Renal Cell Carcinoma in a Pregnant Woman With Horseshoe Kidney

Renal and Bladder Cancer During Pregnancy: A Review of 47 Cases and Literature-based Recommendations for Management

OBJECTIVE

To provide contemporary gestational age-specific recommendations for management, a retrospective series of patients with renal or bladder cancer during pregnancy is reported.

METHODS

Obstetric and oncological data of pregnant patients with a diagnosis of renal or bladder cancer were selected from the worldwide registry of the International Network of Cancer, Infertility and Pregnancy. In addition, the literature was reviewed for recent case reports since last reviews in 2014 for renal cancer and 2004 for bladder cancer.

RESULTS

International Network of Cancer, Infertility and Pregnancy registered 22 cases (14 renal cancer and 8 bladder cancer), diagnosed between 1999 and 2017, and the literature reported 15 cases with renal cancer and 10 cases with bladder cancer between 2004 and 2019. Most common symptoms for renal and bladder cancer were pain (28%) and hematuria (66%), respectively. In more than half of the patients, surgical treatment was performed during pregnancy. Preterm deliveries were mostly medically induced (12 of 17, 71%) and all patients with a planned delivery before 34 weeks had advanced cancer. For renal and bladder cancer respectively, 79% and 87% of patients obtained complete remission. Advanced cancer stages had worse prognosis; 3 of 7 patients with known follow-up deceased within 15 months after diagnosis.

CONCLUSION

Gestational age at diagnosis determines further management of renal and bladder cancers during pregnancy. Advanced stages challenge decision-making. The maternal needs for immediate treatment, and the neonatal risks including the impact of a preterm delivery should be discussed in a multidisciplinary setting while respecting the patient's autonomy.

Renal cell carcinoma treatment during pregnancy: Histopathological findings suggestive of rapid tumor growth

Introduction

Diagnosis of renal cell carcinoma during pregnancy is rare. We report a case of renal cell carcinoma during pregnancy with rapid growth.

Case presentation

A 39‐year‐old woman presented to our hospital for treatment of renal tumor at 22 weeks gestation. The tumor had a cystic lesion with a partition and showed rapid growth from 28 mm to 32 mm over a period of 4 weeks. The tumor was diagnosed as renal cell carcinoma and an open partial nephrectomy was scheduled at 26 weeks gestation. The operation and perioperative course were successful. Pathological findings confirmed the tumor to be clear cell renal cell carcinoma with G2 > G3, Fuhrman grade 2, pT1a, negative surgical margin, and positive detection of progesterone receptor.

Conclusion

We reported the successful management of a patient who was diagnosed with renal cell carcinoma during pregnancy. We also had a suggested association between rapid growth tumor and progesterone based on histopathological analysis of the tumor.

Diameters of Arteries Supplying Horseshoe Kidneys and the Level They Branch off Their Parental Vessels: A CT-Angiographic Study

Background: The most common renal fusion anomaly is horseshoe kidney (HSK), a condition associated with variable arterial blood supply. The aim of this study was to determine whether the height of origin of the renal artery determines its diameter and whether it differs from the mean diameter of the renal arteries of normal kidneys (NK). Methods: Computer tomography angiography (CTA) studies of 336 patients (88 HSK and 248 NK) were obtained in a search of renal arteries; these were than classified into four groups according to height of its origin: Group I, branching from the aorta superior to the inferior mesenteric artery (IMA); Group II, branching from the aorta below the IMA; Group III, branching from the iliac artery; and Group IV, originating from the internal and external iliac artery. Results: The HSK group included 398 arteries (mean diameter 4.30 mm) and the NK group 598 (5.52 mm) (p < 0.0001). In the HSK group, the mean diameters according to groups were: Group I, 4.54 mm; Group II, 4.28 mm; Group III, 3.41 mm; and Group IV, 3.43 mm. Statistically significant differences were found between arteries originating from the aorta and arteries branching from the iliac arteries (p < 0.0001). In the NK group, the corresponding values were: Group I, 5.53 mm; and Group II, 4.45 mm. The number of arteries supplying the HSK wider than 3.0 mm were: Group I, 83.0%; Group II, 82.4%; Group III, 68.4%; and Group IV, 66.6%. Conclusions: The renal arteries of the HSK branch from their parental vessels at lower levels and have smaller diameters than those of NK.

Renal cell carcinoma diagnosed during pregnancy: a case report and literature review

Diagnosing cancer during pregnancy is uncommon. Although pregnancies with concomitant malignancies have been reported, urological tumours are possibly the most rarely identified tumours during pregnancy. Renal cell carcinoma appears to be the most common urological malignancy during pregnancy. In this case report, we discuss successful management of a patient who was diagnosed with renal cell carcinoma during the antenatal period.