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Fabian B, Ragnarsson O, Prazic A, Rydén M, Volpe C, Lindgren O. Diagnostic challenges in patients with reninomas and extrarenal renin-producing tumours. Clin Endocrinol (Oxf) 2024; 101:3-9. [PMID: 38696530 DOI: 10.1111/cen.15069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/04/2024]
Abstract
Renin-secreting tumours are rare causes of secondary hypertension and hypokalaemia. They are usually surgically curable, hence proper diagnostic work-up and tumour localisation is essential. In this paper, we present three Swedish patients recently diagnosed with renin secreting tumours, two with reninomas and one with an extrarenal renin-producing tumour, to illustrate diagnostic challenges. We also discuss the biochemical work-up, the pros and cons of different imaging techniques (computer tomography [CT], magnetic resonance imaging and [18F]fluorodeoxyglucose-positron emission tomography-CT), as well as how renal vein sampling (RVC) may contribute to localisation of the tumour.
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Affiliation(s)
- Botond Fabian
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden
| | - Oskar Ragnarsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Mikael Rydén
- Department of Medicine (H7), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Cristina Volpe
- Department of Molecular Medicine and Surgery, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Ola Lindgren
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences in Lund, Lund University, Lund, Sweden
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2
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Lobo J, Canete-Portillo S, Pena MDCR, McKenney JK, Aron M, Massicano F, Wilk BM, Gajapathy M, Brown DM, Baydar DE, Matoso A, Rioux-Leclerq N, Pan CC, Tretiakova MS, Trpkov K, Williamson SR, Rais-Bahrami S, Mackinnon AC, Harada S, Worthey EA, Magi-Galluzzi C. Molecular Characterization of Juxtaglomerular Cell Tumors: Evidence of Alterations in MAPK-RAS Pathway. Mod Pathol 2024; 37:100492. [PMID: 38614322 DOI: 10.1016/j.modpat.2024.100492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/18/2024] [Accepted: 04/05/2024] [Indexed: 04/15/2024]
Abstract
Juxtaglomerular cell tumor (JGCT) is a rare neoplasm, part of the family of mesenchymal tumors of the kidney. Although the pathophysiological and clinical correlates of JGCT are well known, as these tumors are an important cause of early-onset arterial hypertension refractory to medical treatment, their molecular background is unknown, with only few small studies investigating their karyotype. Herein we describe a multi-institutional cohort of JGCTs diagnosed by experienced genitourinary pathologists, evaluating clinical presentation and outcome, morphologic diversity, and, importantly, the molecular features. Ten JGCTs were collected from 9 institutions, studied by immunohistochemistry, and submitted to whole exome sequencing. Our findings highlight the morphologic heterogeneity of JGCT, which can mimic several kidney tumor entities. Three cases showed concerning histologic features, but the patient course was unremarkable, which suggests that morphologic evaluation alone cannot reliably predict the clinical behavior. Gain-of-function variants in RAS GTPases were detected in JGCTs, with no evidence of additional recurrent genomic alterations. In conclusion, we present the largest series of JGCT characterized by whole exome sequencing, highlighting the putative role of the MAPK-RAS pathway.
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Affiliation(s)
- João Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto; Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center Raquel Seruca (P.CCC) and RISE@CI-IPOP (Health Research Network), Porto, Portugal; Department of Pathology and Molecular Immunology, ICBAS - School of Medicine and Biomedical Sciences, Porto, Portugal
| | - Sofia Canete-Portillo
- Department of Pathology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Albama
| | | | - Jesse K McKenney
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Manju Aron
- Department of Pathology and Laboratory Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Felipe Massicano
- Department of Genetics, Center for Computational Genomics and Data Science, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Albama
| | - Brandon M Wilk
- Department of Genetics, Center for Computational Genomics and Data Science, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Albama
| | - Manavalan Gajapathy
- Department of Genetics, Center for Computational Genomics and Data Science, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Albama
| | - Donna M Brown
- Department of Genetics, Center for Computational Genomics and Data Science, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Albama
| | - Dilek E Baydar
- Department of Pathology, Koc University School of Medicine, Istanbul, Turkey
| | - Andres Matoso
- Departments of Pathology, Urology, Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Chin-Chen Pan
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Maria S Tretiakova
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Sean R Williamson
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Albama; Department of Radiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Albama; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Albama
| | - Alexander C Mackinnon
- Department of Pathology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Albama
| | - Shuko Harada
- Department of Pathology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Albama
| | - Elizabeth A Worthey
- Department of Genetics, Center for Computational Genomics and Data Science, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Albama
| | - Cristina Magi-Galluzzi
- Department of Pathology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Albama; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Albama.
