15]
Vikram S. Dogra, MD OPEN ACCESS
Editor-in-Chief:
Department of Imaging Sciences, University of
Received : 30-01-2013
Key words: Horseshoe kidney, radiology and pathology correlation, renal cell
Accepted : 07-02-2013
carcinoma
Published : 29-03-2013
10.4103/2156-7514.109725
Copyright: 2013 Alamer A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.
a b
Clear cell RCC, the pathology subtype, as found in our
Figure 4: Hematoxylin and eosin stained slides of the clear cell renal cell case, is typically a solitary tumor and the tumor commonly
carcinoma (RCC) mass in a a horseshoe kidney. (a) At x6 magnification
b shows c
presents as bosselated, well-circumscribed mass with
the tumor margin (arrow) in relation to the reminder of the kidney, (b) At 300
shows clear cells with prominent cell borders (black arrow) and vascularity fibrosis and with a capsuleoforthepseudo-capsule.
Figure 1: (a-c) CT scan images of the abdomen obtained at the level of inferior mesenteric artery. (a) Before administration Cystic
contrast material shows a horseshoe
(yellow arrow). (arrow). Post-contrast images in b) axial and c) coronal planes show adegeneration
kidney anomaly is often
large mass arising from the leftseen.
part of[6]
theLipid-rich cells (arrow).
horseshoe kidney in clear
TheRCC
mass is multi-lobulated and heterogeneous in attenuation with a central area of cystic necrosis.
impart the classical golden yellow color seen on gross
pathology analysis. Clear cell RCC appears heterogeneous
functioning renal parenchyma or fibrous tissue that crosses with areas of necrosis and hemorrhage. Clear cell RCC may
anterior-posterior, width,
the mid-line of the body. and crainio-caudal maximum
dimensions, respectively [Figure 1b and c]. The renal vein exhibit a variety of histo-architectural patterns including,
and intravenous vena cava were patent and there was no solid, alveolar, and acinar forms.[7]
Nearly,
evidence one-third of all patients
of significant enlargedwith a horseshoe lymph
intra-abdominal kidney
remain
nodes. Noasymptomatic and thewas
distant metastasis pathology is discovered
detected. The diagnosis
incidentally
made was RCC during
withphysical examination
a horseshoe or CT
kidney and and was
patient
ultrasound scans.
sent for urology [3] When symptoms
consultation are present,
and surgical resection.they are
related to hydro-nephrosis, infection, or calculus formation. CONClUsION
The incidence of renal tumor in a horseshoe kidney is
approximately 3 to 4 times greater than in normal population, Horseshoe kidney is the most common renal fusion anomaly
and is possibly the result
Hemi-nephrectomy of chronic at
was performed obstruction, lithiasis, andand is more predominate in males and it is detected mostly
our institute.
infection. RCC
Follow-up[3]CT is the
scan most
of the common
abdomen neoplasm
and associated as incidental finding on CT or US examination. RCC is one
pelvis obtained
with horseshoe kidney. The tumor can localized
in the post-operative period revealed resection of any part of the malignancies associated with this malformation, as
at the
of the kidney
previously but it mostly
described found within
large mass within the
the left
isthmus.
part of
[4] was seen in our case.
the horseshoe kidney. No residual tumor or recurrence
was seen. The right part of the horseshoe kidney was
unremarkable [Figure 2].
RefeReNCes
Figure 2: Single selected axial computed tomography scan image of the
CT utilizing routine renal mass protocol is the primary 1. Weizer
abdomen AZ, Silverstein
performed AD, Augeperiod
in the post-operative BK, Delvecchio FC, Raj
shows resection G,large
of the Albala DM,
mass et al. left
in the Determining the incidence
part of the horseshoe kidneyofwith
horseshoe kidney surgery.
organ preserving from
imaging modality of choice for localization and staging of
PaThOlOgICal feaTURes
any renal tumor. However, in case of RCC and horseshoe
radiographic
The right part is grossly unremarkable (arrow).
data at a single institution. J Urol 2003;170:1722-6.
The surgically
kidney, removed gross
CT angiography specimen
is highly was a large
recommended mass,
to check 2. Hadzi-Djoki J, Colovi V, Pejci T, Dragievi D. Renal cell carcinoma
which
the hadvascularity,
renal replaced more than
which 2/3 of the
generally left and
varies sideisofessential
the in a horseshoe kidney. Acta Chir Iugosi 2009;56:97-9.
horseshoe
for kidney.planning.
pre-operative The massIf was lobulatedisand
CT scanning variegated, 3. Ying-Long S, Yue-Min X, Hong X, Xiao-Lin X. Papillary renal cell
performed
carcinoma in the horseshoe kidney. South Med J 2010;103:1272-4.
ranging from
specifically totan and yellow
evaluate a knownto dark
renalbrown.
mass,Ittheshowed
study Yab e r- G me z E K , C or te s - Arc o s Y, G on z l e z - Ru i z F G ,
scattered
must hemorrhagic
include and necrotic
an unenhanced areas [Figure
examination prior to3].
theNo 4. Gonzlez-Gomez A, Zuviri-Gonzale A, De Leon-Angeles P, et al.
gross tumor infiltration
administration was identified
of intravenous contrastinmaterial.
the adjoining
After Clear cell carcinoma in horseshoe kidney: A case report and literature
kidney.
administration of contrast, scans are taken at intervals review. Rev Mex Urol 2010;70:111-5.
Israel GM, Bosniak MA. How I do it: Evaluating renal masses. Radiology
of 40 s and 100 s during the enhancement phase. [5] The 2005;236:441-5.
dataset can be manipulated by using a 3D workstation to 5. Grignon DJ, Che M. Clear cell renal cell carcinoma. Clin Lab Med
produce volume-rendered and 3D images when necessary. 2005;25:305-16.
Hematoxylin-Eosin (H and E)
It is becoming increasingly stained histology
important slides to
for radiologists 6. Prasad SR, Humphrey PA, Catena JR, Narra VT. Common
of the above
produce described mass
3D reconstructed revealed
images clearlaparoscopic
as more cell RCC and uncommon histology subtypes of renal cell carcinoma:
Imaging spectrum and pathological correlation. Radiographics
with prominent borders and profuse network
surgery is being performed for the treatment of renal of small, 7. 2006;26:1795-806.
thin-walled
cancer, andsinusoid-like
these images blood vesselsin[Figure
are helpful 4a and b].
such procedures.
The mass was graded as Grade 2 using Fuhrman nuclear
grading system. No capsular invasion was seen. The
diagnosis was made to be conventional type, clear cell RCC.
2
3 Journal of Clinical Imaging Science | Vol. 3 | Issue 1 | Jan-Mar 2013