Renal cell carcinoma treatment during pregnancy: Histopathological findings suggestive of rapid tumor growth

Abstract

Introduction Diagnosis of renal cell carcinoma during pregnancy is rare. We report a case of renal cell carcinoma during pregnancy with rapid growth. Case presentation A 39‐year‐old woman presented to our hospital for treatment of renal tumor at 22 weeks gestation. The tumor had a cystic lesion with a partition and showed rapid growth from 28 mm to 32 mm over a period of 4 weeks. The tumor was diagnosed as renal cell carcinoma and an open partial nephrectomy was scheduled at 26 weeks gestation. The operation and perioperative course were successful. Pathological findings confirmed the tumor to be clear cell renal cell carcinoma with G2 > G3, Fuhrman grade 2, pT1a, negative surgical margin, and positive detection of progesterone receptor. Conclusion We reported the successful management of a patient who was diagnosed with renal cell carcinoma during pregnancy. We also had a suggested association between rapid growth tumor and progesterone based on histopathological analysis of the tumor.

Renal Tumors in Pregnancy: A Case Report Focusing on the Timing of the Surgery and Patient Positioning

“…To rule out this possibility, a timely nephrectomy (partial or radical) should be performed to make a definite diagnosis. Ohyama et al presented a case of renal mass in pregnancy in which the diagnosis was confirmed preoperatively via fine-needle biopsy; however, one should remember that the negative results do not rule out malignancy [ 8 ].…”

“…RCC is the most common tumor in pregnancy and seems heterogeneous; each patient showed variable tumor size, manifestation, and growth rate [ 8 ]. A meta-analysis of 286 solid localized renal lesions revealed a mean growth rate of 0.28 cm each year (median 0.28, range 0.09 to 0.86) during a mean follow-up of 34 months (median 32, range 26 to 39) [ 16 ].…”

“…Although interventions during the first trimester have an increased risk of spontaneous abortion, we recommend surgery unless there is a previous infertility history [ 8 ]. In case of a history of infertility, the decision to perform surgery needs extra caution, and delayed intervention until the second trimester is another option provided close follow-up of the tumor growth rate.…”

A 27-Year-Old Primigravida with a Right Renal Cell Carcinoma Removed at 30 Weeks of Gestation by Robot-Assisted Retroperitoneoscopic Partial Nephrectomy

“…Therefore, according to the current SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) guidelines for the use of laparoscopy during pregnancy [ 15 ], laparoscopic surgery, including renal procedures, may be performed during any trimester of pregnancy despite the possible risk of triggering uterine contractions, thus causing fetal distress or even spontaneous abortion due to surgical manipulation [ 18 – 20 ].…”

“…In the current era of robot-assisted surgery, the partial nephrectomy techniques were revolutionized. This was followed by the robot-assisted experience with partial nephrectomy during pregnancy [ 18 – 20 ]. The retroperitoneoscopic approach to the kidney was first described by Gaur et al 1993.…”