British Journal of Urology (1998), 82, 920–921

CASE RE PORT

Renal oncocytoma fed from the vertebral arteryS. MATSUMOTO, Y. HARA, A. ESA, T. MATSUURA and T. KURITA*Department of Urology, Osaka Teishin Hospital, Osaka, Japan and *Department of Urology, Kinki University School of Medicine,Osaka-Sayama, Japan

phy. Selective vertebral arteriography clearly showedCase report

that the tumour received its blood supply only from thefourth right vertebral artery, with typical tumour vesselsA 71-year-old woman with a right renal mass detected

one year previously at another hospital visited our and tumour staining for RCC, but with no ‘spoke-and-wheel’ arterial supply (Fig. 1). Radical nephrectomy wasdepartment for a further examination. Her serum creati-

nine level was 12 mg/L, the creatinine clearance rate refused by the patient because of the probable need forpostoperative chronic haemodialysis. A final diagnosis41 mL/min and other laboratory data were normal. CT

and MRI showed a protrusive mass of #6 cm diameter, was obtained using ultrasound-guided needle corebiopsy; the pathologist suspected renal oncocytoma.with heterogeneous enhancement, in the middle part of

the right kidney, and the left kidney was markedly After carefully considering the indications for enucleat-ing the tumour, the operation was performed successfullystunted. Aortography showed only one right renal artery

but no tumour was detected on selective renal angiogra- through a right flank incision. Although the tumour

Rt. Renal Artery

4th Rt. Vertebral Artery

Common Iliac

Gonadal

Adrenal

Tumour

AortaFig. 1. Upper; selective renal angiography showed one renal artery but no tumour. Lower; vertebral arteriography showing tumour vesselsand the tumour.

920 © 1998 British Journal of Urology

CAS E REPORT 921

tumour of the renal parenchyma, first described in 1976[1]. Ninety-three cases of renal oncocytoma have beenreported in Japan up to 1997 [2]. Although somecharacteristic radiological findings are reported [3], only13 cases (14%) were correctly diagnosed before surgery.The present patient, with a contralateral dwarf kidneyof unknown origin, was managed successfully by enucle-ating the tumour after confirming the histology by needlebiopsy. The present case is exceptional in that the tumourreceived its arterial supply only from the fourth vertebralartery; the supplying artery might be related to thevascular ladder in the fetal period.

Fig. 2. Pathological examination confirmed the diagnosis of right Referencesrenal oncocytoma. The tumour consisted of large epithelial cells

1 Klein MJ, Valensi QJ. Proximal tubule adenomas of thewith fine granular eosinophilic cytoplasm. Haematoxylin andkidney with so-called oncocytic features. A clinicopatholog-eosin. ×400.ical study of 13 cases of a rarely reported neoplasm. Cancer1976; 38: 906–14

was supplied from the vertebral artery, the venous2 Kawakami S, Fukuoka H, Ikeda I, Sekiguti Y. Renal

systems were connected to the renal parenchymal veins. oncocytoma: a case report. Nishinihon J Urol 1997; 59:The tumour was light brown, weighed 140 g and was 726–970×80×65 mm; routine pathological examination con- 3 Ambos MA, Bosniak MA, Valensi QJ, Madayag MA, Lefleurfirmed the diagnosis of right renal oncocytoma (Fig. 2). RS. Angiographic patterns in renal oncocytoma. Radiology

1978; 129: 615–22The postoperative course was uneventful except for atransient elevation of serum creatinine level to 24 mg/L.She also developed transient slight uraemic symptoms.

AuthorsAt the 3-month follow-up, the serum creatinine was

S. Matsumoto, MD, Urologist.stable at 13 mg/L and the symptoms had not recurred;Y. Hara, MD, PhD, Urologist.

IVP showed good excretion from the operated kidney.A. Esa, MD, PhD, Consultant Urologist.T. Matsuura, MD, PhD, Chief of Urology.T. Kurita, MD, PhD, Professor of Urology.CommentCorrespondence: Dr S. Matsumoto, Department of Urology,

Renal oncocytoma, also known as oxyphilic adenoma Kinki University School of Medicine, 377-2, Ohno-Higashi,Osaka-Sayama, Osaka 589-8511, Japan.or proximal tubular adenoma, is usually a benign

© 1998 British Journal of Urology 82, 920–921