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BMJ Case Rep ; 14(11)2021 Nov 17.
Article in English | MEDLINE | ID: covidwho-1522936


After radical nephrectomy, clear cell renal cell carcinoma (ccRCC) recurs locally in <3% of patients. Recurrences typically occur 1-2 years postoperatively and grow at 5-20 mm per year. In contrast, this patient's recurrence was unexpectedly large and swift. A 71-year-old woman was initially found on workup for recurrent urinary tract infections to have a 12 cm left renal tumour. After negative staging scans, she progressed to left open radical nephrectomy. Histology revealed a stage T2b 12 cm ccRCCwith sarcomatoid differentiation, International Society of Urological Pathology (ISUP) grade 4, with clear margins. Only 3 months later, the patient developed left-sided abdominal pain, and CT scans revealed a 15 cm left retroperitoneal local recurrence, as well as widespread peritoneal tumours. In discussion with her treating team, the patient and her family elected not to undergo biopsy or systemic therapy. The patient was palliated and passed away 8 days after re-presentation.

Carcinoma, Renal Cell , Kidney Neoplasms , Aged , Carcinoma, Renal Cell/diagnostic imaging , Carcinoma, Renal Cell/surgery , Female , Humans , Kidney Neoplasms/diagnostic imaging , Kidney Neoplasms/surgery , Neoplasm Recurrence, Local/surgery , Nephrectomy , Treatment Outcome
BMJ Case Rep ; 14(11)2021 Nov 16.
Article in English | MEDLINE | ID: covidwho-1522934


Renal arteriovenous malformation is a primarily congenital renal vascular abnormality. It is usually diagnosed incidentally on imaging, and the most common subtype is 'cirsoid', consisting of multiple, enlarged arterial feeders interconnecting with draining veins. We present a 74-year-old woman with an incidental finding of what was at first considered a hypervascularised kidney tumour but turned out to be a left intrarenal arteriovenous malformation associated with a left renal vein thrombosis. Selective endovascular embolisation was performed. The cause-consequence relationship between the arteriovenous malformation and the thrombosis is unique. To our knowledge, no such case has ever been reported.

Arteriovenous Malformations , Kidney Neoplasms , Urologic Diseases , Venous Thrombosis , Aged , Arteriovenous Malformations/complications , Arteriovenous Malformations/diagnostic imaging , Female , Humans , Kidney Neoplasms/diagnosis , Kidney Neoplasms/diagnostic imaging , Renal Veins/diagnostic imaging , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/etiology
Am J Emerg Med ; 47: 316.e1-316.e3, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1141562


While primarily a respiratory illness, infection with the novel coronavirus (COVID-19) is associated with pathologic changes in coagulation, characterized by both thromboembolic and bleeding events. We present the case of a 22-year-old female diagnosed with renal angiomyolipoma (AML) rupture 2 weeks after COVID-19 infection, ultimately requiring admission for hemorrhage control via endovascular embolization. Emergency medicine physicians should maintain a high index of suspicion for renal AML rupture and other spontaneous bleeding events in patients with recent COVID-19 infection due to a possible correlation between the two.

Angiomyolipoma/complications , COVID-19/complications , Hemorrhage/etiology , Kidney Neoplasms/complications , Angiomyolipoma/diagnostic imaging , Angiomyolipoma/therapy , Embolization, Therapeutic/methods , Female , Hemorrhage/diagnostic imaging , Hemorrhage/therapy , Humans , Kidney Neoplasms/diagnostic imaging , Kidney Neoplasms/therapy , Rupture , SARS-CoV-2 , Young Adult