Delayed diagnosis of renal carcinoma in patient with autosomal dominant polycystic kidney disease, recurrent hematuria and coexisting adrenocortical carcinoma
Article published in Urologia Polska 2003/56/4.

authors

Waldemar Elikowski ¹, Ryszard Prędki ², Andrzej Karwowski ³, Mieczysław Gawroński ⁴

¹ Szpital Miejski ZOZ Poznań Nowe Miasto, Oddział Chorób Wewnętrznych
Ordynator oddziału: prof. dr hab. Piotr Psuja
² Szpital Miejski ZOZ Poznań Nowe Miasto, Oddział Urologii
Ordynator oddziału: prof. dr hab. Zbigniew Kwias
³ Szpital Miejski ZOZ Poznań Nowe Miasto, Zakład Radiologii
Kierownik zakładu: prof. dr hab. Andrzej Karwowski
⁴ Szpital Miejski ZOZ Poznań Nowe Miasto, Pracownia Patomorfologii
Kierownik pracowni: dr Mieczysław Gawrońsk

keywords

kidney, recurrent hematuria, autosomal dominant polycystic kidney disease, coexisting renal carcinoma, adrenocortical carcinoma, differentiation with metastasis

summary

The authors describe a case of 44-year-old man with autosomal dominant polycystic kidney disease (ADPKD) and recurrent hematuria. Repeated USG assessment and cystoscopy during prehospital observation did not show neoplastic process. Interpretation that ADPKD was the only cause of hematuria delayed true diagnosis of renal carcinoma. Left kidney tumor (45x50 mm) was strictly visualized in CT; unilateral adrenal tumor (13x9 mm) suggesting metastasis was also seen. In the short time after radical nephrectomy with adrenalectomy the patient died with symptoms of renal insufficiency and progressing cachexia and with metastases to bones. Histopathological examination of kidney reveals clear cell carcinoma, unexpectedly adrenal microscopic picture indicates primary neoplastic proliferation. The authors analyse the importance of correct anamnesis and emphasize that CT seems to be more advantageous than ultrasonography in correct clinical evaluation in patient with ADPKD.