| Background/purpose: To explore the clinical features of adult polycystic kidney with malignant renal tumors and to improve the recognition of polycystic kidney with renal tumors.Methods: Five patients with polycystic kidney and renal tumors diagnosed by pathology in Fujian Provincial Hospital/Provincial Jinshan Hospital since 2013 were collected.Their clinical data were analyzed retrospectively,relevant literature were reviewed.Result: Five cases of polycystic kidney with malignant renal tumors,Three patients with renal cell carcinoma.One case of polycystic kidney patient with left kidney space occupying was found by enhanced CT examination because of trauma,and underwent laparoscopic partial nephrectomy,postoperative pathology revealed clear cell renal cell carcinoma.Anther case was a patient witch prostate cancer incidently discovered renal tumors by enhanced CT.He underwent retroperitoneal laparoscopic exploration plus conversion to open partial right nephrectomy,polycystic kidney disease was found in intraoperatively and the pathology was translocation renal cell carcinoma of MiT family.Four months after operation,enhanced CT showed local recurrence with multiple metastases of lung and retroperitoneal lymph nodes.One year after operation,the patient died of metastastic cancer.The last one was a patient of polycystic kidney disease with end-stage renal disease underwenting maintenance dialysis,who seek medical because of recurrent fever and urinary tract infection(UTI).No tumors were found on plain CT scan,diagnosis was right polycystic kidney with recurrent UTI and she accepted right laparoscopic nephrectomy,the pathology was papillary renal cell carcinoma.This patient still had feverish UTI after the operation,Consider the possibility of infection in left polycystic kidney,she received left laparoscopic nephrectomy,The pathology was papillary renal cell carcinoma too.Two patients with upper tract urothelial carcinoma.One was a 51 years old man with a history of bladder cancer and polycystic kidney.Enhanced CT scan revealed recurrent bladder cancer involving the right ureter and malignancy of right polycystic kidney was suspected.He received transurethral resection of bladder tumors and right retroperitoneal laparoscopic nephroureterectomy witch to open converted radical nephroureterectomy,right kidney pathology was invasive urothelial carcinoma of the renal pelvis.The last one was a patient of polycystic kidney complicated with left kidney space occupying lesion which was diagnosed by enhanced CT examination due to repeated hematuria.She accepted palliative left nephrectomy,The pathology was high-grade invasive urothelial carcinoma(sarcomatoid variant).Conclusion: Polycystic kidney with renal tumors is rare,the incidence of renal tumors in patients with polycystic kidney disease is higher than that in the general population.Because of the overlap of clinical manifestations,the imaging of renal tumors is often missed due to the interference of multiple cysts.Contrast enhanced CT is still the main examination method for renal tumors.For such patients,the treatment should first consider the control of tumors,followed by the preservation of renal function as much as possible.Transperitoneal approach is recommended for laparoscopic radical/partial nephrectomy or nephroureterectomy. |
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