Stesura Seveso Archivio Italiano di Urologia e Andrologia 2015; 87, 3256 CASE REPORT Contralateral tumor seeding of renal cell carcinoma mimicking late metastasis of liver after laparoscopic nephrectomy: A case report with review of the literature Özgür Haki Yüksel, Caglar Yildirim, Ahmet Ürkmez, Serkan Akan, Ayhan Verit Fatih Sultan Mehmet Research & Training Hospital, Dept. of Urology, Istanbul, Turkey. Laparoscopic surgery has been increasingly used every day in the management of uro- logic malignancies. Even though it seems as a minimally invasive surgery, during these interventions tumor seeding, as seen in open surgery, confronts us as a rarely seen serious risk. Herein, we have reported a case who demonstrated peritoneal tumor implantation at 12 month postoperative follow up after laparoscopic radical nephrectomy (LRN) performed for Furhman grade 1 (T2N0M0) renal cell cancer. KEY WORDS: Laparoscopic radical nephrectomy; Tumor seeding; Peritoneal implant; Renal cell cancer. Submitted 9 March 2015; Accepted 30 April 2015 Summary No conflict of interest declared. tic biopsy with the aid of transrectal ultrasound. Histopathological report indicated prostate cancer (PCa) with Gleason score 3+3 in 6 out of 12 core biopsy spec- imens. Magnetic resonance imaging (MRI) performed for tumor grading incidentally disclosed a mass lesion radi- ologically suggesting RCC located in the mid-portion of the left kidney with exophytic extension and measuring 45 mm in its largest diameter. With this indication, the patient underwent laparoscopic renal nephrectomy (LRN) in December 2012. His histopathological report indicated the lesion to be Furhman grade 1 (T2N0M0) RCC (Figure 1). Afterwards, we performed radical retropubic prostatectomy and lymph node dissection with the indication of PCa in March 2013 and penile prosthesis was implanted to treat his erectile dysfunc- tion. Up to that time, laboratory and radiological con- trols did not reveal the presence of RCC and PCa recur- rences or metastases. Control MRI performed at 12 month follow up post- LRN, disclosed a perihepatic mass lesion with dimen- sions of 20x18x12 mm consistent with metastasis or tumor seeding located on the anterior segment of the right lobe of the liver (Figure 2). Then, the patient underwent laparotomy in February 2014 in the depart- ment of general surgery and the lesion visualized during MRI was revealed to be a peritoneal tumor implant. The implant was excised and consulted during the perioper- ative period to the department of histopathology for frozen section. Histopathological report indicated the lesion to be a RCC implant (Figure 3). The patient is still at post-LRN 24. months. All abdominal MRI, thoracic CT and bone scans could not reveal any evidence of clin- ically significant RCC and PCa recurrence or metastases. CONCLUSIONS In conclusion, following oncologic laparoscopic inter- ventions, not only local recurrence and distant metas- tases, but also peritoneal implantation should be also considered and atypical abdominal small lesions away from trocar access site should be also taken into consid- eration as for implantation metastases. Discussion and supplementary references are posted in Supplementary Materials on www.aiua.it DOI: 10.4081/aiua.2015.3.256 INTRODUCTION During removal of malignant tumours by means of open surgery or laparoscopic resection, direct inoculation of neoplastic cells can occur. This inoculation is generally seen along the port access route which is known as port- site metastasis (1). In laparoscopic surgeries applied for the management of urologic malignancies, peritoneal implants or port-site metastases have been rarely (0.09- 0.03%) seen up to now (2). Although etiological factors of this phenomenon have not been completely under- stood, tumor aggressivity, laparoscopy-related factors, immune system of the patient and local characteristics of the surgical site have been implicated. Among all uro- logic malignancies, peritoneal tumor seeding and port- site metastasis are extremely rarely seen in renal cell can- cer (RCC). Very scarce number of case reports have been reported in the literature (3). Herein, we presented a case who demonstrated peritoneal tumor implantation at postoperative 12 month follow up after laparoscopic radical nephrectomy (LRN) performed for Furhman grade 1 (T2N0M0) renal cell cancer (RCC). CASE REPORT A 68-year-old male patient consulted to our outpatient clinic in December 2012 with complaints of dysuria and pollakiuria. His medical evaluation revealed a high serum PSA level (10.5 ng/ml) which necessitated prosta- Yuksel_Stesura Seveso 23/09/15 12:46 Pagina 256 257Archivio Italiano di Urologia e Andrologia 2015; 87, 3 Contralateral tumor seeding of renal cell carcinoma mimicking late metastasis of liver after laparoscopic nephrectomy REFERENCES 1. Lee BR, Tan BJ, Smith AD. Laparoscopic port site metastases: incidence, risk factors, and potential preventive measures. Urology. 2005; 65:639-644. 2. Tanaka K, Hara I, Takenaka A, et al. Incidence of local and port site recurrence of urologic cancer after laparoscopic surgery. Urology. 2008; 71:728-734. 3. Castillo OA, Vitagliano G. Port site metastasis and tumor seeding in oncologic laparoscopic urology. Urology. 2008; 1:372-378. Figure 1. Hematoxylin and eosin stain of the left kidney: Renal cell carcinoma (40X). Figure 3. Hematoxylin and eosin stain of the peritoneal renal cell carcinoma implant (100X). Figure 2. MR image: A perihepatic mass lesion measuring 20x18x12 mm located on the anterior segment of the right lobe of the liver. Correspondence Özgür Haki Yüksel, MD (Corresponding Author) ozgurhaki@gmail.com Caglar Yildirim, MD Ahmet Ürkmez, MD Serkan Akan, MD Ayhan Verit, MD. Prof. Fatih Sultan Mehmet Research and Training Hospital, Dept. of Urology, Içerenköy/Ataşehir, Tr- 34752 Istanbul, Turkey Yuksel_Stesura Seveso 23/09/15 12:46 Pagina 257