Left Renal Pole Research Articles

Retroperitoneal infantile hemangioma: a case report and literature review

BackgroundRetroperitoneal infantile hemangioma (RIH), a type of primary retroperitoneal tumors, are exceptionally rare in clinical practice. Infantile hemangiomas typically manifest on the skin’s surface. RIHs are exceptionally rare and typically small. In adults, these tumors often manifest without specific clinical symptoms or detectable signs for a definitive diagnosis. This case report details a patient diagnosed with RIH. We recommend complete excision of the tumor after a comprehensive evaluation, followed by postoperative pathology, to achieve a conclusive diagnosis. We believe that managing critical retroperitoneal structures and vessels intraoperatively presents a significant challenge for all procedures involving primary retroperitoneal tumors.Case summaryA 47-year-old male was diagnosed with gallstones and underwent surgery 3 months ago at other institution for unexplained nausea and vomiting. Follow-up imaging 2 months after surgery revealed a retroperitoneal mass below the left renal pole. Upon presentation to our hospital, the patient continued to experience intermittent nausea and vomiting, with no other significant symptoms or signs. Considering the patient’s 8-year history of hypertension, a paraganglioma was initially suspected. We performed the laparoscopic mass resection after a detailed assessment. However, postoperative pathology revealed it a capillary hemangioma (old term)/infantile hemangioma.ConclusionRIHs are exceedingly rare benign tumor. The possibility of malignancy should be ruled out, and surgical resection is recommended following a thorough evaluation, with the diagnosis confirmed through pathological examination.

Clinical impact of perirenal thickness on short- and long-term outcomes of gastric cancer after curative surgery.

BackgroundA variety of factors for short‐ and long‐term outcomes have been reported after radical resection for gastric cancer (GC). Obesity and emaciation had been reported to be a cause of poor short‐ and long‐term outcomes with gastrointestinal cancer. However, the indicators are still controversial. The purpose of this study was to evaluate the relationship between perirenal thickness (PT) and short‐ and long‐term outcomes after radical surgery for GC.MethodsWe analyzed the data of 364 patients with GC who underwent radical surgery. We evaluated the distance from the anterior margin of the quadratus lumborum muscle to the dorsal margin of the left renal pole using computed tomography (CT) as an indicator of PT. The association between PT and clinicopathological factors and short‐ and long‐term outcomes was evaluated.ResultsThe PT data were divided into low, normal, and high groups by gender using the tertile value. We found that the PT low group was 121 patients, normal group was 121 patients, and high group was 122 patients. Multivariate analyses showed that the high PT group was an independent risk factor for a short‐outcome after curative surgery in GC patients (odds ratio 2.163; 95% confidence interval [CI] 1.156–4.046; P = .016). And the low PT group was an independent risk factor for overall survival (hazard ratio 2.488; 95% CI 1.400–4.421; P = .0019) and relapse‐free survival (hazard ratio 2.342; 95% CI 1.349–4.064; P = .0025) after curative surgery in GC patients.ConclusionPerirenal thickness is a simple and useful factor for predicting short‐ and long‐term outcomes after radical surgery for GC.

Multilocular Cystic Nephroma in a Child: A Rare Case

Multilocular cystic nephroma (MLCN) is classically described as a benign slow-growing renal tumor. The aim of this study was to evaluate MLCN in a child in the West of Iran. The ultrasound examination showed a multicystic mass measuring 6.6x6.5 cm with multiple internal septae in the middle and lower left kidney in a 19-month-old boy. Another sonography revealed multicystic mass 7.4x6.6cm in left renal pole with a diagnosis of multicystic nephroma. The lab data were within normal limits, except for hemoglobin level, that was 11.6 g/dl. The gross examination revealed kidney tissue measuring 10x8x7 cm including multiloculated cyst measuring up to 8 cm and the microscopic examination revealed multiple cysts lined by flat epithelium with spindle cell stroma containing abortive tubular elements and rare foci of small round cells. In conclusion, MLCN occures more in male children and female adults. The results showed that low hemoglobin level had association with some cases of MLCN. Inflammation may be seen in MLCN, but presence of any amount of blastemal cells is diagnosed as cystic partially differentiated nephroblastoma by most experts.

