Renal Arteries Embolization in Unresectable Clear Cell Renal Carcinoma: First Time Experience at Haji Adam Malik Hospital
OBJECTIVE: To report a case of renal arterial embolisation (RAE) in unresectable renal tumour before nephrectomy.
CASE REPORT: On presentation, the clinical features of this patient, including medical history, signs and symptoms, imaging examinations were recorded. After diagnosis and initial treatment, the result and histopathological examination were performed and discussed. We performed RAE in the unresectable renal tumour in the 28-year-old male that was complaining a palpable pain right flank mass and intermittent hematuria that had been observed five months earlier. A month after RAE, the tumour shrinks and become resectable. The parameter used was tumour volume, propulsion and component, with subjective value VAS, hematuria symptom and Quality Of Life Score EORTC-QLQ C30. The next step we performed nephrectomy with histopathology results in Clear Cell Renal Carcinoma (CCRC).CONCLUSION: RAE is an effective therapeutic and adjuvant tool because it facilitates the dissection of unresectable large renal tumours and tumours with extensive involvement around the renal hilum; it leading to lower overall morbidity. However, the lack of randomised prospective studies is the primary reason that RAE is not used often before surgery.
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Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Lyon, France: International Agency for Research on Cancer; 2013. Cancer Incidence and Mortality Worldwide: IARC CancerBase, 2012:10.
Umbas R, Safriadi F, Mochtar CA, et al. Urologic cancer in Indonesia. Jpn J Clin Oncol. 2015; 45:708â€“712. https://doi.org/10.1093/jjco/hyv066 PMid:26085688
Erik, L. Treatment of Renal Adenocarcinoma by embolic occlusion of the renal circulation. B J Urol. 1973; 45:474â€“479. https://doi.org/10.1111/j.1464-410X.1973.tb06806.x
Li D, Pua BB, Madoff DC. Role of embolization in the treatment of renal masses. Semin Intervent Radiol. 2014; 31(1):70-81. https://doi.org/10.1055/s-0033-1363845 PMid:24596442 PMCid:PMC3930649
Protzel C, Maruschke M, Hakenberg OW. Epidemiology, aetiology, and pathogenesis of renal cell carcinoma. Eur Urol Suppl. 2012; 11:52â€“59. https://doi.org/10.1016/j.eursup.2012.05.002
Low G, Huang G, Fu W, et al. Review of renal cell carcinoma and its common subtypesin radiology. W J Radiol. 2016; 8(5):484-500. https://doi.org/10.4329/wjr.v8.i5.484 PMid:27247714 PMCid:PMC4882405
Ramaswamy RS, Darcy MD. Arterial embolization for the treatment of renal masses and traumatic renal injuries. Tech Vasc Intervent Radiol. 2016; 19(3):203-10. https://doi.org/10.1053/j.tvir.2016.06.005 PMid:27641454
Reinhart HA, Ghaleb M, Davis BR. Transarterial embolization of renal tumors improves surgical outcomes: a case series. Int J Surg Case Rep. 2015; 15:116-118. https://doi.org/10.1016/j.ijscr.2015.08.022 PMid:26339789 PMCid:PMC4601965
Khanehzad M, Seyfali E, Hajimomeni Y, et al. A case report of renal artery variation. Anat Sci J. 2014;11,205â€“208.
Bishay VL, Crino PB, Wein AJ, et al. Embolization of giant renal angiomyolipomas: technique and results. J Vasc Interv Radiol. 2010; 21(1):67-72. https://doi.org/10.1016/j.jvir.2009.09.020 PMid:20123192
Davis C, Boyett T, Caridi J. Renal artery embolization: application and success in patients with renal cell carcinoma and angiomyolipoma. Semin Intervent Radiol. 2007; 24(1):111-116. https://doi.org/10.1055/s-2007-971185 PMid:21326748 PMCid:PMC3036337
Jaganjac S, Schefe L. Palliative embolization of renal tumors. Vojnosanit Pregl. 2015; 71(12):1005-1110. https://doi.org/10.2298/VSP140502122J
Ward JF, Velling TE. Transcatheter therapeutic embolization of genitourinary pathology. Reviews in urology. 2000; 2(4):236. PMid:16985760 PMCid:PMC1476124
Tadavarthy SM, Knight L, Snyder C, et al. Therapeutic transcatheter arterial embolization. Radiol. 1974; 112(1):13â€“16. https://doi.org/10.1148/112.1.13 PMid:4545553
Derdeyn CP, Moran CJ, Cross DT, et al. Polyvinyl alcohol particle size and suspension characteristics. Am J Neuroradiol. 1995; 16:1335â€“1343. PMid:7677036
Schwartz MJ, Smith EB, Trost DW, et al. Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int. 2007; 99(4):881â€“886. https://doi.org/10.1111/j.1464-410X.2006.06653.x PMid:17166242
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