Marc Andre

De Novo Renal Tumors Arising in Kidney Transplants: Midterm Outcome after Percutaneous Thermal Ablation

PURPOSE To retrospectively evaluate the midterm outcome of patients treated for primary renal cell carcinomas arising in kidney transplants with minimally invasive techniques. MATERIALS AND METHODS The institutional review board of each participating institution approved this retrospective study and waived informed consent. This study was HIPAA compliant. A request for cases through the European Society of Urogenital Radiology network was made to institutions for patients who fit the requirements outlined by the authors, and a prospective follow-up of recipients was performed. Twenty-four tumors were identified that developed in the renal allograft of 20 patients from 11 institutions who were treated with radiofrequency ablation (n = 19) or cryoablation (n = 5) between 2003 and 2010. Maximal diameter of masses was 6-40 mm (median, 19.5 mm). Twenty masses were solid, and four were type 4 cystic masses. Preablation biopsy was performed for solid tumors only. All images and biologic and biopsy reports were retrospectively reviewed. Significant differences were determined by using a paired t test before and after ablation. RESULTS Mean follow-up was 27.9 months (range, 7-71 months). Histopathologic examination revealed papillary carcinoma in 17 patients and clear cell carcinoma in three. Tumors were successfully treated with ultrasonographic guidance in six patients, with computed tomographic guidance in 10 patients, and with both in four patients. One case of infection of the tumor site and one case of transitory genitofemoral nerve injury were the only reported complications. No significant change of renal function was noted. Subsequent imaging follow-up did not reveal any case of recurrence in the ablative site. CONCLUSION Percutaneous thermal ablation of renal tumors occurring in renal grafts is effective, with low morbidity. .

Complication tardive d'une artério-embolisation sélective rénale après chirurgie per-cutanée : une "coilique" néphrétique

Resume Les auteurs rapportent le cas d’un patient de 31 ans qui evacue un calcul contenant un coil en platine, dans un tableau de colique nephretique non compliquee. Cinq ans auparavant ce patient avait subi une nephrolithoto-mie percutanee. Une hematurie persistante avait cede grâce a l’embolisation arterielle d’une branche polaire inferieure. Le coil evacue avait ete deploye trop distalement et s’etait enroule dans le faux anevrysnie. Differen-tes hypotheses sont developpees pour tenter d’expliquer le processus physiopathologique.

Angiomyolipomes rénaux sans composante graisseuse : caractéristiques tomodensitométriques, histologiques et évolutives☆

INTRODUCTION Angiomyolipoma is the most frequent benign renal solid tumor. Because of the lack of fat component on the CT scan, diagnosis of this tumor is hard and can require percutaneous biopsy of unknown renal tumor. The follow-up of the poor fat CT scan component AML (PFCT AML) is uncertain. METHODS Five hundred percutaneous renal biopsy under tomodenstitometry have been realised between 1998 and 2008. There was 41 PFCT AML on the 500 biopsy. By definition, a PFCT AML is an AML where the diagnosis is done on a percutaneous biopsy but where there was no fat component on the first CT scan. We studied and compared clinical, tomodensitometric and histologic parameters of these 41 patients (mean age: 56, 9±11.04; sexe rate M/F: 6/35) where renal AML was diagnosed on percutaneous renal biopsy but without fat component on CT scan. Average size was 26.44±14.68mm. We phone-called 16 patients for the long-term follow-up. Average follow-up was 41±28.3 months. For four patients on 16, initial diagnosis was done in front of local symptoms, for one of the 16 diagnosis was done in front of general symptoms, for one of the diagnosis was done during Bourneville tuberous sclerosis evolution and 10 of the 16 was done fortuitously. RESULTS After review of the initial CT scan, fat density was found on 24% of them. Ten percent was epithelioid angiomyolipoma. Four renal biopsy on 41 (10%) was epithelioid AML. No epithelioid AML had fat component after the second look of the CT scan. Among the 16 patients who were phone-called, three (19%) underwent a complication. Two had abdominal pain and was treated medically. Initial sizes were 26 and 30mm. Only one patient must be operated by radical nephrectomy for acute hemorrhage. Initial size was 45mm. No neoplasic degeneration was identified for those 16 patients. CONCLUSION In our study, the PFCT AML rate was 8.2%. In 25% cases, CT scan read-through shown a fat component and could help for the diagnosis. PFCT AML evolution seems to be the same as a classic AML. Conservative treatment had a good covering because there was no death and no malignant evolution. However, we found 10% of epithelioid angiomyolipoma in which malignant risk is high. PFCT AML diagnosed on renal percutaneous biopsy of unknown renal tumor requires the same management than the classic AML.