'Pseudo' pseudoaneurysm following robotic assisted partial nephrectomy

A 65-year-old female presented to clinic requesting follow up for a history of right robotic partial nephrectomy done at an outside institution 2 years prior. Initial pathology demonstrated a grade 2/4 3.4 cm clear cell renal cell carcinoma with negative margins. There was no tumor necrosis, sarcomatoid differentiation, or lymphovascular invasion. High quality follow up imaging initially revealed a pseudoaneurysm in the central portion of the right kidney. The patient was sent to interventional radiology for angioembolization. Angiography identified the abnormality to be a recurrent or residual mass in the renal hilum. MRI confirmed these findings, and the patient ultimately required a laparoscopic radical nephrectomy for definitive treatment. Final pathology showed grade 2/4 clear cell renal cell carcinoma with negative margins and no tumor necrosis or sarcomatoid differentiation. The tumor did involve sinus fat and sinus vessels, but not perinephric fat.