1160 | Treatment of Juxtaglomerular Cell Tumor of the Kidney by Retroperitoneal Laparoscopic Partial Nephrectomy Zhi Chen,1 Zheng-Yan Tang,1 Hai-Tao Liu,2 Xiang Chen1 Keywords: kidney neoplasms; laparoscopy; juxtaglomerular apparatus; renin; laparoscopy; retroperitoneal space. INTRODUCTION Juxtaglomerular cell tumor (JCT) of the kidney, first described by Robertson and col-leagues in 1967,(1) is a rare cause of serve hypertension. Because the tumor is small, mainly occurs in children and young adults, and has benign nature, nephron-sparing surgery is particularly recommended.(2) Here we present for the first time a case of JCT in a 29-year old woman who underwent retroperitoneal laparoscopic partial nephrectomy. CASE REPORT A 29-year old woman presented with a history of headache, polyuria, nocturia, and blurred vision. Her blood pressure was 190/120 mmHg and had hypokalemia (2.9 mmol/L). Blood urea and creatinine and 24-hour urinary vanillyl mandelic acid (VMA) levels were all nor- mal. Ultrasonography revealed a hypoechoic 2 × 3 cm mass in the left kidney. Contrast-en- hanced computed tomography (CT) of the abdomen documented a 2 × 3cm hypo enhancing, solitary, well-circumscribed mass lesion in the anterior aspect of the middle pole of the left kidney (Figure 1). Serum levels of plasma renin activity (PRA) and aldosterone (ALD) were high in supine and upright position (PRA 7.3 µg/L/h vs. 8.9 µg/L/h and ALD 258.1 pmol/L vs. 443.7 pmol/L, respectively). Renal venous sampling for renin assay was performed. The ratio of left kidney to right kidney was 1.7. Considering the small peripheral lesion, retrop- eritoneal laparoscopic partial nephrectomy was performed. The operative time was 145 min and the warm ischemic time was 29 min. The estimated blood loss was 80 mL. The hospital Corresponding author: Xiang Chen, MD Department of Urology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, China Tel: +86 0138 7480 8998 Fax: +86 731 8432 7354 E-mail: cxiang1007@126.com Received October 2011 Accepted April 2012 1 Department of Urology, Xiangya Hospital, Central South University, Hunan Province, China. 2 Department of Urology, Second Affiliated Hospital, Hunan University of Traditional Chinese Medicine, Hunan Province, China. CASE REPORT Case Report 1161Vol. 10 | No. 4 | Autumn 2013 |U R O LO G Y J O U R N A L Juxtaglomerular Cell Tumor of the Kidney | Chen et al stay was 3 days. No intraoperative and postoperative com- plication occurred. The pre- and postoperative serum creati- nine levels were 1.38 mg/dL and 1.45 mg/dL, respectively. The pathological findings confirmed the diagnosis of a JCT (Figure 2). Her blood pressure returned to normal without medical treatment postoperatively. Hypokalemia has also resolved. She was alive without evidence of recurrence 25 months after surgery. DISCUSSION The definitive treatment for JCT is surgical excision.(3) To our knowledge, no case of JCT of the kidney treated by re- troperitoneal laparoscopic partial nephrectomy has been re- ported to date. The retroperitoneal approach for JCT of kid- ney offers various obvious advantages. It provides a direct and rapid approach to kidney and renal hilum, allows the renal artery to be dissected directly without the retraction of the vein, there is closer proximity to the conventional open approach, provides the advantage of easier management of post-operative complication such as urine leakage or bleed- ing, and offers an alternative to the patients with previous transperitoneal surgery. Furthermore, our previously ex- tensive experience with many retroperitoneal laparoscopic procedures also contributed to the choice of the retroperito- neal approach for JCT.(4) In conclusion, this case suggested that retroperitoneal lapa- roscopic partial nephrectomy is a safe and feasible proce- dure for JCT of the kidney. ACKNOWLEDGMENT Zhi Chen and Zheng-Yan Tang contributed equally to this work. CONFLICT OF INTEREST None declared. REFERENCES 1. Robertson PW, Klidjian A, Harding LK, Walters G, Lee MR, Robb-Smith AH. Hypertension due to a renin-secreting re- nal tumour. Am J Med. 1967;43:963-76. 2. Mete UK, Niranjan J, Kusum J, Rajesh LS, Goswami AK, Shar- ma SK. Reninoma treated with nephron-sparing surgery. Urology. 2003;61:1259-59. 3. Feliciotti F, Campagnacci R, Perretta S, et al. Laparoscopic re- section of a juxtaglomerular cell tumor of the right kidney. Surg Endosc. 2002;16:539. 4. Chen Z, Chen X, Luo YC, He Y, Li NN, Wu ZH. Retroperitoneo- scopic Decortication of Symptomatic Peripelvic Renal Cysts: Chinese Experience. Urology. Urology. 2011;78:803-7. Figure 1. Contrast-enhanced computed tomography scan shows a 2 × 3cm hypo enhancing, solitary, well circumscribed mass le- sion in the anterior aspect of the middle pole of the left kidney. Figure 2. The pathological examination shows that the tu- mor cells consist of clusters of polygonal cells, with a moderate amount of eosinophilic cytoplasm and centrally located nuclei. There is a prominent vessels under light microscope. (Hematoxy- lin eosin × 400).