Polycythemia vera as a presentation of renal angiomyolipoma: a case report

IntroductionAngiomyolipoma is a common benign renal tumor composed of thick-walled blood vessels, smooth muscle, and adipose tissue. It may be found incidentally during workup for suspected renal disease. Although angiomyolipoma may present as a palpable, tender renal mass with flank pain and gross or microscopic hematuria, many patients are asymptomatic. Erythrocytosis is an unusual presentation, and malignant transformation may be suspected. This report describes a rare case of a woman diagnosed with renal angiomyolipoma and polycythemia vera. The report discusses the differential diagnosis using erythropoietin, erythropoietin-receptor and Janus kinase 2.Case presentationA 79-year-old Chinese woman was diagnosed with erythrocytosis according to World Health Organization criteria. An upper left renal pole angiomyolipoma was successfully ablated after multiple phlebotomy treatments. Red cell count immediately returned to normal, but gradually increased after 4 months. Polycythemia vera was finally diagnosed by positive mutation of Janus kinase 2 and negative erythropoietin protein expression. Her clinical symptoms improved with regular phlebotomy and hydroxyurea treatment.ConclusionConcurrent occurence of angiomyolipoma and polycythemia vera is rare. Polycythemia vera can be easily missed. Polycythemia vera can be confirmed with high specificity and sensitivity by the acquired somatic mutation. Surgical intervention for this renal tumor should be avoided unless malignancy or renal cell carcinoma is suspected or to prevent spontaneous rupture of larger tumors.

A case of pararenal PEComa with extensive bone metaplasia

Dear Editor, The group of perivascular epithelioid cell tumours (PEComas; a family of rare mesenchymal neoplasms arising at different visceral and soft tissue sites) has a wide spectrum of morphology. We present a case with a very unusual feature: wide bone metaplasia. The patient was a 63-year-old hypertensive woman complaining from left flank pain and cystitis. Laboratory data were normal, except E. coli in urine. Results of an abdominal simple X-ray showed a 4-cm calcified round tumour at the upper left renal pole, very evident with the computed tomography (CT) scan (Fig. 1). It was excised through laparoscope. The mass was covered by fatty tissue and had good cleavage from adjacent kidney. The gross specimen was a 28-g, 4-cm-sized, smoothsurfaced tumour with very loose attachments to the fat nearby. It showed haemorrhagic and cystic areas alternating with a few white solid ones. The consistency was so hard that it required decalcification. Microscopically, it was composed by aggregates of clear or light eosinophilic epithelioid cells with relatively bland nuclei and some giant cells, among fine arborizing capillaries or around thick-walled, often hyalinized blood vessels, alternating with hypocellular collagenous–hyalinized areas, sometimes calcified. Endochondral ossification and lamellar bone was frequent (Fig. 2). Occasionally, mature adipose tissue was found. Cellular areas were 21% of the total. There was no mitosis or necrosis. The tumour was entirely circumscribed by a fine connective capsule. Fatty tissue and adrenal gland had no abnormalities. Immunohistochemically, neoplastic cells expressed vimentin, frequent human melanoma black (HMB)45 (more intense in larger epithelioid–clear cells, with paranuclear accentuation; Fig. 3) and melan-A (same staining pattern), also S100, smooth muscle antigen, clusters of differentiation (CD)10, CD68 and occasionally pancytokeratin. They were desmin, myogenin, α-inhibin, epithelial membrane antigen, CD117, cyclin D1, CD34 and CD31 negative. Ki 67 was inapparent. This immunohistochemical profile is specific of PEComa. Other clear cell tumours of that area can be excluded [4]. HMB45-positive large neoplastic cells (proliferating PEC cells) were sometimes located very close to endothelial lined spaces. In sum, this unusual case belongs to the PEComa family, a recently defined group of tumours originated from perivascular epithelioid (PEC) cells [1, 2] at multiple sites, encompassing angiomyolipoma, lymphangiomyomatosis, clear cell “sugar” tumour and rare tumours in other locations. They have a wide range of clinical, pathological and immunohistochemical features: clearly malignant [3, 5], some of uncertain malignant potential and a few benign. This case would fulfil the criteria of the Virchows Arch (2008) 452:349–350 DOI 10.1007/s00428-008-0581-1

The Clinical and Pathological Comments from a Case of Sarcomatoid Renal Carcinoma

