PMC5458372_01
Time course of tumor marker during treatment period.
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August 2013. She was required to undergo follow-up surveillance every three months. As shown in Figure 1, the aforementioned surveillance indicated elevated levels of serum protein induced by vitamin K absence II (PIVKA-II) and alpha-fetoprotein (AFP); however, the intrahepatic space-occupying lesion was not identified by the follow-up enhanced computed tomography (CT) and ultrasonography.
Computed tomography (CT) findings. (a) The initial enhanced CT (arterial phase), depicting massive retroperitoneal bleeding. (b) The previous CT (late portal phase), performed one year before the emergent admission, depicting the renal tumor mimicking a simple renal cyst.
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Table 1. The initial enhanced CT revealed an active retroperitoneal hemorrhage surrounding the right renal tumor, measuring 80 x 60 mm (maximum dimensions) (Figure 2(a)). When retrospectively reviewed, a prior enhanced CT revealed that the right renal tumor mimicked a simple renal cyst, which exhibited low density by plain examination and no enhancing effect from the contrast agent (Figure 2(b)).
Right renal arteriography. (a) The tumor was fed by the dorsal branch of the renal artery and extravasation from the tumor. (b) Hemorrhage disappeared after the TAE.
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Follow-up CT, performed in September 2015. Marked early enhancement on arterial phase and wash-out on late portal phase indicate growing residual viable lesion.
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Administration of sorafenib was commenced in the outpatient clinic; however, the tumor progressed into the retroperitoneal space two months after the emergent TAE (Figure 4).