ABSTRACT
Metanephric adenoma (MA) is a rare embryonal epithelial tumor that is often diagnosed incidentally. A definitive diagnosis can only be made postoperatively based on the pathological findings. This case report discusses the rare occurrence of a metanephric adenoma, the symptoms it can present with, and the diagnosis, treatment, and immunological staining needed to differentiate metanephric adenoma from other types of renal tumors. In this study, a 37-year-old female presented to the emergency room for vague right lower quadrant pain (RLQ) and underwent imaging that showed a lesion on the lower pole of the left kidney. A subsequent biopsy of the lesion showed a low-grade renal epithelial neoplasm favoring metanephric adenoma. The patient successfully underwent a left partial nephrectomy to remove the tumor, which required no further treatment after resection. Due to the rarity of the tumor, it requires immunohistology to differentiate from other renal tumors such as Wilm's tumor and renal cell carcinoma. This case report aims to recognize proper workup, diagnosis, and treatment to achieve a positive outcome in the setting of this rare tumor.
ABSTRACT
Malignant peripheral nerve sheath tumors are rare in the genitourinary organs, with few reports of occurrence in the kidney. We describe a patient with a renal malignant peripheral nerve sheath tumor, discovered after excision of a malignant peripheral nerve sheath scalp lesion, with additional masses in the lung and shoulder on metastatic evaluation. This patient underwent neoadjuvant intravenous doxorubicin therapy, followed by surgical resection of the scalp, lung and shoulder lesions in addition to a radical nephrectomy.
Subject(s)
Kidney Neoplasms/diagnosis , Nerve Sheath Neoplasms/diagnosis , Aged , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Kidney Neoplasms/surgery , Nephrectomy , Nerve Sheath Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
PURPOSE: Breakthrough urinary tract infections (UTI) are considered an indication for surgical intervention in children with vesicoureteral reflux (VUR) with the goal of preventing new or progressive renal scarring. We assessed the incidence of new renal parenchymal inflammatory changes following breakthrough UTI in patients on antibiotic prophylaxis for VUR. MATERIALS AND METHODS: We prospectively analyzed 38 patients (62 refluxing renal units) with VUR. All patients experienced a culture documented breakthrough UTI (greater than 100,000 cfu/ml) while taking antibiotic prophylaxis. Dimercapto-succinic acid (DMSA) scans were obtained 4 to 6 weeks after UTI to detect new renal inflammatory changes and all scans were reviewed by the same pediatric nuclear medicine specialist (MM). To avoid misinterpretation of preexistent renal scarring for acute inflammation, new pyelonephritis was confirmed by comparison to prior DMSA scan. RESULTS: Of 38 patients 14 (38%) had preexistent renal scarring but only 1 (7%) manifested new changes on DMSA scan. Of the remaining 24 patients with normal baseline studies 3 (12.5%) had changes after UTI. Overall, only 4 patients (10.5%) manifested new changes on DMSA scan. Three additional patients who did not have a baseline scan for comparison demonstrated unequivocal changes of acute pyelonephritis on DMSA scan, increasing the incidence to 17% (7 of 41). Of the patients 7 (17%) underwent surgical correction of reflux and 34 (83%) were maintained on antibiotic prophylaxis. CONCLUSIONS: Of patients with VUR who experienced a single breakthrough UTI while on antibiotic prophylaxis, at most only 17% had renal inflammatory changes on acute DMSA scan. Our findings endorse the usefulness of DMSA scan in tailoring management of VUR and breakthrough UTI cases, and lend support to continued nonoperative management for the majority.