Sarcomatoid renal carcinoma represents 1–5% of primitive tumours of the kidney. Materials and Methods. A young man aged 34 presented with left side colic pain, preceded two days earlier by hematuria without pain; no previous complaints. Echotomography was performed revealing a tumour lesion of the upper left renal pole, which was subsequently confirmed by computerized tomography scanning, with a maximum diameter of approximately 6cm, and evidence of multiple lymph nodes with increased volume. A left-side nephroadrenalectomy was performed with locoregional lymphadenectomy; a sarcomatoid renal carcinoma with massive metastases in 4/19 excised lymph nodes was shown through histological examination. IL-2 therapy was commenced but interrupted due to intolerance. After only three months the disease resumed locally with diffuse lymph nodes metastases and multiple encephalic metastases. A carboplatinum and vinorelbine therapy was started; the possibility of an allogeneic transplant with non-myeloablative conditioning (“miniallogeneic”) was suggested, though being impossible to be performed due to the further rapid disease progression. The patient died after approximately 10 months. Conclusions. Sarcomatoid renal carcinoma is characterised histologically by closely interconnected epithelial and connective tissue elements; sarcomatous cells seem to originate from a phenotype conversion to carcinomatous cells, as they both belong to the same DNA clone. Their behaviour is very aggressive and the prognosis is unfavourable: 6-month average survival after diagnosis. Radical nephrectomy is still the main therapeutic approach, although it is has no significant influence on prognosis and survival rate. This case showed an approximately 10-month patient's survival, with some different chemotherapeutic approaches being followed (first IL-2 and then carboplatinum) after surgery. (Urologia 2007; 74: 40–2)

The clinical and pathological comments from a case of sarcomatoid renal carcinoma

Sarcomatoid renal carcinoma represents 1-5% of primitive tumours of the kidney. MATERIALS AND METHODS. A young man aged 34 presented with left side colic pain, preceded two days earlier by hematuria without pain; no previous complaints. Echotomography was performed revealing a tumour lesion of the upper left renal pole, which was subsequently confirmed by computerized tomography scanning, with a maximum diameter of approximately 6cm, and evidence of multiple lymph nodes with increased volume. A left-side nephroadrenalectomy was performed with locoregional lymphadenectomy; a sarcomatoid renal carcinoma with massive metastases in 4/19 excised lymph nodes was shown through histological examination. IL-2 therapy was commenced but interrupted due to intolerance. After only three months the disease resumed locally with diffuse lymph nodes metastases and multiple encephalic metastases. A carboplatinum and vinorelbine therapy was started; the possibility of an allogeneic transplant with non-myeloablative conditioning ("miniallogeneic") was suggested, though being impossible to be performed due to the further rapid disease progression. The patient died after approximately 10 months. CONCLUSIONS. Sarcomatoid renal carcinoma is characterised histologically by closely interconnected epithelial and connective tissue elements; sarcomatous cells seem to originate from a phenotype conversion to carcinomatous cells, as they both belong to the same DNA clone. Their behaviour is very aggressive and the prognosis is unfavourable: 6-month average survival after diagnosis. Radical nephrectomy is still the main therapeutic approach, although it is has no significant influence on prognosis and survival rate. This case showed an approximately 10-month patient's survival, with some different chemotherapeutic approaches being followed (first IL-2 and then carboplatinum) after surgery.

Alterations in renal endothelin production in rats with reduced renal mass

Renal endothelin-1 (ET-1) production is diminished in spontaneously hypertensive rats. An increase has been reported of renal ET-1 production associated with progression of renal disease in rats with reduced renal mass. The purpose of the present study was to investigate the evolution over time of the urinary ET-1 excretion in an experimental model of renal mass reduction not caused by renal infarction. Rats were subjected to 2 3 nephrectomy (right nephrectomy and resection of the lower left renal pole) and thereafter randomly assigned to a notreatment control group or to treatment with recombinant erythropoietin, recombinant erythropoietin plus verapamil, or recombinant erythropoietin plus enalapril. The urinary ET-1 excretion was decreased by week 16 after nephrectomy as compared with healthy animals and with the levels 6 weeks after nephrectomy. The temporal evolution of urinary ET-1 excretion in the various groups of rats showed a trend toward decrease in all groups except the one receiving enalapril. The urinary ET-1 excretion correlated directly with creatinine clearance and inversely with tubulointerstitial damage. We observed an inverse correlation between urinary ET-1 excretion and arterial blood pressure 16 weeks after nephrectomy. These results indicate that renal ET-1 production decreases with the progression of renal disease and in relation with the severity of tubulointerstitial damage. The decrease in renal ET-1 production might contribute to the development and perpetuation of renal disease-associated arterial hypertension; this situation may be favorably modified by the use of enalapril.