A Case of Renal Cell Carcinoma in a Kidney Allograft Presenting as Acute Cyst Rupture

Renal cell carcinoma in a kidney allograft is a rare event and is often conservatively managed. This case describes a 53-year-old woman with a failed kidney allograft who presented with acute abdominal pain and leukocytosis. She was found to have spontaneous hemorrhagic cyst rupture and infection of her allograft requiring urgent nephrectomy. Pathology demonstrated renal cell carcinoma in the allograft and, later, in her native kidney, which delayed and eventually precluded retransplantation. This case highlights a gap in guidelines for malignancy surveillance in patients with graft failure awaiting second-chance transplantation.