Multiple bilateral oncocytomas of the native kidneys following renal transplantation: report of a rare case and review of the literature

Rare images of renal mass and lithiasis in native kidney after renal transplantation in a patient with hematuria: Casual or correlated?

Renal transplantation is a common treatment option for patients with end-stage renal disease. The goal of transplantation is to restore normal renal function and improve their quality of life. However, some patients may experience complications after transplantation, including the development of calculi or tumors in their native kidneys. In such cases, the question arises whether native nephrectomy should be performed during renal transplantation or not. A 62-year-old patient with a history of renal transplant twenty years ago presented a macroscopic hematuria.

Small renal masses in kidney transplantation: overview of clinical impact and management in donors and recipients

Kidney transplantation is the best replacement treatment for the end-stage renal disease. Currently, the imbalance between the number of patients on a transplant list and the number of organs available constitutes the crucial limitation of this approach. To expand the pool of organs amenable for transplantation, kidneys coming from older patients have been employed; however, the combination of these organs in conjunction with the chronic use of immunosuppressive therapy increases the risk of incidence of graft small renal tumors. This narrative review aims to provide the state of the art on the clinical impact and management of incidentally diagnosed small renal tumors in either donors or recipients. According to the most updated evidence, the use of grafts with a small renal mass, after bench table tumor excision, may be considered a safe option for high-risk patients in hemodialysis. On the other hand, an early small renal mass finding on periodic ultrasound-evaluation in the graft should allow to perform a conservative treatment in order to preserve renal function. Finally, in case of a renal tumor in native kidney, a radical nephrectomy is usually recommended.

Bilateral benign renal oncocytomas and the role of renal biopsy: single institution review

BACKGROUND

The goal was to assess the natural history and management of patients with pathologically proven bilateral (synchronous) RO after undergoing initial partial nephrectomy (PN).

METHODS

All patients underwent either robotic/laparoscopic or open PN by two experienced genitourinary oncologists from 2005-2013. Final pathology was determined by surgical excision, CT-guided percutaneous core biopsy (CT-biopsy) or fine needle aspiration (FNA). Patient demographics, tumor characteristics (pathologic data, location, size) type of surgery, pre/post estimated glomerular filtration rate (eGFR) and surgical complications were recorded.

RESULTS

Twelve patients were identified with bilateral RO. Median age at the time of surgery was 68 years (46-77) (Table 1). The median size of the largest tumor(s) resected was 2.75 cm (1.5-5.5 cm) and second largest tumor(s) was 1.75 cm (1.0-4.0 cm). Four patients underwent bilateral staged PN and one patient underwent simultaneous bilateral PN (horseshoe kidney). Two patients underwent RFA at the time of biopsy of the contralateral mass after PN. Five patients underwent CT-bx/FNA (5/5) of the contralateral mass followed by active surveillance. Mean follow up was 34 months. There was no significant change in median creatinine pre- and post-operatively. One patient was lost to follow up and one patient died of unknown causes 5 years post-operatively. eGFR decreased an average of 16.96% post-operatively, including a single patient whose eGFR increased by 7.8% after surgery and a single patient whose eGFR did not change (Table 2).

CONCLUSIONS

Patients with bilateral renal masses and pathologically proven RO can be safely managed with active surveillance after biopsy confirmation of the contralateral mass.

Simultaneous occurrence of non-Hodgkin lymphoma, renal cell carcinoma and oncocytoma: A case report

We herein report the case of a 74 year-old woman with a diffuse large B-cell lymphoma and bilateral renal masses identified on computed tomography scans during the initial staging process. Following partial bilateral nephrectomy, histopathological examination revealed renal cell carcinoma (RCC) and oncocytoma in the left and the right kidneys, respectively. Shortly afterwards, lymphoma of the left palatine tonsil was diagnosed and the patient received chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP regimen), followed by radiotherapy. Due to metastasis of the RCC to the right breast, pancreas and the area of the left psoas major muscle, systemic treatment with pazopanib was commenced. To the best of our knowledge, this is the first reported case of simultaneous diagnosis of non-Hodgkin lymphoma (NHL), RCC and oncocytoma. The aim of this study was to review the related literature, discuss issues regarding the management of this unusual case and identify possible common etiopathological mechanisms underlying the simultaneous occurrence of NHL, RCC and oncocytoma.

Bladder leiomyoma in male patient presenting with renal oncocytoma: Are the two conditions related?

A 64-year-old male patient with a large pelvic mass and a right renal mass was referred to our facility. The patient underwent a right radical nephrectomy and pelvic mass excision. A histopathological examination led to a diagnosis of renal oncocytoma and urinary bladder leiomyoma.