Abstract
BackgroundThe most common pediatric renal neoplasm is Wilms tumor, but clear cell sarcoma of the kidney or synovial sarcoma of the kidney are also sometimes encountered. Accurate pathological diagnosis is important, because adjuvant therapies including chemotherapy and radiotherapy differ according to the pathological type.Case presentationA 9-year-old boy presented with a headache, and ultrasonography, computed tomography, and magnetic resonance imaging revealed a heterogeneous enhancement of soft tissue originating from the upper pole of the left kidney, measuring approximately 11.0 × 10.0 × 8.0 cm. A left radical nephrectomy was performed using an intraperitoneal approach through an anterior subcostal incision. Pathological examination suggested clear cell sarcoma of the kidney or synovial sarcoma of the kidney based on morphological and immunohistological features. Using genetic analysis, a final diagnosis of spindle cell pattern clear cell sarcoma of the kidney was made based on the absence of the SYT-SSX fusion gene. After adjuvant chemo-radiotherapy was administered, no recurrence or metastasis has been identified as of 60 months postoperatively.ConclusionIn this case, it was difficult to discriminate clear cell sarcoma of the kidney from synovial sarcoma of the kidney based on histopathological examination alone, and genetic analysis was required. Accurate pathological diagnosis of pediatric renal tumor is important for determining optimal treatment and preventing recurrence and metastasis.
Highlights
The most common pediatric renal neoplasm is Wilms tumor, but clear cell sarcoma of the kidney or synovial sarcoma of the kidney are sometimes encountered
In this case, it was difficult to discriminate clear cell sarcoma of the kidney from synovial sarcoma of the kidney based on histopathological examination alone, and genetic analysis was required
Accurate pathological diagnosis of pediatric renal tumor is important for determining optimal treatment and preventing recurrence and metastasis
Summary
We report the case of a 9-year-old boy who underwent radical nephrectomy for a tumor in the left kidney. A final diagnosis of CCSK was made based on genetic analysis, and adjuvant chemo-radiotherapy was administered. Accurate pathological diagnosis of pediatric renal tumor is important for determining optimal treatment and preventing recurrence and metastasis. Consent Written informed consent was obtained from the patient’s parents for publication of this Case Report and any accompanying images. KM was involved in the drafting of the manuscript. HK performed the clinical follow-up and contributed to the manuscript. All authors read and approved the final manuscript. Authors’ information MH, HK, HN, YM: Postdoctoral fellow, KM: Assistant professor, YH: Associate professor, and KK: Professor and chairman, Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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