IS Case 255: Radiofrequency ablation of papillary renal cell carcinoma

Scott Cassar, MD


Imaging Sciences URMC 2008
Publication Date: 2009-05-26

History

Patient is an elderly man status post right nephrectomy for renal cell cancer, now with a new left renal lesion.

Findings

Radiofrequency ablation of a minimally enhancing exophytic left renal lesion

Discussion

Papillary (chromophilic) renal cell carcinoma accounts for 7 to 14% of primary epithelial renal neoplasms and is the second most common type or renal cell cancer after clear cell carcinoma. The classic papillary pattern is seen histologically as fronds containing a central fibrovascular core lined by neoplastic epithelial cells. Papillary renal cell carcinoma is further divided into two histologic subtypes, type 1 basophilic and type 2 eosinophilic.

Renal cell carcinoma has traditionally been treated with radical nephrectomy. In patients who are non-surgical candidates or in patients who have only one kidney, such as our patient, alternative, less invasive renal sparing approaches have been developed to preserve renal function. These include image-guided radiofrequency ablation or cryoablation.

Percutaneous radiofrequency ablation uses an electrode which has been placed sonographically or with CT-guidance into the tumor. This electrode transmits energy from a monopolar radiofrequency generator to the surrounding tissue where it generates heat. Protein denaturation and cell membrane disruption resulting in cell death occur when the tissue reaches 50°C. Radiofrequency ablation has proven most effective in small tumors less than 3cm and in exophytic tumors with surrounding insulating fat. The most common complication is hemorrhage which is evaluated for on a post-ablation scan.

References

  1. Bajorin DF. Tumors of the kidney, bladder, ureters, and renal pelvis. IN: Goldman L, Ausiello D (Eds). Goldman: Cecil Medicine, 23rd ed., Saunders, 2007: Chapter 207. [MDConsult]
  2. Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR. Radiofrequency ablation of renal cell carcinoma: part 1, Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol. 2005 Jul;185(1):64-71. [PMID: 15972400]
  3. McLaughlin CA, Chen MY, Torti FM, Hall MC, Zagoria RJ. Radiofrequency ablation of isolated local recurrence of renal cell carcinoma after radical nephrectomy. AJR Am J Roentgenol. 2003 Jul;181(1):93-4. [PMID: 12818836]

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