Renal Adenocarcinoma On Tuberculosis Nephritis · 2012. 6. 25. · Renal Adenocarcinoma On...

Article ID: WMC003515 ISSN 2046-1690

Renal Adenocarcinoma On Tuberculosis NephritisCorresponding Author:Dr. Nfifakh Adil,Urology, Chu Avicenne Rabat - Morocco

Submitting Author:Dr. Nfifakh Adil,urology, Chu Avicenne Rabat - Morocco

Article ID: WMC003515

Article Type: Case Report

Submitted on:24-Jun-2012, 05:40:47 PM GMT Published on: 25-Jun-2012, 08:26:25 PM GMT

Article URL: http://www.webmedcentral.com/article_view/3515

Subject Categories:UROLOGY

Keywords:Adenocarcinoma ,Tuberculosis,Kidney

How to cite the article:Adil N . Renal Adenocarcinoma On Tuberculosis Nephritis . WebmedCentral UROLOGY2012;3(6):WMC003515

Copyright: This is an open-access article distributed under the terms of the Creative Commons AttributionLicense(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided theoriginal author and source are credited.

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Renal Adenocarcinoma On Tuberculosis NephritisAuthor(s): Adil N

Abstract

The association of renal tuberculosis and renal canceris rare. We report a patient who was followed forlithases kidney. The diagnosis of renal tumorassociated was made intraoperatively. A lumpectomywas performed. Histological examination revealed aclear cell renal cell carcinoma redesigned bygranuloma-follicular caseo tuberculeux.Le patient wasunder treatment for bacillary for a period of 9 months(2SRHZ/7RH). The outcome was favorable after adecline of 06 months. The objective of this study is toanalyze the pathogenesis, diagnostic aspects andtherapeutic modalities of this association, which isexceptional.

Introduction

The association of renal tuberculosis and renal canceris exceptional; less than fifty cases have beenreported in the literature [1]. We report a patient whowas followed at the urology department A , throughwhich we will analyze the pathogenesis, diagnosticaspects and therapeutic modalities of this association.

Case Report(s)

This is a patient aged 35 years, having benefited in2004 from left percutaneous nephrolithotomy for renalstones left who was admitted for three years of backpain again later left after febrile with pus from a leftlumbar cutaneous fistula in the context of impairedgeneral condition. clinical examination normal apartfrom the left lumbar fistula. Radiological assessment:chest radiograph was normal renal ultrasound and CTurography showed the presence of bilateral renalstones: an average of 8 mm caliceal right and 3 lowerand middle caliceal millimeter, DMSA has lefthydronephrosis (Figure 1) predominant at the middleand lower caliceal group and a left renal fistulaperished (Figure 2), on renal scintigraphy showed aleft kidney providing 30% of renal function with lesionsdeep sequelae of lower 2/3 of the left kidney. Atsurgical exploration, there is a medio renal tumor 1.5cm lower pole nephrectomy and a tumerectomie wereperformed. Histological renal tuberculosis iscaseo-follicular (Figure 3) associated with renal cell

carcinoma type tubulopapillary Fürhman grade 2(Figure 4). The patient was under treatment forbacillary for a period of 9 months (2SRHZ/7RH). Afterfalling 06 months an ultrasound does not objectifiedtumor recurrence.

Discussion

Some authors report that kidney cancer occurs in0.2% of cases of renal tuberculosis. [2] There is a highfrequency of this association in the Mediterraneanincluding Spain [2]. The age of onset of thisassociation according to published cases is between50 and 70 years with a male predominance [3]. Formost authors this association could be related toreactivation of latent tuberculosis secondary to localimmunosuppression induced by the tumor [4] Theclear cell adenocarcinoma is histological formpredominantly found associated with renaltuberculosis [2,4]. The association of tuberculouslesions in a tumor from another histologic type hasbeen rarely described two cases of tuberculosisoccurring in renal adenocarcinoma tubulopapillarywere reported in the literature [5]. Cancer treatment onrenal tuberculous nephritis is based on the radicalnephrectomy, this one can only be achieved afterimpregnation with a TB treatment for at least fourweeks to prevent secondary infection and spread ofMycobacterium tuberculosis. Currently conservativesurgery is increasingly performed for tumors of smallsize [6].

Conclusion

The originality of our observation is based on thedouble chance discovery of a tumor of the kidney andrenal tuberculosis. Treatment should be adapted to thecharacteristics of cancer. In case of small tumor polarpartial nephrectomy followed or preceded by a TBtreatment is possible.

Abbreviations(s)

R : Rifampicine

H: Izoniazide

Z: Pyrazinamide



S: Streptomycine

References

1. NEIBLING H.A., WALTERS W.: Adenocarcinomaand tuberculosis of the same kidney: review of theliterature and report of seven cases. J. Urol., 1948, 59,1022-1026.2. CONDE REDONDE C., ESTEBANEZ ZARRANZ J.,RODRIGUEZ TOVES A., DE CASTRO OLMEDO C.,CAMACHO PAREJO J., SANZ SANTACRUZ J.,MARTINEZ SEGARRA OCEJA J.M. : Tuberculosisand renal cancer. Actas Urol. Esp., 1999 ; 23 :617-620.3. PEYROMAURE M., SEBE P., DARWICHE F.,CLAUDE V., RAVERY V.,BOCCON-GIBOD L. :Tuberculose rénale et adénocarcinome du rein: Uneassociation trompeuse. Prog Urol., 2002 ; 12 : 89-91.4. PATARD J.J., BOUET F., RIOUX-LECLERCQ N.,LOBEL B., CATROSQUEMENER V., GUILLE F. :Mécanismes de tolérance immunitaire locale dans lescancers du rein. Prog. Urol., 2002 ; 12 : 205-212.5. GUILLEMIN P. : Tuberculose et cancer du rein. J.Urol. Nephrol., 1970 ; 10: 964.6. Adénocarcinome rénal sur néphrite tuberculeuseAmine EL MEJJAD, Hamid FEKAK, Adil DEBBAGH,Abdenbi Saad BENNANI, Mohamed EL MRINI;Progrès en Urologie (2005), 15, 309-311.



Illustrations

Illustration 1

Left hydronephrosis.



Illustration 2

bilateral renal stones and cutaneous fistula renovation.



Illustration 3

tuberculous granuloma caséofolliculaire.



Illustration 4

Histology of carcinoma papillary architecture.



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Renal Adenocarcinoma On Tuberculosis Nephritis · 2012. 6. 25. · Renal Adenocarcinoma On...

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