A 57-year-old man (No Ha 3877389) with a history of resection of sigma due to intestinal adenocarcinoma six years ago was admitted to our hospital with the diagnosis of recurrent right renal mass nephritic nephrotic syndrome.c
Physical examination showed no relevant findings.
In the blood analytical determinations all parameters were within normal limits except glucose (122 mgr/dl), ̄ acid (7.70 mgr/dl) and cholesterol (275 mgr/dl).
Ultrasound and Computerized Axial Tomography (CAT) revealed a lesion in the interpolar region of the right kidney.
Ultrasound was an isoechoic lesion with the rest of the parenchyma and moderately exophytic of approximately 5 cm in diameter.
The CT scan showed a 4.5 cm hypodense lesion with a slightly lobulated contour-like diameter and exophytic growth, which was slightly enhanced after intravenous contrast administration.
It was recommended to re-launch a magnetic resonance, in which a complex mass was observed in the interpolar region of the right kidney with exophytic growth approximately 4.3 x 4.1 cm separated multiple contrasts, cystic thin septa.
No retroperitoneal pathological lymph nodes, adrenal gland metastases, or renal vein or inferior vena cava thrombi were identified.
With imaging techniques the main diagnostic options were multilocular cystic nephroma or cystic renal carcinoma.
Right partial nephrectomy was performed by lumbar incision with pre-operative histological evidence of surgical resection margins: free surgical margins.
1.
Macroscopically, a piece of partial nephrectomy weighing 109 grs and measuring 6.5 x 4.5 x 4.5 cm was received.
Most of the specimen was occupied by an eccentric tumor of well-defined borders that did not macroscopically resemble fat or adjacent renal parenchyma.
The tumor was grayish, microcystic and had a diameter greater than 5 cms.
He did not contact the surgical margins of resection.
The histological study showed a tumor composed of multiple ducts of diverse size that were covered by a tapered epithelium or flat, sometimes adopting a "tachuela" morphology.
Cells showed a slight increase in the nucleus/cytoplasmic and striking features ratio, with mitoses being very occasional.
The ducts were of various sizes and sometimes adopted a microcystic pattern.
A stroma with marked demoplasia was observed between the ducts.
No areas of necrosis or hemorrhage were observed.
In the surrounding renal parenchyma, focal areas of hyperplasia and dysplasia are observed in the collecting tubules that did not contact the resection surgical margin.
Immunohistochemical studies showed intense positivity for keratins (AE1-AE3), high molecular weight (CKEM7) and vimentin staining European high molecular weight (CKEM), weak positivity for antigen of epithelial membrane.
The definitive diagnosis was collecting duct carcinoma of 5 cm in diameter larger than non-fat mass and respected surgical borders.
Stage pT1b and Fuman grade II.
Currently, with a 4-month follow-up, the patient is asymptomatic and tumor-free.
