Advanced-stage Wilms tumor arising in a horseshoe kidney of a 9-year-old child: a case report

Abstract Background Horseshoe kidney (HK) is one of the most common renal fusion abnormalities, with an incidence of 1:400 in the normal population. However, Wilms tumor (WT) arising in an HK is a rare occurrence. We report the case of a 9-year-old boy who presented with an advanced WT in an HK and also highlight the management challenges in a resource-poor setting such as ours. Case presentation The patient was a 9-year-old Nigerian boy presented to the Pediatrics Outpatient Clinic of the University of Maiduguri Teaching Hospital (UMTH) with a history of progressive abdominal swelling, weight loss, abdominal pain, and cough. Abdominal examination revealed an irregular, firm, and non-tender mass in the right lumbar region. A computed tomography (CT) scan of the abdomen showed a heterogeneously dense mass that was predominantly to the right side of the abdomen and crossed the midline to the left side, where it continued with the relatively normal renal tissue. Chest CT revealed pulmonary metastases. A diagnosis of WT in an HK was made. The patient had a 6-week course of neoadjuvant chemotherapy, and a right nephrectomy and left partial nephrectomy was performed. The final histologic diagnosis of WT was made. Radiotherapy was intended but was not available in our facility, and the parents could not afford referral to another center. Conclusions Children with a clinically suspected HK with WT should undergo a careful imaging evaluation such as CT before any surgical intervention. Neoadjuvant chemotherapy to reduce tumor bulk might be a good treatment method to reduce surgical morbidity and aid in complete excision and potential for preserving renal function.

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Posterior C2-6 Laminoplasty for Resection of Arteriovenous Malformation: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz403 ◽

2019 ◽

Vol 18 (3) ◽

pp. E72-E73 ◽

Cited By ~ 1

Author(s):

Benjamin K Hendricks ◽

Robert F Spetzler

Keyword(s):

Vertebral Artery ◽

Video Recording ◽

Preoperative Embolization ◽

Surgical Morbidity ◽

Imaging Evaluation ◽

Institutional Review ◽

Long Term Follow Up ◽

History Of ◽

Surgical Cure ◽

The Right

Abstract Large extramedullary-intramedullary arteriovenous malformations (AVMs) within the spinal cord provide a unique management opportunity, compared with the cranial counterpart, in that the surgical morbidity can be minimized and surgical cure can still be achieved by resecting the extramedullary segment and leaving the intramedullary segment without invading the parenchyma. This management strategy minimizes morbidity and provides an excellent chance of surgical cure. This patient had a history of longstanding left hemiparesis since birth that progressed, prompting imaging evaluation that demonstrated a large cervical AVM with bilateral vertebral artery, anterior spinal artery, and left thyrocervical trunk feeding vessels. The AVM had both extramedullary and intramedullary components, making this a challenging lesion for microsurgical obliteration and preservation of neurological function. Preoperative embolization was utilized through the right vertebral artery pedicle. Microdissection was performed to isolate the extramedullary from the intramedullary component. Surgical cure was attempted for this patient by removing the extramedullary component and leaving the intramedullary segment. Indocyanine green fluoroscopy was used to isolate the feeding pedicle and guide surgical resection. Postoperative imaging demonstrated a small residual from the thyrocervical injection, which was obliterated with embolization. The patient improved neurologically within the postoperative period and regained ambulatory status during long-term follow-up. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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Parathyroid Carcinoma in the Setting of Tertiary Hyperparathyroidism: Case Report and Review of the Literature

Case Reports in Endocrinology ◽

10.1155/2020/5710468 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Federico Cappellacci ◽

Fabio Medas ◽

Gian Luigi Canu ◽

Maria Letizia Lai ◽

Giovanni Conzo ◽

...