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Dong H, Zuo Y, An X, Li H, Zheng Z, Chen Y, Zou Y, Jiang X. Clinical features, laboratory findings and treatment of juxtaglomerular cell tumors: a systemic review. Hypertens Res 2024; 47:1380-1390. [PMID: 38438720 DOI: 10.1038/s41440-024-01606-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/06/2024] [Accepted: 01/17/2024] [Indexed: 03/06/2024]
Abstract
Juxtaglomerular cell tumors (JGCTs) or reninoma are rare kidney tumors leading to secondary hypertension, and the non-specific clinical manifestations bring about challenges to the diagnosis. This study is to summarize the clinical features, laboratory findings, and treatment of JGCTs. The PubMed, EMBASE database, and manual search were utilized to find all cases, and 158 reports containing 261 patients were identified. Data on patients' demographics, clinical features, diagnostic methods, and treatment options were collected and analyzed. JGCTs occurred predominantly in female patients (female to male ratio, 2.1:1). The median age of patients was 25 years (IQR:18-34 years). Hypertension (97.24%) was the cardinal manifestation. Hypokalemia was reported in 78.71% (159/202) of subjects, and normal serum potassium accounted for 20.79% (42/202). In cases with assessed plasma renin activity (PRA) levels, the median PRA was 7.89 times the upper limit of normal (IQR:3.58-14.41), and 3.82% (5/131) of cases in the normal range. Tumors were detected in 97.8% (175/179) computed tomography (CT), 94.7% (72/76) magnetic resonance imaging (MRI), and 81.5% (110/135) ultrasound, respectively. For 250/261 patients undergoing surgical procedures, 89.14% (197/221), 94.94% (150/158), and 100% (131/131) of patients were restored to normal blood pressure, PRA, and serum potassium, respectively. JGCTs are commonly associated with hypertension, hypokalemia, and hyperreninemia, whereas patients with normotension, normokalemia, and PRA should be systematically pursued after drug-elution lasting for 2 weeks. CT and MRI are more sensitive imaging diagnostic methods. The blood pressure and biochemical parameters of most patients returned to normal after surgery.
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Affiliation(s)
- Hui Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yujie Zuo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuanqi An
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongwu Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihao Zheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yubao Zou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiongjing Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Wang L, Li M, Jin S, Ouyang Y, Wang F, Lv K, Li J, Jiang Y, Liu H, Zhu Q. How to identify juxtaglomerular cell tumor by ultrasound: a case series and review of the literature. BMC Med Imaging 2024; 24:46. [PMID: 38365645 PMCID: PMC10870572 DOI: 10.1186/s12880-024-01220-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 02/02/2024] [Indexed: 02/18/2024] Open
Abstract
PURPOSE To study the value of ultrasound in the diagnosis of juxtaglomerular cell tumor (JGCT). METHODS From January 2005 to July 2020, fifteen patients diagnosed as JGCT by surgical pathology in Peking Union Medical College Hospital were collected. All patients underwent preoperative ultrasound examination. The clinical, laboratory, ultrasound, computed tomography (CT), surgical, and pathological features of the patients were analyzed retrospectively. RESULTS The 15 patients were 5 males and 10 females with a median age of 29 years (10∼72 years). 14 of them had hypertension and one had normal blood pressure. The tumors were all solitary, with a median diameter of 1.5 cm (0.9-5.9 cm). Among the fifteen patients, eleven were correctly detected by preoperative ultrasound, and four were missed. There was a significant difference in tumor size (2.64 ± 1.48 cm vs. 1.23 ± 0.21 cm) and whether the tumor protruded outward (9/11 vs. 0/4) between the ultrasound-detected group and the ultrasound-missed group (p = 0.010, p = 0.011). Of the 11 tumors detected by ultrasound, four were extremely hypoechoic, two were hypoechoic, three were isoechoic, and two were hyperechoic. Color Doppler showed no blood flow in five tumors with the size range from 0.9 to 2.0 cm, and mild blood flow in six tumors with the size range from 2.8 to 5.9 cm. CONCLUSIONS JGCT is rare, and has characteristic clinical manifestations. Diagnosis should be suspected in case of secondary hypertension, particularly in young women, if no renal vascular cause was found. Ultrasound, combined with clinical manifestations, was helpful for the diagnosis.
