Renal Cell Carcinoma in Pregnancy From a Gynecological Perspective: A Case Report and Review of Management Algorithm
الكلمات المفتاحية:
MRI، Nephrectomy ، Pregnancy neoplasm ، Renal cell carcinoma ، Ultrasoundالملخص
Renal cell carcinoma (RCC) is a rare urological malignancy that may present during pregnancy. There is a lack of standardized management protocols, which makes RCC diagnosis and treatment challenging due to the need to balance maternal oncologic results and fetal safety. Using imaging modalities is restricted by the pregnancy-related limitations, and surgery carries the risk of preterm delivery. A multidisciplinary approach and minimally invasive technique had improved the outcome. A 25-year-old primigravida with 23 weeks of gestation reported left flank pain and hematuria. The ultrasonography showed a solid left renal mass of 4.5 by 4 cm, which was later defined using non-contrast MRI as suspicious of RCC. At 26 weeks, a left radical nephrectomy using a retroperitoneal approach was done under epidural anesthesia with close intraoperative supervision with obstetric standby following multidisciplinary consultation and informed patient consent. The surgery went smoothly with an intraoperative blood loss of 400 mL and stable maternal-fetal measurements. Diagnosis: Histopathology showed clear cell RCC, pT1bN0Mx, WHO/ISUP grade 2, with free margins. After an uneventful recovery, the patient delivered a healthy female child by caesarean delivery at the 38th week. RCC should be considered in pregnant women who report persistent urinary symptoms, hematuria, flank pain, or masses. Ultrasound continues to be the main diagnostic modality, with MRI having better tissue characterization without radiation exposure. A multidisciplinary decision-making process that is unique and considers the tumor biology, size, gestational age, and preferences of the patient will maximize both oncologic and obstetric results.
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