Renal cell carcinoma in pregnancy: Still a management challenge

Abstract

Background: Renal cell carcinoma during pregnancy is uncommon. We present a rare case, highlighting the dilemma faced by the patient and the challenge of deciding the appropriate management option.
Patient: A 28-year-old patient presented at 14 weeks of gestation with a 2-month history of left loin pain. Physical examination revealed a ballotable left flank mass. Abdominal ultrasound showed a heterogeneous lower-pole left renal mass measuring 9.2 cm × 7.0 cm and a viable intrauterine 14-week gestation. The patient declined magnetic resonance imaging (MRI) study for further evaluation, even after counseling on the acceptable safety of the modality.
Intervention: She also declined radical nephrectomy during pregnancy for fear of spontaneous abortion. She subsequently underwent left radicalnephrectomy after delivery. Histopathological examination of the resected specimen showed a Fuhrman grade-III clear renal cell carcinoma confined to the kidney, stage pT1b.
Conclusion: Renal malignancy though rare in pregnancy can however occur. The key treatment is radical nephrectomy. Offering this very invasive treatment and getting patient to accept the treatment at any stage of pregnancy is difficult.

KEYWORDS Renal cell carcinoma; Pregnancy; Radical nephrectomy