AN UNUSUAL RENAL MASS AFTER PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA

Abstract

Surgicel*' is an absorbable hemostatic agent widely used in surgery to control bleeding with few reported complications. We describe a case in which Surgicel produced a foreign body giant cell reaction after partial nephrectomy for renal cell carcinoma. This inflammatory reaction mimicked a tumor 5 years later. CASE REPORT A 66-year-old man was found to have a mass in the upper pole of the left kidney incidentally on computerized tomography (CT). Five years previously he had undergone left upper pole partial nephrectomy elsewhere for clear renal cell adenocarcinoma. Chronic renal failure in the setting of an atrophic, poorly functioning right kidney that contributed 10% to overall function on a nuclear scan was due to an inflammatory abdominal aortic aneurysm, which had been repaired in 1993. Preoperative renal function was 139 mmol./l. sodium (normal 135 to 145), 4.8 mmol./l. potassium (normal 3.5 to 4.5), 8.4 mmo1.A. urea (normal 4.8 to 8.2) and 143 mmo1.A. creatinine (normal 60 to 120). Ultrasound revealed a 1.5 cm. semisolid parapelvic lesion in the left kidney that was confirmed by CT. Repeat CT 10 months later showed a 2.5 cm. mass with a low attenuation center and a thicker, irregular, contrast enhancing rim (fig. 1). The appearance was consistent with enlarging renal cell carcinoma. Renal arteriography demonstrated evidence of a 2 to 3 cm. peripheral lesion but no evidence of neovascularity. The patient underwent left upper pole nephrectomy. Postoperative renal function was 141 mmo1.A. sodium, 4.6 mmo1.A. po