Approach to Carcinoma Cervix with Pelvic Kidney

Abstract

To study the management of carcinoma cervix when the patient has an associated pelvic kidney. The simultaneous occurrence of carcinoma cervix and pelvic kidney is rare. It is an interesting scenario where surgery is technically challenging and radiation is difficult since the pelvic kidney lies within the field of radiation. In our department, we treated three cases of cervical carcinoma with pelvic kidney. First case was FIGO IIB treated with external beam radiotherapy followed by radical hysterectomy; second case stage IB1 treated with radical hysterectomy, third case was referred to us after panhysterectomy with carcinoma detected in postoperative histopathological report, and she was treated with external beam radiotherapy. We made an online database search and found few case reports of gynecological malignancies associated with pelvic kidney and reviewed their management. All the three patients are alive and disease free in the last follow up. None of the patients developed uremia. The pelvic kidney of the patients treated with radiotherapy has shrunken in size. Surgery is preferred over radiotherapy in early stages of carcinoma cervix with pelvic kidney to avoid radiation-induced damage to pelvic kidney.

Total Exenteration En Bloc with a Nephrectomy for Locally Advanced Cervical Cancer Invading a Pelvic Kidney—A Case Report and Literature Review

“…The third case was per primam submitted for a radical hysterectomy followed by adjuvant radiotherapy with a total dose of 500 Gy. In all cases, good oncological and renal long-term outcomes were obtained [2].…”

“…An ectopic kidney refers to the situation in which developmental arrest of the renal ascent is encountered, leading to the location of this viscus in the pelvic, iliac or abdominal area [1]. Most often, a pelvic kidney is situated opposite to the sacrum bone and below the aortic bifurcation and presents an incomplete rotation [2]. Such cases also present certain modifications with regard to the length and disposition of the ureter and vascular supply: In up to half of these patients, a certain degree of hydronephrosis can be encountered, while the renal arteries can arise from the distal aorta, aortic bifurcation, common or external iliac arteries or even from the inferior mesenteric artery [1,2].…”

“…Most often, a pelvic kidney is situated opposite to the sacrum bone and below the aortic bifurcation and presents an incomplete rotation [2]. Such cases also present certain modifications with regard to the length and disposition of the ureter and vascular supply: In up to half of these patients, a certain degree of hydronephrosis can be encountered, while the renal arteries can arise from the distal aorta, aortic bifurcation, common or external iliac arteries or even from the inferior mesenteric artery [1,2]. Therefore, its pelvic location makes it susceptible to be invaded by all the tumoral processes of pelvic origin, while the surgical approach can be significantly influenced.…”

Unexpected encounters challenging modified radical hysterectomy

“…There is no etiological association between carcinoma cervix and pelvic kidney but they pose therapeutic dilemma during management [8] . Rajaraman Ramamurthy et.al recommended surgery in early stages of carcinoma cervix with pelvic kidney to avoid radiation induced damage to pelvic kidney [3] . During early embryologic development, the urinary bladder is continuous with the allantois, a canalized fibromuscular stalk that connects the fetal bladder to the umbilical cord for drainage.…”

“…Cancer cervix is an entity which needs multimodality treatment at various levels. Associated anomalies will be an important factor in planning management as the treatment modality may be associated with risk of inducing pathological changes in the anatomical structure that is anomalously situated in treatment field [3] . Surgery will be disastrous if anatomical anomaly is not recognized prior to procedure.…”