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Affiliation(s)
- Li Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, 100730, Beijing, China
- Department of Ultrasound, Tangshan Central Hospital, West of Youyi Road, Lubei District, 063000, Tangshan City, Hebei, China
| | - Meiying Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, 100730, Beijing, China
| | - Siqi Jin
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, 100730, Beijing, China
| | - Yunshu Ouyang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, 100730, Beijing, China
| | - Fenglan Wang
- Department of Ultrasound, Tangshan Central Hospital, West of Youyi Road, Lubei District, 063000, Tangshan City, Hebei, China
| | - Ke Lv
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, 100730, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, 100730, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, 100730, Beijing, China
| | - He Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, 100730, Beijing, China.
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, 100730, Beijing, China.
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Yan DE, He HB, Guo JP, Wang YL, Peng DP, Zheng HH, Zhou XZ, Fu JX, Wang ML, Luo X, Shen YF. Renal venous sampling assisted the diagnosis of juxtaglomerular cell tumor: a case report and literature review. Front Oncol 2024; 13:1298684. [PMID: 38304038 PMCID: PMC10830867 DOI: 10.3389/fonc.2023.1298684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024] Open
Abstract
Juxtaglomerular cell tumor (JCT) is an endocrine tumor marked by elevated renin levels and high blood pressure. This case report presents the clinical findings of a 47-year-old woman with a history of recurrent hypokalemia, headaches, hypertension, and increased plasma renin activity (PRA). Dynamic enhanced magnetic resonance imaging (MRI) revealed a small nodule on the upper part of the right kidney. Selective renal venous sampling indicated a higher PRA only in the right upper pole renal vein. The patient underwent surgical removal of the right kidney mass, and the pathology results confirmed the diagnosis of JCT. This case underscores the importance of conducting selective renal venous sampling for accurate JCT diagnosis.
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Affiliation(s)
- Di-en Yan
- Department of Endocrinology, Ji’an Central Hospital, Ji’an, Jiangxi, China
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hong-bing He
- Department of Endocrinology, Ji’an Central Hospital, Ji’an, Jiangxi, China
| | - Jian-ping Guo
- Department of Endocrinology, Ji’an Central Hospital, Ji’an, Jiangxi, China
| | - Yu-lan Wang
- Department of Endocrinology, Ji’an Central Hospital, Ji’an, Jiangxi, China
| | - Dan-ping Peng
- Department of Endocrinology, Ji’an Central Hospital, Ji’an, Jiangxi, China
| | - Huan-huan Zheng
- Department of Endocrinology, Ji’an Central Hospital, Ji’an, Jiangxi, China
| | - Xiao-zi Zhou
- Department of Endocrinology, Ji’an Central Hospital, Ji’an, Jiangxi, China
| | - Jin-xiang Fu
- Department of Endocrinology, Ji’an Central Hospital, Ji’an, Jiangxi, China
| | - Mei-li Wang
- Department of Endocrinology, Ji’an Central Hospital, Ji’an, Jiangxi, China
| | - Xian Luo
- Department of Endocrinology, Ji’an Central Hospital, Ji’an, Jiangxi, China
| | - Yun-feng Shen
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Fu X, Deng G, Wang K, Shao C, Xie LP. Pregnancy complicated by juxtaglomerular cell tumor of the kidney: A case report. World J Clin Cases 2023; 11:2541-2548. [PMID: 37123308 PMCID: PMC10130993 DOI: 10.12998/wjcc.v11.i11.2541] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/27/2023] [Accepted: 03/17/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Juxtaglomerular cell tumor (JGCT) of the kidney, also known as reninoma, is a rare renal tumor that typically clinically manifests as hypertension, hypokalemia, high renin, and high aldosterone. It is a cause of secondary hypertension. Pregnancy with JGCT is rarer and easily misdiagnosed as pregnancy-induced hypertension, thus affecting treatment.
