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Trisacryl Gelatin Microembolism and Metastases in the Lung after Renal Artery Embolization and Nephrectomy for Renal Cell Carcinoma.

Borja Alvarez A, Leventhal JP, Cortese C, McComb BL, Thiel DD, Khoor A - Case Rep Urol (2015)

Bottom Line: Her past medical history included clear cell RCC, which was treated with preoperative trisacryl gelatin microsphere RAE and right nephrectomy 9 years earlier.Computed tomography of the chest showed multiple lung nodules, a mass-like density in the left lower lobe, and mediastinal and hilar lymphadenopathy.Wedge resections of the lung showed multiple foci of metastatic RCC and extensive involvement of the muscular pulmonary arteries by trisacryl gelatin microspheres.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary and Allergy Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.

ABSTRACT
This is the first report, to our knowledge, of widespread, histologically confirmed trisacryl gelatin pulmonary microembolism after renal artery embolization (RAE). In addition, this is the first report of lung involvement by both metastatic renal cell carcinoma (RCC) and an embolic agent used for RAE. The patient was a 63-year-old woman who recently presented with both dyspnea on exertion and productive cough. Her past medical history included clear cell RCC, which was treated with preoperative trisacryl gelatin microsphere RAE and right nephrectomy 9 years earlier. Computed tomography of the chest showed multiple lung nodules, a mass-like density in the left lower lobe, and mediastinal and hilar lymphadenopathy. Wedge resections of the lung showed multiple foci of metastatic RCC and extensive involvement of the muscular pulmonary arteries by trisacryl gelatin microspheres.

No MeSH data available.


Related in: MedlinePlus

Trisacryl gelatin microemboli. (a) Microemboli (arrows) involving muscular pulmonary arteries (hematoxylin-eosin, original magnification ×1.4). (b) Microembolus with giant cells (arrows) on the left lateral aspect (hematoxylin-eosin, original magnification ×17.6).
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fig3: Trisacryl gelatin microemboli. (a) Microemboli (arrows) involving muscular pulmonary arteries (hematoxylin-eosin, original magnification ×1.4). (b) Microembolus with giant cells (arrows) on the left lateral aspect (hematoxylin-eosin, original magnification ×17.6).

Mentions: The patient underwent wedge resections of the lingula and left lower lobe and biopsy of a hilar lymph node. Histological sections of the lung showed multiple foci of metastatic RCC, measuring up to 1.0 cm in greatest dimension (Figure 2). In addition, numerous muscular pulmonary arteries contained trisacryl gelatin microemboli (Figure 3) and had medial hypertrophy consistent with pulmonary hypertension. Colocalization of metastatic RCC and trisacryl gelatin microspheres was noted (Figure 4). Sections of the hilar lymph node showed metastatic RCC.


Trisacryl Gelatin Microembolism and Metastases in the Lung after Renal Artery Embolization and Nephrectomy for Renal Cell Carcinoma.

Borja Alvarez A, Leventhal JP, Cortese C, McComb BL, Thiel DD, Khoor A - Case Rep Urol (2015)

Trisacryl gelatin microemboli. (a) Microemboli (arrows) involving muscular pulmonary arteries (hematoxylin-eosin, original magnification ×1.4). (b) Microembolus with giant cells (arrows) on the left lateral aspect (hematoxylin-eosin, original magnification ×17.6).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4465717&req=5

fig3: Trisacryl gelatin microemboli. (a) Microemboli (arrows) involving muscular pulmonary arteries (hematoxylin-eosin, original magnification ×1.4). (b) Microembolus with giant cells (arrows) on the left lateral aspect (hematoxylin-eosin, original magnification ×17.6).
Mentions: The patient underwent wedge resections of the lingula and left lower lobe and biopsy of a hilar lymph node. Histological sections of the lung showed multiple foci of metastatic RCC, measuring up to 1.0 cm in greatest dimension (Figure 2). In addition, numerous muscular pulmonary arteries contained trisacryl gelatin microemboli (Figure 3) and had medial hypertrophy consistent with pulmonary hypertension. Colocalization of metastatic RCC and trisacryl gelatin microspheres was noted (Figure 4). Sections of the hilar lymph node showed metastatic RCC.

Bottom Line: Her past medical history included clear cell RCC, which was treated with preoperative trisacryl gelatin microsphere RAE and right nephrectomy 9 years earlier.Computed tomography of the chest showed multiple lung nodules, a mass-like density in the left lower lobe, and mediastinal and hilar lymphadenopathy.Wedge resections of the lung showed multiple foci of metastatic RCC and extensive involvement of the muscular pulmonary arteries by trisacryl gelatin microspheres.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary and Allergy Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.

ABSTRACT
This is the first report, to our knowledge, of widespread, histologically confirmed trisacryl gelatin pulmonary microembolism after renal artery embolization (RAE). In addition, this is the first report of lung involvement by both metastatic renal cell carcinoma (RCC) and an embolic agent used for RAE. The patient was a 63-year-old woman who recently presented with both dyspnea on exertion and productive cough. Her past medical history included clear cell RCC, which was treated with preoperative trisacryl gelatin microsphere RAE and right nephrectomy 9 years earlier. Computed tomography of the chest showed multiple lung nodules, a mass-like density in the left lower lobe, and mediastinal and hilar lymphadenopathy. Wedge resections of the lung showed multiple foci of metastatic RCC and extensive involvement of the muscular pulmonary arteries by trisacryl gelatin microspheres.

No MeSH data available.


Related in: MedlinePlus