Keyword(s):

Parathyroid Gland ◽

Parathyroid Carcinoma ◽

Histopathological Examination ◽

Normal Population ◽

Survival Rates ◽

Horseshoe Kidney ◽

Cervical Region ◽

Tertiary Hyperparathyroidism ◽

The Right ◽

Inferior Parathyroid Gland

Introduction. Parathyroid carcinoma is one of the rarest cancers in normal population, and it is extremely uncommon in the setting of tertiary hyperparathyroidism. Indeed, only 24 cases have been reported in the literature. Presentation of the Case. We report the case of parathyroid carcinoma in a 51-year-old man, with a history of end-stage renal disease due to a horseshoe kidney treated with haemodialysis since 2013. He came to our attention due to an increase in calcium and parathyroid hormone serum levels. Neck ultrasound (US) showed a solid hypodense mass, probably the right inferior parathyroid gland, with an estimated size of 25 × 15 × 13 mm; the 99mTc-sestamibi SPECT/CT scan revealed a large radiotracer activity area in the right cervical region, compatible with a hyperfunctioning right inferior parathyroid gland. So, a tertiary hyperparathyroidism diagnosis was made. In April 2018, resection of three parathyroid glands was performed. Histopathological examination demonstrated the right inferior parathyroid gland specimen to be a parathyroid carcinoma, due to the presence of multiple, full-thickness, capsular infiltration foci, and a venous vascular invasion focus. Discussion. Diagnosis of parathyroid carcinoma in tertiary hyperparathyroidism is remarkably complex because of the lack of clinical diagnostic criteria and, in many cases, is made postoperatively at histopathological examination. Conclusion. To date, radical surgery represents the mainstay of treatment, with a five- and ten-year survival rates overall acceptable.

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Resting state alpha oscillatory activity is a valid and reliable marker of schizotypy

Scientific Reports ◽

10.1038/s41598-021-89690-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jelena Trajkovic ◽

Francesco Di Gregorio ◽

Francesca Ferri ◽

Chiara Marzi ◽

Stefano Diciotti ◽

...

Keyword(s):

At Risk ◽

Resting State ◽

Right Hemisphere ◽

Normal Population ◽

Alpha Activity ◽

Oscillatory Activity ◽

Loop Current ◽

Clinical Tool ◽

Reliable Marker ◽

The Right

AbstractSchizophrenia is among the most debilitating neuropsychiatric disorders. However, clear neurophysiological markers that would identify at-risk individuals represent still an unknown. The aim of this study was to investigate possible alterations in the resting alpha oscillatory activity in normal population high on schizotypy trait, a physiological condition known to be severely altered in patients with schizophrenia. Direct comparison of resting-state EEG oscillatory activity between Low and High Schizotypy Group (LSG and HSG) has revealed a clear right hemisphere alteration in alpha activity of the HSG. Specifically, HSG shows a significant slowing down of right hemisphere posterior alpha frequency and an altered distribution of its amplitude, with a tendency towards a reduction in the right hemisphere in comparison to LSG. Furthermore, altered and reduced connectivity in the right fronto-parietal network within the alpha range was found in the HSG. Crucially, a trained pattern classifier based on these indices of alpha activity was able to successfully differentiate HSG from LSG on tested participants further confirming the specific importance of right hemispheric alpha activity and intrahemispheric functional connectivity. By combining alpha activity and connectivity measures with a machine learning predictive model optimized in a nested stratified cross-validation loop, current research offers a promising clinical tool able to identify individuals at-risk of developing psychosis (i.e., high schizotypy individuals).

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Laparoscopic transposition for crossing vessels (vascular hitch) in pure extrinsic pelvic-ureteric junction obstruction: a successful case report of a 2-year-old infant with horseshoe kidney

Surgical Case Reports ◽

10.1186/s40792-021-01190-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Satoshi Ieiri ◽

Kouji Nagata

Keyword(s):