CASE SUMMARY A 28-year-old woman presented in early pregnancy with hypertension (blood pressure of 229/159 mmHg), nausea, and occasional dizziness and headache. The patient was diagnosed with pregnancy-induced hypertension, and no relief was found after symptomatic treatment; hence, the pregnancy was terminated by artificial abortion. Her blood pressure remained high following termination of pregnancy. Blood tests suggested hypokalemia (2.997 mmol/L), blood aldosterone measured 613 ng/L, and computed tomography urography showed a tumor in the right kidney. Therefore, laparoscopic partial nephrectomy was performed. After surgery, the patient’s blood pressure returned to normal, and blood potassium, aldosterone, and renin normalized. Postoperative pathological examination revealed JGCT. After long-term follow-up, the patient became pregnant again 6 mo after surgery. No hypertension occurred during pregnancy, and the patient delivered a healthy female neonate.
CONCLUSION Patients with pregnancy complicated by JGCT are difficult to diagnose. Herein, we advise surgeons on proper handling of such situations.
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Affiliation(s)
- Xian Fu
- Department of Urology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Gang Deng
- Department of Urology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Kai Wang
- Department of Urology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Chang Shao
- Department of Pathology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Li-Ping Xie
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Gupta S, Nichols P, Lohse CM, Kosari F, Kattah AG, Harris FR, Karagouga G, Mehra R, Fine SW, Reuter VE, Herrera-Hernandez L, Zganjar AJ, Britton CJ, Potretzke AM, Boorjian SA, Thompson RH, Jimenez RE, Leibovich BC, Garovic VD, Cheville JC, Sharma V. Renin Production by Juxtaglomerular Cell Tumors and Clear Cell Renal Cell Carcinoma and the Role of Angiotensin Signaling Inhibitors. Mayo Clin Proc 2022; 97:2050-2064. [PMID: 35753824 PMCID: PMC10225974 DOI: 10.1016/j.mayocp.2022.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/13/2022] [Accepted: 03/23/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To profile juxtaglomerular cell tumors (JXG) and histologic mimics by analyzing renin expression; to identify non-JXG renin-producing tumors in The Cancer Genome Atlas (TCGA) data sets; and to define the prevalence of hypertension (HTN) and patient outcomes with angiotensin signaling inhibitor (ASI) use in tumors of interest. PATIENTS AND METHODS Thirteen JXGs and 10 glomus tumors (GTs), a histologic mimic, were evaluated for clinicopathologic features; TCGA data were analyzed to identify non-JXG renin-overexpressing tumors. An institutional registry was queried to determine the incidence of HTN, the use of ASIs in hypertensive patients, and the impact of ASIs on outcomes including progression-free survival (PFS) in a tumor type with high renin expression (clear cell renal cell carcinoma [CC-RCC] diagnosed between January 1, 2005, and December 31, 2012). RESULTS We found an association between renin production and HTN in JXG compared with GT. Analysis of TCGA data found that a subset of CC-RCCs overexpress renin relative to 29 other tumor types. Furthermore, analysis of our institutional registry revealed a high prevalence (64%) of HTN among 1203 patients treated with radical or partial nephrectomy for nonmetastatic CC-RCC. On multivariable Cox regression, patients with HTN treated with ASIs (34%) had improved PFS (hazard ratio, 0.76; 95% CI, 0.57 to 1.00; P=.05) compared with patients with HTN not treated with ASIs (30%). CONCLUSION The identification of renin expression in a subset of CC-RCC may provide a biologic rationale for the high prevalence of HTN and improved PFS with ASI use in hypertensive patients with nonmetastatic CC-RCC.
