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Renal Cell Carcinoma Metastasis from Biopsy Associated Hematoma Disruption during Robotic Partial Nephrectomy.

Caputo C, Lee Z, Harbin A, Eun D - Case Rep Urol (2014)

Bottom Line: The renal cell carcinoma (RCC) and the associated hematoma were widely excised with negative surgical margins.On follow-up imaging at five months postoperatively, a recurrent renal mass at the surgical resection bed and several new nodules in the omentum were detected.During completion left robotic total nephrectomy and omental excision, intraoperative frozen sections confirmed metastatic RCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Temple University School of Medicine, 3401 N. Broad Street, Suite 330, Zone C, Philadelphia, PA 19140, USA.

ABSTRACT
We describe a case in which a patient with a past medical history of ovarian cancer received a diagnostic renal biopsy for an incidentally discovered renal mass. During left robotic partial nephrectomy (RPN), a perinephric hematoma was encountered. The hematoma was not present on preoperative imaging and was likely a result of the renal biopsy. The renal cell carcinoma (RCC) and the associated hematoma were widely excised with negative surgical margins. On follow-up imaging at five months postoperatively, a recurrent renal mass at the surgical resection bed and several new nodules in the omentum were detected. During completion left robotic total nephrectomy and omental excision, intraoperative frozen sections confirmed metastatic RCC. We believe that a hematoma seeded with RCC formed as a result of the renal biopsy, and subsequent disruption of the hematoma during RPN caused contamination of RCC into the surrounding structures.

No MeSH data available.


Related in: MedlinePlus

Intraoperative picture of the partial nephrectomy, demonstrating the tumor (T), hematoma (H), and kidney (K).
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fig1: Intraoperative picture of the partial nephrectomy, demonstrating the tumor (T), hematoma (H), and kidney (K).

Mentions: Given that the patient was asymptomatic and the uneventful nature of the renal mass biopsy, the lesion was not reimaged and we proceeded with transperitoneal RPN. After dissecting the renal hilum and overlying renal fat, a 12 mm laparoscopic drop-in ultrasound probe was used to evaluate the renal mass prior to resection. The mass was well visualized and there was no obvious perinephric hematoma noted. During sharp tumor resection, however, we encountered an intrarenal hematoma that was clearly outside of the tumor margin (Figure 1). The hematoma had several small areas of pale yellow coloration that appeared to be organizing hematoma. Since this was consistent with recent biopsy, we completely suctioned the hematoma and performed a wide margin resection to completely remove the tumor and hematoma. The tumor pseudocapsule was not violated during the resection. The specimen was extracted via an EndoCatch bag, and was grossly confirmed to be an intact specimen on the back table. Final pathology confirmed a 4.5 cm Fuhrman Grade 3 Papillary RCC with negative margins and an adjacent organizing hematoma.


Renal Cell Carcinoma Metastasis from Biopsy Associated Hematoma Disruption during Robotic Partial Nephrectomy.

Caputo C, Lee Z, Harbin A, Eun D - Case Rep Urol (2014)

Intraoperative picture of the partial nephrectomy, demonstrating the tumor (T), hematoma (H), and kidney (K).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4269283&req=5

fig1: Intraoperative picture of the partial nephrectomy, demonstrating the tumor (T), hematoma (H), and kidney (K).
Mentions: Given that the patient was asymptomatic and the uneventful nature of the renal mass biopsy, the lesion was not reimaged and we proceeded with transperitoneal RPN. After dissecting the renal hilum and overlying renal fat, a 12 mm laparoscopic drop-in ultrasound probe was used to evaluate the renal mass prior to resection. The mass was well visualized and there was no obvious perinephric hematoma noted. During sharp tumor resection, however, we encountered an intrarenal hematoma that was clearly outside of the tumor margin (Figure 1). The hematoma had several small areas of pale yellow coloration that appeared to be organizing hematoma. Since this was consistent with recent biopsy, we completely suctioned the hematoma and performed a wide margin resection to completely remove the tumor and hematoma. The tumor pseudocapsule was not violated during the resection. The specimen was extracted via an EndoCatch bag, and was grossly confirmed to be an intact specimen on the back table. Final pathology confirmed a 4.5 cm Fuhrman Grade 3 Papillary RCC with negative margins and an adjacent organizing hematoma.

Bottom Line: The renal cell carcinoma (RCC) and the associated hematoma were widely excised with negative surgical margins.On follow-up imaging at five months postoperatively, a recurrent renal mass at the surgical resection bed and several new nodules in the omentum were detected.During completion left robotic total nephrectomy and omental excision, intraoperative frozen sections confirmed metastatic RCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Temple University School of Medicine, 3401 N. Broad Street, Suite 330, Zone C, Philadelphia, PA 19140, USA.

ABSTRACT
We describe a case in which a patient with a past medical history of ovarian cancer received a diagnostic renal biopsy for an incidentally discovered renal mass. During left robotic partial nephrectomy (RPN), a perinephric hematoma was encountered. The hematoma was not present on preoperative imaging and was likely a result of the renal biopsy. The renal cell carcinoma (RCC) and the associated hematoma were widely excised with negative surgical margins. On follow-up imaging at five months postoperatively, a recurrent renal mass at the surgical resection bed and several new nodules in the omentum were detected. During completion left robotic total nephrectomy and omental excision, intraoperative frozen sections confirmed metastatic RCC. We believe that a hematoma seeded with RCC formed as a result of the renal biopsy, and subsequent disruption of the hematoma during RPN caused contamination of RCC into the surrounding structures.

No MeSH data available.


Related in: MedlinePlus