Introduction: Renal cell carcinoma (RCC) is a rare diagnosis in pregnancy. We report a case of a pregnant woman with a RCC and summarised characteristics of 37 further published case reports over the last 20 years
Our case: A 34 year old primigravid woman presented with a left solid renal mass (56x71x55mm) discovered incidentally on a dating scan at 9weeks gestation. Fine needle aspirate was suggestive of clear cell RCC. An abdominal MRI at 13weeks gestation demonstrated growth of the solid heterogeneous renal mass (80x52x47mm). Chest x-ray was normal. After discussion in a multi-disciplinary team, the patient underwent a successful laparoscopic partial nephrectomy at 23weeks gestation with post-operative ileus and chyle leak but without obstetric complication. Histopathology confirmed type 1 papillary RCC, grade 2, stage pT2aNx. She delivered a 3kg baby girl at 395 weeks gestation via caesarean section due to obstructed labour. She remained recurrence free 12 months post-operatively.
Summary of cases: Women had a median age of 32 years with median gravidity of 2 and were diagnosed at a median gestation of 17weeks. Seventy-three percent were operated on antenatally at a median gestational age of 20 weeks while 27% were post-natally. Most women presented with flank, groin or abdominal pain(34%) or incidentally on antenatal imaging(34%), followed by haematuria(29%), hypertension(13%), palpable flank mass(8%) and urinary symptoms. Right sided tumours occurred more frequently(53%). Most RCCs were clear cell type(62%), followed by chromophobe(27%), papillary(8%) and cystic(3%).
Sixty-eight percent had open, while 32% had laparoscopic nephrectomies and 82% were radical while 18% were partial nephrectomies. Pregnancies reached a median gestational age of 38weeks with half delivering vaginally and one third via caesarean. There were 2 spontaneous abortions, 2 terminations and one neonatal death. Two women died from metastatic disease.
Conclusion: A database to collate additional RCC data may help inform future practice.