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Successful management of chromophobe type renal cell carcinoma in pregnancy

A 23-year-old gravida 3, para 2 woman with pre-eclampsia at 30 weeks’ gestation and renal mass was referred to our hospital. She gave a past obstetric history of pre-eclampsia at 28 weeks’ gestation with a stillbirth 1 year previously, and a term normal vaginal delivery 4 years previously. Her blood pressure was 140/90 mmHg and there was remarkable pretibial oedema. She had been taking alphamethyldopa 500 mg four times daily for 2 months. Apart from this she had no general health problems. She had suffered right flank pain for 1 year. Abdominal Doppler ultrasonography and magnetic resonance imaging (MRI) revealed a 15 cm × 14 cm × 14 cm right renal mass with increased vascularity (Figs 1, 2). The left kidney was normal and there were no evidence of other organ involvement. The fetal weight was estimated to be 1481 g on ultrasound examination. A biophysical profile was normal apart from a low (4 cm) amniotic fluid index. Umbilical and middle cerebral arterial Doppler studies were all normal without evidence of redistribution. A persistent early diastolic notch was identified in the right uterine artery Doppler study. Blood analysis showed a haemoglobin level of 10.8 g/dL (normal range: 12–16 g/dL) and a platelet count of 378 000/μL (normal range: 150.000–450.000/μL). Serum albumin was 3.0 g/dL (normal range: 3–4.5 g/dL), lactate dehydrogenase was 365.8 U/L (normal range: 150–400 U/L), uric acid was 6.2 mg/dL (normal range: 2–6 mg/dL), blood urea nitrogen and creatinine were normal. Urine analysis revealed 2.1 g/L proteinuria and microscopic haematuria. Considering the diagnosis of pre-eclampsia, treatment with an intravenous infusion of magnesium sulphate and two doses of betamethasone 12 mg intramuscular within a 24 h interval for fetal lung maturation were administered. At 32 weeks’ gestation, because of an uncontrollable increase in blood pressure, low biophysical profile scores and persistent variable spontaneous decelerations on cardiotocography, emergency Caesarean section was performed under general anaesthesia. A 1520 g healthy female infant was delivered. At 3 weeks post-partum the mother was subjected to right abdominal radical nephrectomy. The histologic examination revealed a T2N0M0 chromophobe renal cell carcinoma. The postoperative course was unremarkable. Six weeks postpartum the mother and infant were in good health.