Asynchronous rupture of bilateral renal cell carcinoma in a hemodialysis patient: A case report

A case of asynchronous rupture of bilateral renal cell carcinoma that developed in a 64-year-old man receiving long-term dialysis is reported. The patient, who had undergone maintenance hemodialysis for 11 years, was admitted in May, 2007 with the complaints of macrohematuria and right lumbar pain. CT scan demonstrated rupture of the right kidney associated with acquired cystic kidney disease (ACDK), containing a solid mass and hemorrhage. He underwent right nephrectomy. The patient was subsequently followed up for 10 months and underwent left nephrectomy for rupture of the left kidney caused by hemorrhage of ACDK. Grossly, both resected kidneys had been replaced by acquired renal cysts of various sizes and showed hemorrhagic cysts and contained multicentric solid lesions. Histologically, neoplasms of both resected kidneys consisted of renal cell carcinomas, clear cell subtype, showing grade 1 to 2 in atypism. Moreover, lesions that could not be detected as neoplasms macroscopically and were considered remnant normal renal parenchyma, could be recognized as multiple small renal cell carcinomas. Additionally, the lining epithelium of the cysts in part showed papillary proliferation of atypical cells. The patient remains well on hemodialysis, with no evidence of recurrence or metastasis for 15 months since undergoing the bilateral nephrectomy.