Abstracts: CLINICAL VIGNETTES/CASE REPORTS - ENDOSCOPY
EUS-guided FNA for Metastatic Renal Cell Carcinoma of Native Kidney in a Renal Transplant Patient
Introduction: Malignancies are the second most common cause of death among renal transplant recipients after cardiovascular causes and exceed infectious diseases. Common malignancies in renal transplant recipients are non melanoma skin cancer, Kaposi sarcoma and non-hodgkin lymphoma with a 20 fold increase in their risk. Renal cell carcinoma in native kidneys after renal transplant is quite infrequent (0.3-4.8%). Here we report first case of renal cell carcinoma originating in native kidney, diagnosed by EUS guided FNA. Case Description: A 54-year-old gentleman status post renal transplant secondary to Goodpastures syndrome presented with nausea, vomiting, and abdominal pain. His past medical history include hypertension and diabetes mellitus type 2. Early investigations included a liver battery, amylase, lipase; CBC and a basic metabolic panel were found negative. A right upper quadrant ultrasound revealed normal liver and gallbladder, however, cyst was found in an enlarged right native kidney. MRI of the abdomen showed retroperitoneal lymph nodes concerning for lymphoma along with enlargement of the right native kidney with irregular borders concerning for neoplasm. He then underwent endoscopic ultrasound to evaluate the perigastric/peripancreatic area for possible fine-needle aspiration of lymph nodes. The endosonographic examination revealed multiple lymph nodes at sub-carinal, paraesophageal, celiac axis, peripancreatic and periduodenal areas. Small-to-moderate amount of ascites was identified. Using a 25-gauge needle, fine-needle aspiration was performed from mediatsinal lymph nodes, celiac lymph nodes and peripancreatic lymph nodes. Ascetic fluid was then aspirated using a 19-gauge needle under endosonographic guidance. Cytopathology of the lymph node and ascetic fluid samples revealed metastatic renal cell carcinoma. PET scan confirmed it by lighting up in right kidney and other areas of metastatic lymphadenopathy. Conclusion: In conclusion, EUS guided FNA could have an important role in identifying the primary source of metastatic lymphadenopathy in renal transplant patients. It is safe, minimally invasive, feasible and highly accurate in making such diagnosis and assisting further management.© The American College of Gastroenterology 2012. All Rights Reserved.