Bilateral renal cell carcinoma

Bilateral RCC is a rare entity and when it presents synchronously is managed with nephron- sparing surgery. We report a case of 44-year-old man, in whom the diagnosis of bilateral renal tumor was established incidentally after an abdominal ultrasound performed because of dysuric symptoms. CT imaging confirmed the presence of a pathologic mass in the central part of the right kidney, enhancing irregularly after intravenous administration of contrast medium and a smaller lesion within the cortex of the left kidney. No enlarged lymph nodes were seen. Selective renal arteriography revealed a poorly vasculated mass in the right kidney; it failed to visualise the lesion within the left kidney. No other abnormalities were found on physical examination and in laboratory tests. The patient underwent nephron-sparing surgery. Both tumors were completely resected. Pathology revealed renal cell carcinoma of papillary type, 3 cm in diameter, and of granullocellular type of 1 cm, in the right kidney and left kidney, respectively. There was no involvement of the perirenal fat. After the operation, a gradual impairment of renal function based on laboratory tests occurred, despite normal duresis. A tendency to hipokalemia, decreased haemoglobin levels and subfebrlile state persisted. The patient required an intensive medical treatment, which resulted in substantial improvement of renal function. Consulting oncologist prescribed octate megestrol in a daily dose of 480 mg. No metastatic lesions were found with scanning and the patient was referred to an out-patient follow-up. The performance status and patient's general being were good; no abnormalities were found on physical examination. The patient put on weight by 17 kg. Three months after the operation, the patient was hospitalised due to lesions suspicious of hepatic metastases found in ultrasound. CT scanning revealed two hypodensic 7–8 mm lesions in liver, which were too small to judge on their character. Two months later, a control ultrasound and CT were performed. No suspected lesions were found either in the kidneys or the liver. Renal tests were slightly increased. Recent control CT has shown small left kidney and a slightly deformed right kidney, with no impairment in urine secretion. There were no enlarged lymph nodes. At present, eighteen months after the operation, the patient stays on regular follow-up, is disease-free, in a good performance status and with only a slightly increased serum creatinine level.