult. Despite this, the paucity of reported cases (ours is the sixth) suggests a lower incidence of c a r c i n o m a in pelvic kidneys t h a n in normally positioned kidneys. The reason for this decreased incidence is unclear. It is p r o b a b l e that no explanation for this observation can be given until the pathogenesis of renal cell c a r c i n o m a itself is better understood.
References 1. Warkany J: The Kidney: Ectopia and Malrotation in Congenital Malformations, p 1053. Year Book Medical Publishers, Chicago, 1971 2. Dretler SP, Olsson C, Pfister RC: The anatomic, radiologic and clinical characteristics of the pelvic kidney: an analysis of 86 cases. J. Urol 105:610-627, 1971 3. Stevens AR: Pelvic single kidneys. J. Urol 37:610~618, 1937 4. Bartley, O.: Hypernephroma in a pelvic kidney demonstrated by angiography. Acta Radiol 48:175-180, 1958 5. Lucke B, Schlumberger HG : Tumors of the kidney, renal pelvis and ureter. American Registry of Pathology, Armed Forces Institute of Pathology, pp 12-20, 1957
0171-1091/80/0001-0173 $01.00 © 1980 Springer-Verlag N e w Y o r k , Inc.
174
P.W. Rails et al.: U l t r a s o u n d for Renal Cell C a r c i n o m a
Fig. 1. Retrograde pyelogram. The arrows outline the distorting mass
Fig. 3. Selective a n g i o g r a m of the largest of multiple feeding arteries. The open arrow d e m o n s t r a t e s venous invasion
Fig. 2. Sagittal pelvic u l t r a s o n o g r a m 1 c m left o f the midline. Note the large solid m a s s m o s t consistent with renal neoplasm
Urol. Radiol. 1, 173-174 (1980)
Ultrasonographic Demonstration of Renal Cell Carcinoma in a Pelvic Kidney Philip W. Rails, William Boswell, D o n a l d Boger, and J a m e s Halls Department of Radiology, University of Southern California School of Medicine, Los Angeles County-USC Medical Center, Los Angeles, California, USA
Abstract. Renal cell c a r c i n o m a in pelvic kidneys is a surprisingly rare entity. This case report describes the first instance in which the t u m o r was delineated ultrasonographically. N o clear rationale for this apparently lower incidence can be determined.
Key words: Kidney - U l t r a s o u n d - Renal cell carcin o m a - Pelvic kidney.
associated pelvic and peri-aortic l y m p h nodes. P a t h o logic e x a m i n a t i o n showed a mixed clear cell-granular cell renal adenocarcinoma. The resected nodes were free o f tumor. I m m e d i a t e evaluation for metastases showed no lesions. The patient remains t u m o r free after 21/2 years' clinical follow-up.
Discussion Pelvic kidney, resulting f r o m failure of cephalad migration of the m e t a n e p h r o s [1], is an u n c o m m o n a n o m aly with a reported incidence varying f r o m 1/1000 [2] to 1/3000 [3] in p o s t m o r t e m series. Renal cell carcin o m a s in pelvic kidneys are rare, the last reported in 1958 by Bartley [4], whose case was the fifth reported. W e present an additional case, the first case that has been delineated by u l t r a s o n o g r a p h y .
Case Report A 56-year-old agricultural laborer presented with a lower a b d o m i n a l mass after having intermittent hem a t u r i a for 1 year. The patient denied other symptoms. Intravenous and r e t r o g r a d e pyelography revealed a pelvic kidney with distortion f r o m a huge mass (Fig. 1). U l t r a s o n o g r a p h y showed a large solid t u m o r consistent with renal cell carcinoma (Fig. 2). A n g i o g r a p h y confirmed this diagnosis, showing a hypervascular t u m o r with venous invasion (Fig. 3). The t u m o r and involved veins were resected, along with Address reprint requests to ." Philip W. Rails, M.D., Los Angeles
County-University of Southern California Medical Center, 1200 North State Street, Box 631, Los Angeles, CA 90033, USA.
Renal cell c a r c i n o m a comprises a p p r o x i m a t e l y 2% of all malignancies and has an a u t o p s y incidence of 0.3% [5]. Since this report deals with a relatively low incidence lesion in an u n c o m m o n ectopia, precise statistical analysis is difficult. Despite this, the paucity of reported cases (ours is the sixth) suggests a lower incidence of c a r c i n o m a in pelvic kidneys t h a n in normally positioned kidneys. The reason for this decreased incidence is unclear. It is p r o b a b l e that no explanation for this observation can be given until the pathogenesis of renal cell c a r c i n o m a itself is better understood.
References 1. Warkany J: The Kidney: Ectopia and Malrotation in Congenital Malformations, p 1053. Year Book Medical Publishers, Chicago, 1971 2. Dretler SP, Olsson C, Pfister RC: The anatomic, radiologic and clinical characteristics of the pelvic kidney: an analysis of 86 cases. J. Urol 105:610-627, 1971 3. Stevens AR: Pelvic single kidneys. J. Urol 37:610~618, 1937 4. Bartley, O.: Hypernephroma in a pelvic kidney demonstrated by angiography. Acta Radiol 48:175-180, 1958 5. Lucke B, Schlumberger HG : Tumors of the kidney, renal pelvis and ureter. American Registry of Pathology, Armed Forces Institute of Pathology, pp 12-20, 1957
0171-1091/80/0001-0173 $01.00 © 1980 Springer-Verlag N e w Y o r k , Inc.
174
P.W. Rails et al.: U l t r a s o u n d for Renal Cell C a r c i n o m a
Fig. 1. Retrograde pyelogram. The arrows outline the distorting mass
Fig. 3. Selective a n g i o g r a m of the largest of multiple feeding arteries. The open arrow d e m o n s t r a t e s venous invasion
Fig. 2. Sagittal pelvic u l t r a s o n o g r a m 1 c m left o f the midline. Note the large solid m a s s m o s t consistent with renal neoplasm
