Renal cell carcinoma in a pancake kidney: A rare entity.

Pancake kidney is a rare form of renal fusion anomaly. Renal cell carcinoma in such an entity is even rarer and poses a challenge in management due to anomalous vessels. We describe one such patient with an emphasis on successful performance of partial nephrectomy by meticulous planning, with good oncological and functional outcomes. Copyright:

INTRODUCTION

Pancake kidney is a rare form of fusion anomaly with an estimated incidence of 1:65,000–375,000 population.[1] Associated malignancy is even rarer, with only one pediatric rhabdomyosarcoma having been reported so far in a pancake kidney.[2]

CASE REPORT

A 60-year-old male presented with a renal mass of 6 cm × 5 cm size, located in the right moiety of a pancake kidney, at the site of fusion of both moieties, just below the aortic bifurcation [Figure 1a and b]. Bilateral renal arteries were arising from the ipsilateral external iliac arteries with an accessory renal artery on the right side from the aorta [Figure 1c].

Figure 1

Contrast-enhanced tomographic scan showing pancake kidney with a tumor at the upper pole (a) arterial phase, (b) urographic phase, (c) threedimensional reconstruction of vascular anatomy

Intraoperatively, both the feeding renal arteries were looped and clamped [Figure 2a and b]. The mass was then dissected all around, and the tumor was resected with a normal parenchymal margin. The pelvicalyceal system was repaired using 4–0 Vicryl sutures. Renorrhaphy was performed using barbed sutures and hem-o-lock clips [Figure 2c and d]. The warm ischemia time was 11 min. Histopathology revealed clear cell carcinoma with negative surgical margins. The patient was doing well with preserved renal function without recurrence at 6 months [Figure 3].

Figure 2

(a): Intraoperative image: black arrow showing arterial control of the right-sided artery arising from the right common iliac artery, (b) intraoperative image: blue arrow showing arterial control from the left-sided artery arising from the left common iliac artery, (c) intraoperative image showing tumor bed, (d) cut-open specimen

Figure 3

Follow-up computed tomography scan at 6 months

DISCUSSION

Performing nephron-sparing surgery in a pancake kidney presents great challenge because of uncertain blood supply. Computed tomography angiography becomes an imperative tool in preoperative planning. We report this case for the rarity of its occurrence and successful management.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.