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Affiliation(s)
- Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
| | | | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Farhad Kosari
- Biomarker Discovery Program, Center of Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Andrea G Kattah
- Division of Nephrology and Hypertension, and Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Faye R Harris
- Biomarker Discovery Program, Center of Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Giannoula Karagouga
- Biomarker Discovery Program, Center of Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Rohit Mehra
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI
| | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | - Rafael E Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Vesna D Garovic
- Division of Nephrology and Hypertension, and Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN.
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8
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Wang B, Ding L, Xu S, Fan Y, Wang J, Zhao X, Fu D, Bian B, Tang K, Ni C, Dong Z, He Q, Liu M. A case of atypical reninoma with mild hypertension and normal plasma renin activity but elevated plasma renin concentration. BMC Endocr Disord 2022; 22:71. [PMID: 35303838 PMCID: PMC8932068 DOI: 10.1186/s12902-022-00977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Reninoma is a rare, benign renal neoplasm. Typical clinical features include severe hypertension, secondary hyperaldosteronism, hypokalaemia and metabolic alkalosis caused by the overproduction of renin. CASE PRESENTATION A 25-year-old lean Chinese woman with no family history of hypertension was hospitalized for stage 1 hypertension that gradually developed over two years. Endocrine investigation showed hyperreninemia without hyperaldosteronism and hypokalaemia. Interestingly, although the patient had an elevated plasma renin concentration (PRC), her plasma renin activity (PRA) was in the normal range. Abdominal contrast-enhanced computed tomography (CT) scanning revealed a solid, low-density, renal cortical mass with delayed enhancement. Selective renal vein sampling (SRVS) was performed, and a lateralization of the renin secretion from the left kidney was found. Enucleation of the tumour led to a rapid remission of hypertension and hyperreninemia. Based on pathological findings, the patient was diagnosed with reninoma. Immunohistochemical staining of the tumour was positive for Renin, CD34, Vimentin, and synaptophysin (Syn) and negative for somatostatin receptor 2 (SSTR2) and chromogranin A (CgA). CONCLUSIONS Reninoma can present as mild hypertension without hyperaldosteronism and hypokalaemia. The clinical features of reninoma may depend on the degree of activation of the renin-angiotensin-aldosterone system (RAAS). PRC should be incorporated in the differential diagnosis of secondary hypertension.
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Affiliation(s)
- Baoping Wang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Ding
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Shuanghua Xu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuxin Fan
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiabo Wang
- Department of Clinical Medicine, Tianjin Medical University, Tianjin, China
| | - Xin Zhao
- Department of Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Diansheng Fu
- Department of Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Bo Bian
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Kunlong Tang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Chunsheng Ni
- Department of Pathology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zuoliang Dong
- Department of Medical Laboratory, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing He
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China.
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9
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Zimmermann Y, Tawadros C, Andrejevic-Blant S, Vogel G. [A rare cause of hypertension with hypokalemia: A case of reninoma]. Nephrol Ther 2021; 17:538-542. [PMID: 34334338 DOI: 10.1016/j.nephro.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 11/17/2022]
Abstract
Reninoma or juxtaglomerular cell tumor is a rare usually benign renal renin secreting tumor. We report the case of an 18-year old woman, without any medical history, investigated in our hospital's emergency department for a bilateral papilledema. Ambulatory ophthalmological investigations were performed because of a newly occurring blurry vision, associated with diffuse headaches. Cerebral mRI and lumbar puncture recommended by the ophthalmologist and neurologist excluded intra-cranial hypertension. The patient presented with severe hypertension. Laboratory values showed hypokalemia, compensated metabolic alkalosis and microalbuminuria. During the hospital stay, she developed AKIN 1 acute renal injury. Ultrasound revealed a tissular cystic lesion of the superior pole of the right kidney. Abdominal mRI confirmed the lesion and raised suspicion for a renal cell carcinoma without calicial or vascular invasion. Plasma renin value was >500 mUI/L with normal values for plasma aldosterone. Renal biopsy diagnosed a juxtaglomerular cell tumor. After an aggressive initial treatment, hypertension remained well controlled with spironolactone only, finally allowing for withdrawal of all antihypertensive medications. Robot-assisted laparoscopic partial nephrectomy was performed. Studies of the operative specimen confirmed the diagnosis of benign reninoma. Clinical follow-up showed complete resolution of clinical and biological parameters.