Laparoscopic Surgery ◽

Left Kidney ◽

Horseshoe Kidney ◽

Renal Scintigraphy ◽

Multicystic Dysplastic Kidney ◽

Extrinsic Compression ◽

Dysplastic Kidney ◽

Renal Vessels ◽

The Right ◽

Crossing Vessels

Abstract Background Pediatric hydronephrosis induced by pelvic-ureteric junction obstruction (PUJO) is treated by dismembered pyeloplasty (DP) via open and laparoscopic surgery. The etiology of PUJO involves both intrinsic stenosis and extrinsic compression of crossing vessels (CVs). PUJO owing to CVs is also treated by DP, as there is no consensus concerning this vascular condition. We encountered a 2-year-old infant with pure extrinsic PUJO combined with horseshoe kidney who successfully underwent laparoscopic transposition for CVs (vascular hitch). Case presentation A 2-year-old boy was prenatally diagnosed with left multicystic dysplastic kidney (MDCK) and right hydronephrosis and received a definitive diagnosis after birth. At 6 months old, renal scintigraphy revealed a non-functioning pattern in the left kidney and an obstructive pattern in the right, showing no response to furosemide loading. The patient also had recurrent urinary tract infection, and his right hydronephrosis gradually worsened. We decided to perform surgery for the right PUJO. Preoperative enhanced computed tomography detected three right renal vessels independently branching from the abdominal aorta. The middle renal vessels were located at the ventral side of the pelvis and coincident with the site of PUJO. These vessels were suspected of being CVs. The patient underwent laparoscopic surgery electively. A 5-mm trocar was inserted at the umbilicus for a 5-mm, 30° rigid scope. Two additional ports were then inserted under laparoscope inspection. The dilated right pelvis and CVs were detected after ascending colon mobilization. To confirm the pathogenesis of PUJO, the CVs were dissected and taped. After taping the CVs, an intraoperative diuretic test was performed using furosemide loading. Peristalsis of the right ureter was recognized, and the extrinsic PUJO owing to the CVs was definitively confirmed. We therefore performed transposition for the CVs (vascular hitch procedure). The CVs were mobilized in the cranial direction and those were wrapped by dilated pelvis. The post-operative course was uneventful. The renal scintigraphy findings improved and showed a favorable response of furosemide loading. Conclusions The laparoscopic vascular hitch procedure is minimally invasive and effective for extrinsic PUJO due to CVs. Anastomotic stricture after Anderson and Hynes DP can be prevented by appropriate patient selection.

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HYPERTENSION IN EMBRYOMA (WILMS' TUMOR)

PEDIATRICS ◽

10.1542/peds.3.2.201 ◽

1949 ◽

Vol 3 (2) ◽

pp. 201-207

Author(s):

JAMES G. HUGHES ◽

HERMAN ROSENBLUM ◽

LACY G. HORN

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Clinical Features ◽

Wilms Tumor ◽

Hypertensive Encephalopathy ◽

Renal Ischemia ◽

Cerebral Anoxia ◽

Cardiac Decompensation ◽

First Case ◽

The Right

A case of Wilms' tumor of the right kidney is presented, in which the dominant clinical features were extreme elevation of blood pressure and hypertensive encephalopathy, associated with cardiac decompensation and death. Generalized convulsions and right hemiplegia developed, believed to have been due to cerebral anoxia incident to angiospasm. No metastases were found, and no other cause for arterial hypertension was discovered. This patient is thought to be the first case reported where death from Wilms' tumor was due to the hypertensive factor. The literature with reference to the association of hypertension with Wilms' tumor is reviewed. The mechanisms by which Wilms' tumors may produce unilateral renal ischemia with arterial hypertension are discussed. The presence of clearcut hypertension in a child with a kidney area mass points toward the probability of a Wilms' tumor.

