Indian Journal of Urology
CASE REPORT
Year
: 2002  |  Volume : 19  |  Issue : 1  |  Page : 81--82

Horseshoe kidney with renal adenocar­cinoma - report of a rare case


Suresh Bhat, AS Muhammed Fassaludeen, Appu Thomas, Jacob Cherian 
 Department of Urology, Medical College, Kottayam, India

Correspondence Address:
Suresh Bhat
Department of Urology, Medical College, Kottayam (Kerala) - 686 008
India




How to cite this article:
Bhat S, Muhammed Fassaludeen A S, Thomas A, Cherian J. Horseshoe kidney with renal adenocar­cinoma - report of a rare case.Indian J Urol 2002;19:81-82


How to cite this URL:
Bhat S, Muhammed Fassaludeen A S, Thomas A, Cherian J. Horseshoe kidney with renal adenocar­cinoma - report of a rare case. Indian J Urol [serial online] 2002 [cited 2021 Dec 3 ];19:81-82
Available from: https://www.indianjurol.com/text.asp?2002/19/1/81/21087


Full Text

 Case Report



A 52-year-old male presented with hematuria of recent onset. Clinical examination revealed a well-defined mass to the left of the epigastric region. Routine biochemical investigations were normal. Intravenous urogram (IVU) showed horse shoe kidney (HSK) with a space occupying lesion arising from the lower pole of the left kidney. CT scan confirmed the diagnosis [Figure 1]. Left radical nephrec­tomy with isthmusectomy was done. Histopathological examination showed clear cell renal cell carcinoma.

 Comments



Horse shoe kidney was recognized as an anomaly of the upper urinary tract as early as 1522 by De Carpi. In most cases the kidneys are linked at the lower poles by an isthmus of parenchyma. The incidence is 1 in 400 cases, being 2-3 times as frequent in males as in females. The association with other congenital anomalies is reflected in the inverse relationship between incidence and patient age.

The first tumour in HSK was reported in 1894. About 125 cases of HSK with renal tumours have been reported of which 50% are renal cell carcinomas, 25% each are Wilm's tumour and renal pelvic tumour. [1] However, of late carcinoid tumours are being reported arising from HSK. [2] ­Tumours arising from HSK are difficult to characterise. CT scan and angiographic studies are useful preoperative studies especially to plan surgery.

Regardless of whether the procedure is radical or organ sparing, the division of the isthmus is essential not only to achieve complete access to lymph nodes but also to nor­malize the course of the ureters and to prevent potential development of Rovsing's syndrome. [3] Bleeding and uri­nary fistula formation can be prevented by replacing the fibrous capsule of the parenchyma at the resection site with a free peritoneal patch.

The theory that mechanical fusion of metanephroi is responsible for the genesis of HSK has been shown to be true in only a minority of cases: those with connective tissue isthmus. Abnormal migration of the cells of the pos­terior nephrogenic area leads to majority of the HSKs with parenchymal isthmus.[4] The sole kidney would develop its horse shoe shape as a result of cranial pulling of the lat­eral aspects of the metanephric tissue by growth of the trunk while the isthmus is restrained by the inferior me­senteric artery. The parenchyrnatous renal isthmus that is the result of an abnormal migration process may predis­pose the development of renal cell carcinoma.

References

1Bauer SB : Anomalies of the kidney and ureteropelvic junction. In Walsh PC, Retik AB, Vaughan ED, Wein AJ, (eds). Campbell's Urology, 7m Edn, Pa. WB Saunders, 1998; 1728.
2Krishnan B, Truong LD. Saleh G, Sirbasku DM et al. Horse Shoe kidney is associated with an increased relative risk of primary renal carcinoid tumour. J Urol 1997; 157: 2059-66.
3Hohenfeller M, Schultz-Lampel D, Lampel A et al. Tumour in the horse shoe kidney - clinical implications and review of embryo­genesis. J Urol 1992; 147: 1098-1100.
4Domenech-Mateu JM, Gonzalez Compta X. Horse shoe kidney - A new theory on its embryogenesis based on the study of a 16 mm human embryo. Anat Rec 1988; 222: 408.