PMC3114540_01
Abdominal computed tomography demonstrated two masses, 2.1 x 2.0 cm and 2.4 x 2.2 cm in diameter, at the middle of the left kidney with acquired cystic disease of the kidney.
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An 81-year-old man under hemodialysis for 6 years was incidentally discovered to have two left renal masses with ACDK (Figures 1(a)-1(d)).
(a) Actual port placement for a left nephrectomy. (b) Photograph of a patient's abdomen 1 month postoperatively.
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One 10-mm and a 5-mm trocars were placed on either side of camera port on the edges of the GelPort (Figure 2(a)). The skin incision was a small single scar 1 month postoperatively (Figure 2(b)).
Intraoperative view after renal hilus dissection. (a) Renal artery was divided with Hem-O-Lok clips. (b) The renal vein was clipped with Hem-O-Lok clips. (c) Dissection of the inferior pole of the kidney from the undersurface of the peritoneum in a satisfactory degree of triangulation.
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The renal artery was dividedand triple-clippedwith Hem-O-Lok clips (size L), and the renal vein was divided with 4 Hem-O-Lok clips (size XL) (Figures 3(a) and 3(b)).
Histological findings (H&E staining) (a) The posterior tumor consisted of clear renal cell carcinoma in alveolar pattern (x40). (b) The tumor cells were round or polygonal with abundant cytoplasm (x200). (c) The lateral tumor was composed solely of eosinophilic cells in tubulocystic pattern (x40). (d) The tumor cells had small nuclei with granular cytoplasm (x200).
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The resected specimen was pathologically diagnosed as clear cell carcinoma and renal oncocytoma with ACDK (Figures 4(a)-4(d)).