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EMBRYOMA OF KIDNEY (WILMS' TUMOR) IN CHILDREN

PEDIATRICS ◽

10.1542/peds.4.2.197 ◽

1949 ◽

Vol 4 (2) ◽

pp. 197-200

Author(s):

LLOYD B. DICKEY ◽

L. R. CHANDLER

Keyword(s):

Survival Rate ◽

Physical Examination ◽

Wilms Tumor ◽

Left Kidney ◽

Bottle Feeding ◽

Postoperative Radiation ◽

History Of ◽

The Right ◽

Infants And Young Children ◽

Careful Physical Examination

A series of 12 cases of Wilms' tumor, in which the diagnosis was confirmed in all instances by examination of the gross or microscopic tissue, is reported, with a survival rate of 33.3%. Four patients are living and well, 4, 8, 10, and 15 years, respectively, after treatment. All recurrences appeared less than 10 months after treatment. The sex incidence, and the sex survival incidence were exactly equal. Six tumors were in the left kidney, and six in the right. Eight of the patients were under 2 years of age when first diagnosed and treated, and all were under 7 years. The history of breast or bottle feeding was irrelevant. In a large number of these and reported cases, the presence of the tumor was the first symptom, and in a considerable number the only symptom. This fact stresses the importance of careful physical examination of infants and young children, regardless of complaint, or of lack of it. The finding of calcification in the tumor is possibly a good prognostic sign. All three patients in whom calcification was noted in the tumor are living and well. Immediate removal of the tumor by transperitoneal nephrectomy, with postoperative radiation to the area, seems to be the advisable treatment.

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Extraovarian primary seromucinous cystadenoma masquerading as mesenteric cyst

BMJ Case Reports ◽

10.1136/bcr-2020-240414 ◽

2021 ◽

Vol 14 (5) ◽

pp. e240414

Author(s):

Kishor R J ◽

Bhuvaneshwari Harikrishnan ◽

Naveen Alexander ◽

Veena Bheeman

Keyword(s):

Lower Abdominal Pain ◽

Interesting Case ◽

Mesenteric Cyst ◽

Lumbar Region ◽

Normal Limits ◽

Mesenteric Border ◽

Contrast Enhanced ◽

Laparoscopic Excision ◽

Abdominal Examination ◽

The Right

We report an interesting case of extraovarian, primary seromucinous cystadenoma, which presented as a mesenteric cyst. A 31-year-old woman came with complaints of lower abdominal pain for 2 years, which is intermittent and aggravated during the menstrual cycle. On examination, her vitals were within normal limits; per abdominal examination revealed 7×7 cm mass in the right lumbar and right hypochondrium with well-defined margins. A Contrast-enhanced whole abdomen done showed a thin-walled of cyst of size 7×8×9 cm in the right lumbar region abutting and replacing the mesenteric border of ascending colon suggesting of mesenteric cyst. Patient underwent laparoscopic excision of mesenteric cyst. Histopathology revealed seromucinous cystadenoma without ovarian stroma.

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Pure laparoscopic unilateral nephrectomy for a patient with a polycystic horseshoe kidney

Canadian Urological Association Journal ◽

10.5489/cuaj.1919 ◽

2014 ◽

Vol 8 (11-12) ◽

pp. 881 ◽

Cited By ~ 2

Author(s):

Shawn Dason ◽

Christopher B Allard ◽

Bobby Shayegan ◽

Kevin Piercey

Keyword(s):

Renal Transplantation ◽

Autosomal Dominant ◽

Iliac Fossa ◽

Laparoscopic Approach ◽

Horseshoe Kidney ◽

Laparoscopic Nephrectomy ◽

Polycystic Kidney ◽

Large Size ◽

Autosomal Dominant Polycystic Kidney ◽

The Right

A 45-year-old female patient with autosomal dominant polycystic kidney disease (ADPKD) and a horseshoe kidney underwent right laparoscopic nephrectomy. The indication for nephrectomy was to create space within the right iliac fossa for renal transplantation. The operation proceeded as routine for laparoscopic nephrectomy for ADPKD, but was uniquely challenging due to the large size and extensive vasculature of the polycystic horseshoe kidney. In addition to documenting the feasibility of the pure laparoscopic approach for nephrectomy in patients with ADPKD and horseshoe kidney, this case highlights the abnormal location and vasculature encountered when operating on horseshoe kidneys.

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