The experience in applying the contrast-enhanced ultrasonography in successfully operated patient with malignant tumor of kidney transplant. Case Study and Review of Literature

The risk of neoplasms development among kidney transplant (KT) recipients is twice higher than in the general population. The frequency of renal cell carcinoma (RCC) occurrence in KT recipients is about 0,6%. RCC more often develops in the native kidney than in KT (0,7% vs 0,2%). Several histopathological features in KT recipients were noted: reduced frequency of clear cell carcinoma (CCC) and wider distribution of papillary cell carcinoma in comparison with the general population. CCC is the most aggressive type of RCC in terms of metastasis and worst prognosis. The majority of KT tumors are asymptomatic and detected by accident. Presently, contrast-enhanced multispiral computed tomography (CEMCT) is considered to be the gold standard of noninvasive diagnostics of RCC. Since the 2000s, contrast-enhanced ultrasonography (CEUS) has been actively implemented. This technique demonstrates results comparable to CEMCT. The article contains a brief overview of CEUS diagnostic capabilities in cases of RCC and highlights some technological and practical aspects of CEUS application in real clinical practice. The clinical case of diagnostics and successful surgical intervention in the patient with RCC and preserved KT function is presented. The perfusion pattern of rapid contrast media wash-in and wash-out during CEUS in a patient with histologically verified CCC was demonstrated. The patient underwent laparoscopic resection of the KT tumor. The diagnosis of CCC was finally verified by the results of histological examination. KT function was not affected during and after the surgery. To the best of our knowledge, this clinical case is the first description of CEUS application in a KT recipient with CCC in the Russian Federation. The presented data allows introduction the capabilities of CEUS as a diagnostic link in nephron-sparing strategy to a wide audience of clinicians.

почечный трансплантат, почечно-клеточный рак, ультразвуковое исследование с контрастным усилением, парциальная нефрэктомия, нефрон-сохраняющая стратегия, kidney transplant, renal cell carcinoma, contrast-enhanced sonography, partial nephrectomy, nephron-sparing strategy

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