Hypernephromas with parasitic blood supply derived from the superior and inferior mesenteric arteries

A rare manifestation of clinical T1 renal tumor with parasitic arterial supply from the superior mesenteric artery

A 50-year-old man with von Hippel-Lindau syndrome who had undergone repeated tumor enucleation and transcatheter arterial embolization for multiple renal cell carcinomas (RCC) was referred to our hospital for percutaneous cryoablation (PCA) of an RCC of 42 mm in the midpole region of the right kidney. Transcatheter arterial embolization was planned prior to devascularize the RCC and selective angiography revealed parasitic arterial supply to the tumor by the ileocecal artery. Parasitic arterial supply to RCCs, particularly in patients with history of nephron-sparing treatment, can originate even from an intraperitoneal source and may lead to unexpected embolization.

The sub-peritoneal arterial plexus of Sir William Turner

Sir William Turner (1832-1916) was Professor of Anatomy at the University of Edinburgh. His classic paper of 1863 on the anastomoses between the parietal and visceral branches of the abdominal aorta, later known as the sub-peritoneal arterial plexus of Turner, has mostly been forgotten. Located in the retroperitoneum and surrounding the kidneys and other adjacent structures, this plexus is an important route of collateral circulation. In the current paper, we discuss the sub-peritoneal arterial plexus as described by Turner in 1863 and review the literature concerning its potential clinical significance in the kidney, emphasizing its probable role in the metastatic spread of various tumors of abdominal organs and in the continuing viability of the kidney after renal artery occlusion. A biographical sketch of Sir William Turner is also presented.

Extrarenal arterial connections of the normal renal artery

An angiographic study in cadavers has demonstrated connections between the renal artery and remote vessels including the intercostal, testicular, and inferior mesenteric arteries in subjects with no known history of renal disease. Such communications are a potential route by which embolic material introduced into the renal artery may inadvertently reach other organs.

Skin necrosis: a complication of alcohol infarction of a hypernephroma

A case of skin infarction after transcatheter ablation of a hypernephroma using alcohol is described. Possible avenues for migration are discussed.

Collateral circulation in stenosis or occlusion of the renal artery

The abdominal angiograms of 381 patients were critically reexamined for the existence of collateral circulation in cases of renal artery stenosis or occlusion. Typical renal artery stenosis was found in 39 patients; among these, 17 had a collateral circulation, which was extrarenal in 15 and intrarenal in two. Collateral circulation involving the lumbar arteries was most common. In two patients a collateral circulation was established via the inferior mesenteric artery.

Parasitic arterial supply to renal angiomyolipoma

A case of a large renal angiomyolipoma in a relatively asymptomatic female subject without tuberous sclerosis is presented. The case demonstrates a parasitized blood supply from a lumbar artery and the superior mesenteric artery, in addition to the characteristic angiographic features that have been reported previously. A parasitized blood supply to renal masses has been considered previously to be associated with malignant processes. It is emphasized that parasitization of a blood supply by a renal mass lesion is not definite evidence of malignancy.

Parasitic blood supply from the inferior mesenteric arteries to the hypernephromas

A case of left hypernephroma obtaining its blood supply from the inferior mesenteric artery is reported. The origin of the blood supply was demonstrated by selective arteriography. It was proved at operation that the hypernephroma can extend beyond the renal capsule and invade the mesentery of the colon.

Why every renal mass is not always a surgical lesion, the need for an orderly, logical, diagnostic approach

The fact that approximately 95 per cent of asymptomatic renal masses are benign is a compelling reason for the streamlined diagnostic approach which is described herein. Within the confines of these guidelines for the study of renal masses, when proceeding from simple to complex methods of evaluation, one should always consider the age of the patient, the status of the cardiovascular system, the radiologic appearance of the mass on drip infusion nephrotomography and the results of renal echography as qualifying determinants and then propose the logical sequence of individualized studies under the best possible circumstances.