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Management of renal cell carcinoma presenting as inflammatory renal mass.

Eltahawy E, Kamel M, Ezzet M - Urol Ann (2015 Jul-Sep)

Bottom Line: With a positive biopsy radical surgery was considered, while with a negative result a follow up CT was planned.Histopathology and bacteriology are the mainstay of diagnosis.If biopsy was negative, follow up should include a CT scan to exclude any residual enhancing masses.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Arkansas for Medical Sciences, USA.

ABSTRACT

Introduction: Renal cell carcinoma (RCC) can have a wide spectrum of clinical presentations. In the immunocompromised patient fever and an inflammatory renal mass can harbor RCC.

Materials and methods: We reviewed the charts of patients who were managed at our department during 1998-2008 as renal abscess or perinephric collection. Renal ultrasound and subsequently abdominal CT was done. Medical treatment in the form of antibiotics, control of diabetes and drainage was done. Percutaneous or open biopsy, pus cultures, and histopathology were used to guide therapy. With a positive biopsy radical surgery was considered, while with a negative result a follow up CT was planned.

Results: We identified 11 patients who had high fever, a renal abscess (in 4), or a suspicious mass with perinephric collection (in 7), and were eventually diagnosed to have RCC. Mean patient age was 66 years (53-82). 8 patients had uncontrolled diabetes. Five patients had a percutaneous drainage biopsy; of those two had a positive histopathology, the other three patients had a persistent enhancing mass on follow-up CT scan. Of this group three patients underwent radical nephrectomy. Another five patients had open drainage and biopsy, four patients had very poor performance status. One patient had radical surgery without the need for biopsy.

Conclusion: In the elderly and immunocompromised patient renal cancer may present as renal abscess or perinephric collection. Histopathology and bacteriology are the mainstay of diagnosis. If biopsy was negative, follow up should include a CT scan to exclude any residual enhancing masses.

No MeSH data available.


Related in: MedlinePlus

Renal CT scan with large right perirenal collection with areas of increased tissue enhancement
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Figure 3: Renal CT scan with large right perirenal collection with areas of increased tissue enhancement

Mentions: There were a total of 11 patients with constitutional symptoms of toxemia, high fever (>39°C), and an inflammatory renal lesion. Patient data and management are summarized in Table 1. Mean patient age was 66 years (53-82). All but 3 patients had uncontrolled diabetes and were started during their hospital stay on short acting insulin by sliding scale protocol. 5 patients had renal impairment (s. creatinine > 1.4 mg/ml). Pelvi abdominal US and CT findings were: Renal abscess in four, and a suspicious mass with perinephric collection extending in the psoas with or without gas, in seven patients. The size of this suspicious mass was < 5 cm in five patients and > 5 cm in two patients. Initial management was broad-spectrum antibiotics, antipyretics, and fluids, later adjustments according to the case progress were done. Five of the patients in this study underwent percutaneous drainage and biopsy [Figure 1]. Of the five patients, histopathology in two patients revealed renal adenocarcinoma Furman grade (I-II), with extensive necrosis and inflammatory infiltrate. In those two patients with a positive biopsy elective radical surgery was planned. The three other patients had persistent enhancing mass in the follow-up CT scans despite a negative biopsy. One of them only was prepared for a nephrectomy. By radiography alone one patient had a highly suspicious mass; arteriography was performed to confirm the diagnosis [Figure 2]. After the initial therapy he underwent radical nephrectomy. Five patients had a collection of pus that was drained by open surgical drainage [Figure 3]. The initial histopathology revealed no evidence of malignancy in two of them. Those were discharged for follow up. The wound site however continued to discharge pus. The follow-up CT scan revealed a resectable mass in one patient who underwent nephrectomy. In the other patient, the mass was irresectable. Three patients who underwent open drainage and biopsy had RCC on histopathology. Their performance status did not allow further therapy.


Management of renal cell carcinoma presenting as inflammatory renal mass.

Eltahawy E, Kamel M, Ezzet M - Urol Ann (2015 Jul-Sep)

Renal CT scan with large right perirenal collection with areas of increased tissue enhancement
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4518369&req=5

Figure 3: Renal CT scan with large right perirenal collection with areas of increased tissue enhancement
Mentions: There were a total of 11 patients with constitutional symptoms of toxemia, high fever (>39°C), and an inflammatory renal lesion. Patient data and management are summarized in Table 1. Mean patient age was 66 years (53-82). All but 3 patients had uncontrolled diabetes and were started during their hospital stay on short acting insulin by sliding scale protocol. 5 patients had renal impairment (s. creatinine > 1.4 mg/ml). Pelvi abdominal US and CT findings were: Renal abscess in four, and a suspicious mass with perinephric collection extending in the psoas with or without gas, in seven patients. The size of this suspicious mass was < 5 cm in five patients and > 5 cm in two patients. Initial management was broad-spectrum antibiotics, antipyretics, and fluids, later adjustments according to the case progress were done. Five of the patients in this study underwent percutaneous drainage and biopsy [Figure 1]. Of the five patients, histopathology in two patients revealed renal adenocarcinoma Furman grade (I-II), with extensive necrosis and inflammatory infiltrate. In those two patients with a positive biopsy elective radical surgery was planned. The three other patients had persistent enhancing mass in the follow-up CT scans despite a negative biopsy. One of them only was prepared for a nephrectomy. By radiography alone one patient had a highly suspicious mass; arteriography was performed to confirm the diagnosis [Figure 2]. After the initial therapy he underwent radical nephrectomy. Five patients had a collection of pus that was drained by open surgical drainage [Figure 3]. The initial histopathology revealed no evidence of malignancy in two of them. Those were discharged for follow up. The wound site however continued to discharge pus. The follow-up CT scan revealed a resectable mass in one patient who underwent nephrectomy. In the other patient, the mass was irresectable. Three patients who underwent open drainage and biopsy had RCC on histopathology. Their performance status did not allow further therapy.

Bottom Line: With a positive biopsy radical surgery was considered, while with a negative result a follow up CT was planned.Histopathology and bacteriology are the mainstay of diagnosis.If biopsy was negative, follow up should include a CT scan to exclude any residual enhancing masses.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Arkansas for Medical Sciences, USA.

ABSTRACT

Introduction: Renal cell carcinoma (RCC) can have a wide spectrum of clinical presentations. In the immunocompromised patient fever and an inflammatory renal mass can harbor RCC.

Materials and methods: We reviewed the charts of patients who were managed at our department during 1998-2008 as renal abscess or perinephric collection. Renal ultrasound and subsequently abdominal CT was done. Medical treatment in the form of antibiotics, control of diabetes and drainage was done. Percutaneous or open biopsy, pus cultures, and histopathology were used to guide therapy. With a positive biopsy radical surgery was considered, while with a negative result a follow up CT was planned.

Results: We identified 11 patients who had high fever, a renal abscess (in 4), or a suspicious mass with perinephric collection (in 7), and were eventually diagnosed to have RCC. Mean patient age was 66 years (53-82). 8 patients had uncontrolled diabetes. Five patients had a percutaneous drainage biopsy; of those two had a positive histopathology, the other three patients had a persistent enhancing mass on follow-up CT scan. Of this group three patients underwent radical nephrectomy. Another five patients had open drainage and biopsy, four patients had very poor performance status. One patient had radical surgery without the need for biopsy.

Conclusion: In the elderly and immunocompromised patient renal cancer may present as renal abscess or perinephric collection. Histopathology and bacteriology are the mainstay of diagnosis. If biopsy was negative, follow up should include a CT scan to exclude any residual enhancing masses.

No MeSH data available.


Related in: MedlinePlus