Laparoscopic cryoablation of renal angiomyolipoma.

PURPOSE: Angiomyolipomas are rare benign renal tumors which occasionally require intervention. Preservation of renal function is essential when treating renal angiomyolipoma in patients with multiple or bilateral lesions. We report on the first series of patients with renal angiomyolipoma treated with laparoscopic cryoablation. MATERIALS AND METHODS: Seven patients with pathologically confirmed renal angiomyolipoma underwent laparoscopic cryoablation. Transperitoneal surgery with intraoperative ultrasound was performed, followed by clinical monitoring with creatinine and axial imaging. RESULTS: Mean patient age was 44.9 years. Six patients were female, and 2 patients had associated tuberous sclerosis and multiple bilateral angiomyolipoma. In 1 patient 5 lesions were treated, in another 3 lesions were treated and in the remaining patients solitary lesions were treated. The average size of the largest lesion in each patient was 4.2 cm (range 2.5 to 7.0). The procedures were tolerated well with 3 minor complications in 2 patients. Average operative time was 170 minutes (range 137 to 232) and decreased as expertise was gained. Average estimated blood loss was 116 cc (range 15 to 250). Renal function was preserved, with mean preoperative and postoperative creatinine 0.83 (range 0.6 to 1.6) and 0.91 (range 0.7 to 1.8), respectively. Average decrease in estimated creatinine clearance was 8.6 ml per minute. Followup imaging using computerized tomography or magnetic resonance imaging showed reduction in lesion size, lack of blood flow and no subsequent regrowth in all patients. CONCLUSIONS: Laparoscopic cryoablation is a safe and feasible minimally invasive, nephron sparing alternative for the treatment of angiomyolipoma.

Signet-ring cell carcinoma of the urinary bladder mimicking retroperitoneal fibrosis.

We present the case of a 77-year-old white woman with a past medical history of transitional cell carcinoma of the urinary bladder that presented with symptoms of acute renal failure and duodenal obstruction and posed a diagnostic dilemma. Initially, she presented with bilateral ureteral strictures and eventually required bilateral nephrostomy tubes. Later, the patient developed intractable nausea and vomiting secondary to a duodenal stricture. The finding of a "stranding appearance" on computed tomography imaging of the retroperitoneal space raised the suspicion of retroperitoneal fibrosis. Subsequent endoscopic placement of metal stents to relieve the duodenal obstruction failed to relieve her symptoms. The patient's poor general condition precluded an exploratory laparotomy. The patient expired shortly thereafter and an autopsy was performed. The autopsy results revealed full wall thickness signet-ring cell carcinoma of the urinary bladder with extensive metastasis to the retroperitoneum.

Intermediate results of laparoscopic cryoablation in 59 patients at the Medical College of Wisconsin.

PURPOSE: We report our experience with LC for small renal tumors. MATERIALS AND METHODS: Patients who underwent LC at our institution between February 2000 and September 2004 were included in the study. A retrospective chart review was done for perioperative and postoperative parameters as well as clinical outcomes. RESULTS: A total of 65 LCs were performed in 59 patients during the period reviewed. Overall 81 renal tumors were cryoablated. Median patient age was 62 years. Median tumor size was 2.5 cm. Median operative time was 190 minutes. Median estimated blood loss was 50 ml. Median hospital stay was 2 days. Conversion to open surgery occurred in 2 patients. Nephrectomy for bleeding occurred in 1 patient. Median followup was 26.8 months. Two recurrences were identified after LC. CONCLUSIONS: LC is an alterative modality to laparoscopic partial nephrectomy or open partial nephrectomy for small renal tumors. Tumor recurrence rates in the studies published to date are comparable to those of partial nephrectomy, although longer followup is needed.

Intra-abdominal desmoid tumor following retroperitoneal lymph node dissection for testicular germ cell tumor.

In the testicular cancer post-treatment setting a rapidly growing retroperitoneal mass leads to a differential diagnosis including recurrent germ cell tumor, residual mature teratoma, or sarcomatoid degeneration. We report the case of a 27-year-old man with a large abdominal mass occurring in the setting of a mixed germ cell tumor after radical orchiectomy with primary chemotherapy followed by retroperitoneal lymph node dissection. Surgical excision of this mass followed by pathological review revealed an intra-abdominal desmoid tumor. Fluorescence in situ hybridization (FISH) for isochromosome 12p failed to demonstrate a germ cell tumor origin. This is the fourth such case of an intra-abdominal desmoid tumor after retroperitoneal lymph node dissection for testicular cancer in the urologic literature. This case highlights the need for careful consideration of a desmoid tumor when a rapidly growing spindle cell tumor is encountered in a post-treatment testis cancer patient.