-Case Reports-

Successful Transcatheter Arterial Embolization to Control Intratumoral Hemorrhage in Clear-Cell Sarcoma of the Kidney

Ryoichi Uchimura¹, Takahiro Ueda¹, Tsubasa Takahashi², Yujiro Tanabe¹, Toshikazu Itabashi¹, Miho Maeda¹ and Yasuhiko Itoh¹

¹Department of Pediatrics, Nippon Medical School Hospital, Tokyo, Japan
²Department of Pediatric Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan

Clear-cell sarcoma of the kidney (CCSK) is a rare, aggressive pediatric renal tumor. Intratumoral hemorrhage and tumor rupture are oncologic emergencies requiring a rapid and appropriate response. An 11-year-old boy visited our hospital with abdominal distension of 1 month's duration. Computed tomography (CT) revealed a tumor in the left kidney (size: 200 mm), and analysis of a biopsy specimen confirmed a diagnosis of CCSK. Chemotherapy was initiated to shrink the large, densely vascularized tumor before surgical removal. Two days after starting chemotherapy, the patient developed abdominal and back pain, anemia, and hypotension. CT scanning showed intratumoral bleeding. Emergency transcatheter arterial embolization (TAE) was performed to control the bleeding. Three tumor feeding vessels were identified: an ascending branch from the celiac artery, an intermediate branch from the left renal artery, and a descending branch from the inferior mesenteric artery, of which the intermediate and descending branches were large and bleeding profusely. Therefore, the intermediate branch was injected with ethanol, and the descending branch was treated by gel-foam embolization. Chemotherapy was resumed, and the patient's condition gradually stabilized. The tumor began to shrink, and subsequent chemotherapy progressed well. In week 12 of chemotherapy, the patient underwent tumor resection and left nephrectomy. Postoperative chemotherapy was completed without complications, and there was no recurrence during a 6-year follow-up period. Therefore, TAE can effectively control intratumoral bleeding in pediatric solid tumors, thus preventing high-risk open surgery.

J Nippon Med Sch 2022; 89: 233-237

Keywords
transcatheter arterial embolization, clear cell sarcoma of the kidney, hemorrhage, anemia

Correspondence to
Takahiro Ueda, MD, PhD, Department of Pediatrics, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
yuri878t@nms.ac.jp

Received, December 14, 2020
Accepted, January 6, 2021