title: Prolonged treatment of chronic renal insufficiency, acquired cystic kidney disease, simultaneous precancerous lesions and multiple tumors of left kidney.
abstract: OBJECTIVE
  Description of precancerous lesions and kidney tumors developing in a patient with chronic uremia treated by long-term hemodialysis.
  Light microscopy, polarization and immunohistochemistry with CK1/CK3, CK5/6, CK7, CK8, CK20, EMA, Renal cell, CD10, Ki-67, PCNA, p53 and E-cadherin antibodies were used.
  
  
  RESULTS
  After 11 years of hemodialysis treatment of end-stage diabetic nephropathy and chronic tubulointerstitial nephritis an urgent left-sided nephrectomy was performed because of pain and massive intrarenal bleeding. Biopsy revealed acquired cystic kidney disease associated with multiple precancerous lesions, several small papillary adenomas and a multifocal renal cell carcinoma with conventional and papillary structures with admixture of small foci of highly cellular sarcomatoid features. Severe vascular nephrosclerosis and uremic oxalosis were additional findings. The upper pole of the kidney was massively hemorrhagic.
  
  
  CONCLUSIONS
  This case illustrates the association of chronic renal insufficiency, uremic oxalosis, long-term hemodialysis, acquired cystic kidney disease and development of variable precursor intratubular and intracystic lesions progressing to several papillary adenomas and multifocal renal cell carcinomas with variegated microscopic structures in one kidney.
authors.affiliation: Department of Pathology, Faculty of Medicine, P.J. Safárik University in Kosice, Slovak Republic. andrej.boor@upjs.sk
authors.forename: A
authors.initials: A
authors.lastname: Böör
authors.forename: I
authors.initials: I
authors.lastname: Jurkovic
authors.forename: Z
authors.initials: Z
authors.lastname: Havierová
authors.forename: P
authors.initials: P
authors.lastname: Kocan
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications* / Q000473:pathology; D003928:Diabetic Nephropathies / Q000150:complications* / Q000473:pathology / Q000628:therapy; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000150:complications* / Q000473:pathology; D007680:Kidney Neoplasms / Q000150:complications* / Q000473:pathology; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000150:complications* / Q000473:pathology; D009395:Nephritis, Interstitial / Q000150:complications* / Q000473:pathology / Q000628:therapy; D011230:Precancerous Conditions / Q000150:complications* / Q000473:pathology; D006435:Renal Dialysis