A malignant 'incidentaloma' in a patient with autosomal dominant polycystic kidney disease.

Key words: autosomal dominant polycystic kidney followed, as shown in Figure 1. This examination revealed similar changes. A selective renal arteriogram disease; clear-cell renal-cell carcinoma; urinary tract infection is shown in Figure 2, which shows several abnormal polar vessels supplying the upper pole mass. Involvement of the renal vein by tumour could not be shown. An ultrasound-guided biopsy specimen Case report revealed typical changes of a clear-cell renal-cell carcin-oma (RCC). The right kidney was carefully visualized with the imaging studies, but revealed no suspicious A 72-year-old woman with known, stable, renal lesions. Additional work-up failed to show any evid-insufficiency was admitted because of fever, malaise, ence of distant metastasis and the patient recovered and dysuria, which began 48 h prior to admission. She from her urinary tract infection uneventfully, although had known autosomal dominant polycystic kidney her creatinine concentration remained at 348 mmol/l. disease (ADPKD) and several family members had developed end-stage renal disease. She had previously had urinary tract infections which had responded to Discussion antibiotics. Her creatinine had exceeded 200 mmol/l a year prior to admission and was gradually increasing. Modern imaging techniques not uncommonly confront On physical examination she was moderately febrile physicians with disturbing findings in asymptomatic (38°C), but not in acute distress. She had mild back patients. The term 'incidentaloma' is generally applied and abdominal tenderness. The kidneys and the liver to accidentally located adrenal masses; however, the were easily palpable and exhibited gross, nodular struc-term appears appropriate here. Our patient with tures consistent with ADPKD. The urinalysis showed ADPKD had developed RCC, which we carefully and many leukocytes and bacteria. Her serum creatinine zealously documented. Her actual reason for coming concentration was 351 mmol/l. A urine culture yielded to the hospital had resolved and she wanted to go Klebsiella sp. and ciprofloxacin was administered with home. We were confronted with serious medical good response. decisions in this case of an elderly woman with An ultrasound examination revealed cystic changes ADPKD-induced chronic renal failure, who was other-in both kidneys and the liver, as well as a denser wise doing relatively well. structure in the upper pole of the left kidney, prompting The association of RCC and ADPKD is controver-the computerized tomographic study shown in sial; an increased incidence has not been clearly shown. Figure 1. A large, dense structure with a single cavity Zeier et al. [1] could find no evidence for an increase can …