Eosinophilic Variant of Chromophobe Renal Cell Carcinoma During Pregnancy: A Multidisciplinary Approach and Successful Management in a Tertiary Hospital in Mexico

Abstract

Renal cell carcinoma (RCC) is rarely diagnosed during pregnancy and its management represents a challenge as it necessitates considerations for the well-being of both the mother and the developing fetus. Diagnosis can be challenging and is often an incidental finding during routine imaging, which can lead to difficult decision-making. The choice of the ideal imaging study in these cases is a matter of debate. When the tumor is detected at an early stage, radical nephrectomy is indicated. However, there is still controversy regarding whether it should be performed conventionally or laparoscopically, as both techniques have their risks and benefits. In this context, our primary objective was to provide adequate surgical treatment for the patient, while safeguarding fetal health. Here, we present a patient with a history of recurrent miscarriages, in whom a renal tumor was incidentally diagnosed during pregnancy. Adding to the uniqueness of this case, the patient was diagnosed with an eosinophilic variant of chromophobe RCC through histopathological analysis. Our aim is to highlight the controversies surrounding diagnostic and treatment methodologies and to present the surgical techniques employed in this unique situation. This case underscores the importance and need for a multidisciplinary approach, which, in our instance, resulted in favorable outcomes for both maternal and neonatal health.

Keywords: high-risk pregnancy; laparoscopic radical nephrectomy; laproscopic urology; non-clear cell renal carcinoma; pregnancy surveillance; renal neoplasm; second trimester pregnancy; unexplained recurrent pregnancy loss.

Figure 1. CT scan in the axial plane that shows a mass (arrow) located on the mid-portion of the right kidney.

CT: computed tomography

Figure 2. CT scan in a coronal plain that demonstrates the same renal tumor (arrow), which showed enhancement after contrast administration.

CT: computed tomography

Figure 3. Enlarged uterus observed during diagnostic laparoscopy, which correlated with the patient's weeks of gestation.

Figure 4. Laparoscopic image of renal vessels, showing an arterial anatomical variant depicted by the presence of two ligated and cut renal arteries (yellow arrows). In addition, a single renal vein is observed, dissected along its course with no evidence of tumor invasion (green arrow).

Figure 5. Surgical specimen that shows a right renal kidney with a well-defined tumor located at its mid pole.

Trocar used as a reference for size comparison.

Figure 6. Histopathological images of the excised tumor.

A. Histological picture showing chromophobe neoplastic cells with eosinophilic cytoplasm (H&E 10x). B. Microscopic image that demonstrates small, binucleate cells, a common finding in eosinophilic variant of chromophobe RCC (H&E 40x). H&E: hematoxylin and eosin