PMC2685045_01
A 59-year-old man with renal cell carcinoma in a horseshoe kidney.. A. Preoperative CT scan reveals a horseshoe kidney with a well enhanced isthmus (white arrows) and a 3-cm enhancing mass (black arrows) close to the collecting system in the left part.. B. Digital subtraction angiography of the aorta at the level of the isthmus shows the isthmus was fed by a three-vessel supply that consisted of two aberrant vessels (arrows) originating from the aorta, which entered both sides of isthmus, and an additional vessel to the medial portion of the left side of the isthmus that originated from the left common iliac artery (curved arrow).. C. Digital subtraction angiography of the left renal artery demonstrates hypervascular tumor staining (arrows) that was supplied by the anterior inferior segmental branch of the left main renal artery. The tumor feeding vessel was superselectively catheterized with the use of a 3-F microcatheter, and then it was embolized with Contour and a microcoil. . D. Postembolization angiography shows successful segmental embolization of the anterior inferior segment of the left kidney, including the tumor.. E. Gross specimen shows a well-circumscribed, bright yellow mass (arrows) that measured about 3 cm.. F. Microscopically, the tumor was a typical clear cell carcinoma showing abundant clear cytoplasm, bland nuclei and small inconspicuous nucleoli (H & E stain, x300).. G. A follow-up CT scan 33 days after surgery shows the parenchymal defect (arrow) at the previous tumor site with postoperative changes.
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F1
A CT scan (LightSpeed QX/i, General Electric Co., Milwaukee, WI, USA) with contrast media was performed and it incidentally revealed a horseshoe kidney with a well-enhanced isthmus and a 3-cm enhancing mass in the left part (Fig. 1A). The DSA of the aorta showed that the horseshoe kidney was fed by a five-vessel supply that consisted of both the two normal main renal arteries, two aberrant vessels that were originating from the aorta and they entered both sides of the isthmus (Fig. 1B), and an additional vessel (Fig. 1B) that entered the left side of the isthmus and it originated from the left common iliac artery. The DSA of the left renal artery demonstrated hypervascular tumor staining that was supplied by the anterior inferior segmental branch of the left main renal artery (Fig. 1C). The feeding vessel to the tumor was catheterized with the use of a 3-F microcatheter (Renegade; Boston Scientific, Watertown, MA, USA) and it was embolized superselectively with Contour (355-500 microns, Boston Scientific International, La Garenne Colombes Cedex, France) (Fig. 1C). The contour granules were slowly and carefully injected (to prevent reflux of the particles) under fluoroscopic guidance before embolization with the use of a 0.018-inch-diameter Tornado microcoil (3 mm to 2 mm, Cook). A postembolization angiography shows a successful segmental embolization of the anterior inferior segment of the left part kidney, including the tumor (Fig. 1D). Upon examination of the gross specimen, the tumor showed as a well-circumscribed, bright yellow, solid mass measuring about 3 cm at its greatest diameter (Fig. 1E). The tumor was confined to the kidney and it proved to be a renal cell carcinoma, grade 2 (Fig. 1F).