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  • Recipient of a live donor kidney transplant 20 years prior to current presentation.

  • Stable renal function until recently.

  • Imaging studies showed a 20 × 15 cm mass originating in the transplanted organ.

  • Immunosuppression was tapered down, and the transplant renal vessels were embolized percutaneously prior to transplant nephrectomy.

  • Pathology revealed renal cell carcinoma.

FIGURE 112-284

CT and MRI Images. Right lower quadrant kidney transplant with a 20 × 15 cm central mass in the renal hilum. Calcifications and additional masses involving the transplant kidney and measuring up to 5 cm are also seen.

FIGURE 112-285

Allograft Nephrectomy. Intraoperative appearance of the tumoral kidney as it is being resected. The transplant renal artery and vein had been embolized pre-operatively.

FIGURE 112-286

Resected Specimen. The specimen weighed 2,350 grams. Pathology showed a unifocal papillary renal cell carcinoma, Type 2. Non-involved parenchyma had moderately advanced chronic changes, with 20%-30% global glomerulosclerosis, tubular atrophy and interstitial fibrosis (30% of cortex), and moderate arterial and arteriolar sclerosis.

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