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zmir niversitesi Tp Dergisi

Izmir University Medical Journal

zm niv Tp Derg 2014; 2:32-34


Izm Univ Med J 2014; 2:32-34

Giant kidney tumor: Radiological case report


CASE REPORT
OLGU SUNUMU

Dev bbrek tmr: Radyolojik olgu sunumu


1,

Gkin Nilfer Yongu Sava ahinli , Esat Adgzel , Mehmet Blent zdemir , ahika Pnar Akyer

Izmir University, Faculty of Medicine, Department of Anatomy, Denizli, Turkey


Denizli State Hospital, Department of Urology, Denizli, Turkey
3
Pamukkale University, Faculty of Medicine, Department of Anatomy, Denizli, Turkey
2

Sorumlu Yazar/Corresponding Author:


Gkin Nilfer Yongu
Izmir University, Faculty of Medicine, Department of Anatomy, Denizli, Turkey
e-posta: nyonguc@gmail.com
Geli Tarihi/Received: 15.04.2014 - Kabul Tarihi/Accepted: 07.05.2014

Abstract
A 74-year-old man admitted to hospital with abdominal pain and gastrointestinal symptoms. Physical
examination was normal except for a large, solid mass lacalized in the right upper quadrant and extending to
right lower quadrant. Computed tomography exam revealed a giant kidney tumor; filling right half of the
abdominal cavity. In this present case report, we described how the abdominal structures were affected due
to this retroperitoneal giant kidney mass.
Key words: Abdominal mass, anatomy, kidney tumor.
zet
74 yanda bir erkek, karn ars ve gastrointestinal sistem belirtileri ile hastaneye bavurdu. Fizik muayene, sa
st kadranda yerlemi ve sa alt kadrana doru uzanan byk, solid kitle dnda normaldi. Bilgisayarl
tomografide, karn boluunun sa yarsn dolduran ve abdominal dev bir bbrek tmr izlendi. Bu olgu
sunumunda, retroperitoneal dev bbrek tmrnn abdominal yaplar nasl etkilediini tanmladk.
Anahtar kelimeler: Abdominal kitle, anatomi, bbrek tmr.

Introduction
An abdominal mass is a swelling which
localized in abdomen, and usually detected
during routine physical examination. In
general, abdominal masses develop slowly.
Therefore, patients may have no symptoms
until the mass enlarges and pressurizes on
neighboring anatomical structures (1).
Depending on its size, an abdominal mass
may cause change in the shape of the
abdomen (2). Symptoms of abdominal masses
may include abdominal tenderness, pain and
functional disturbances.
The abdomen is divided into four quadrants;
right upper, right lower, left upper and left
lower. Right and left kidneys are located in the
right upper and left upper quadrants,
respectively. Therefore, an abdominal mass
may occur originating from kidney cancer (3).

Papillary renal cell carcinoma (PRCC) is the


second most common histologic type of
kidney cancer (4).
We aimed to present a giant abdominal mass,
originated from the right kidney (PRCC), which
pressurizes on the neighboring anatomical
structures and further changes the anatomical
localization of the abdominal contents.
Case Report
A 74-year-old man presented with a 3-weeks
history of abdominal pain and gastrointestinal
symptoms. In physical examination, a largesolid mass extending to the right lower
quadrant was detected in the right upper
quadrant (Figure 1).

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Yongu ve ark
Yonguc et al

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Izmir University Medical Journal
The lower pole of the mass was located in
right iliac fossa (Figure 5). The right lobe of the
liver, gallbladder and loops of the small
intestine were dislocated to the left and
pressured to anterior abdominal wall (Figure
2,3,4). Hiatal hernia was detected (Figure 2).
The caput of the pancreas was dislocated to
the left side (Figure 3). The ascending colon
and the inferior vena cava were compressed
by the mass (Figure 4,5). The patient was
treated surgically, right radical nephrectomy
was
performed.
Histopathological
examination revealed papillary renal cell
carcinoma.

Figure 1 : Picture of the anterior abdominal wall


was taken during physical examination before
the operation. Abdominal swelling (asymmetry)
was seen on the anterior abdominal wall in the
right upper quadrant.

The patient underwent computed tomography


(CT) exam. CT showed a mass in size 235 x 180
x195 mm, originating from the right kidney;
filling right half of the abdominal cavity. The
upper pole of the mass was extending to just
inferior of the diaphragm (Figure 2).

Figure 2: Image of axial section. 1. Aorta 2. Left


lung 3. Spleen 4. Stomach 5. Hiatal hernia 6. Cor
7. Liver 8. Mass 9. Inferior vena cava 10. Right
lung 11. Body of vertebra 12. Rib

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Izm Unv Med J 2014; 2:32-34

Figure 3: Image of axial section. 1. Left kidney 2.


Spleen 3. Pancreas 4. Left colic flexure 5. Stomach
6. Liver 7. Right kidney 8. Mass 9. Aorta 10. Body
of vertebra 11. Rib

Figure 4: Image of axial section. 1. Aorta 2. Left


kidney 3. Descending colon 4. Small intestine 5.
Pyloric part of the stomach 6. Duodenum 7. Liver
8. Gall bladder 9. Mass 10. Compressed inferior
vena cava 11. Body of vertebra
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Izmir University Medical Journal
As a conclusion, most of abdominal masses
are determined incidentally during routine
physical examinations. During physical
examination, the clinician must determine the
location of the mass, and describe well its
location (in terms of quadrants). Also clinicians
should be aware of how giant masses can
dislocate the anatomical structures while
performing manipulations.
References

Figure 5: Image of axial section. 1. Psoas muscle


2. Two common iliac arteries 3. Small intestine 4.
Transverse colon 5. Mass 6. Compressed
ascending colon 7. Inferior vena cava 8. Ilium 9.
Body of vertebra

Discussion
Kidneys are retroperitoneally located lateral to
the vertebral coloumn. They are bean-shaped
and lie in the extraperitoneal connective
tissue of the posterior abdominal region (5).
Our case presented a giant abdominal mass,
caused by PRCC of kidney, with uncommon
clinical condition of filling the right half of the
abdominal cavity; pressurizing and dislocating
abdominal structures.
Papillary renal cell carcinoma (PRCC) is the
second most common histopathologic type of
kidney cancer, and exhibits a large range of
morphologic variants (4,6). Although, PRCC is
one of the common type of kidney cancer,
there is no any case of giant PRCC that leads
dislocation of abdominal structures in the
literature. On the other hand, Taneja and
Singh (7) report a female case of giant renal
angiomyolipoma of the left kidney displacing
the rest of the abdominal contents toward the
other side of the midline. In this
aforementioned case, mass is originited from
left kidney and filling the left abdominal
cavity, hence the abdominal content was
remowed to the right abdominal cavity.
Similarly, Akbulut et al. (8) report a female
case of giant left renal oncocytoma. However,
in these studies, dislocation of anatomical
contents are not explained.
zm nv Tp Derg 2014; 2:32-34
Izm Unv Med J 2014; 2:32-34

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