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Affiliation(s)
- Yaël Zimmermann
- Service de néphrologie, hôpital Riviera-Chablais site de Rennaz, route du Vieux Sequoia 20, 1847 Rennaz, Suisse
| | - Cécile Tawadros
- Service d'urologie, hôpital Riviera-Chablais site de Rennaz, 1847 Rennaz, Suisse
| | | | - Gérard Vogel
- Service de néphrologie, hôpital Riviera-Chablais site de Rennaz, route du Vieux Sequoia 20, 1847 Rennaz, Suisse.
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Zhang R, Xu M, Xie XY. The Role of Real-Time Contrast-Enhanced Ultrasound in Guiding Radiofrequency Ablation of Reninoma: Case Report and Literature Review. Front Oncol 2021; 11:585257. [PMID: 33686368 PMCID: PMC7935754 DOI: 10.3389/fonc.2021.585257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/06/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Reninoma is a rare renal endocrine tumor that can cause secondary hypertension, characterized by hypertension, hypokalemia, high renin and aldosterone with normal aldosterone renin ratio (ARR), and occurs more in young female. Mainstream treatment option is surgery, but is less suitable for small or deep lesions, which makes ablation a promising alternative. CASE PRESENTATION Two young female with typical manifestations of reninoma, including hypertension, hypokalemia, high renin, high aldosterone and normal ARR, were treated successfully with real-time contrast-enhanced ultrasound guided radiofrequency ablation, and contrast-enhanced ultrasound was also performed before and after treatment for diagnosis and postoperative assessment. Afterward, their blood pressure and laboratory tests became normal and remained steady during the follow-up of 32 and 6 months, respectively. CONCLUSION Contrast-enhanced ultrasound guided radiofrequency ablations is a promising alternative for reninoma treatment with comparable safety and efficacy with surgery, and has advantages especially in small or deep lesions.
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Affiliation(s)
| | - Ming Xu
- Department of Medical Ultrasonics, The First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-sen University, Guangzhou, China
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Spindle Cell Hemangioma and Atypically Localized Juxtaglomerular Cell Tumor in a Patient with Hereditary BRIP1 Mutation: A Case Report. Genes (Basel) 2021; 12:genes12020220. [PMID: 33546375 PMCID: PMC7913579 DOI: 10.3390/genes12020220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
Spindle cell hemangioma is a benign vascular tumor typically occurring in the dermis or subcutis of distal extremities as red-brown lesions that can grow in both size and number over time. They can be very painful and potentially disabling. A family history of cancer or previous history may be relevant and must be taken into consideration. Juxtaglomerular cell tumor (reninoma) is an extremely rare cause of secondary hypertension diagnosed mostly among adolescents and young adults. Excessive renin secretion results in secondary hyperaldosteronism. Subsequent hypokalemia and metabolic alkalosis, together with high blood pressure, are clues for clinical diagnosis. Histological examination of the excised tumor leads to a definitive diagnosis. Reninoma is found in subcapsular localization, in most cases as a solitary mass, in imaging studies of kidneys. Exceptionally, it can be located in another part of a kidney. Both spindle cell hemangioma and reninoma are extremely rare tumors in children and adolescents. Herein, the authors present a case report of a patient with hereditary BRCA1 interacting protein C-terminal helicase 1 (BRIP1) mutation, spindle cell hemangioma, and secondary hypertension caused by atypically localized reninoma.
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Ye Z, Fan H, Tong A, Xiao Y, Zhang Y. The Small Size and Superficial Location Suggest That Laparoscopic Partial Nephrectomy Is the First Choice for the Treatment of Juxtaglomerular Cell Tumors. Front Endocrinol (Lausanne) 2021; 12:646649. [PMID: 33995279 PMCID: PMC8120284 DOI: 10.3389/fendo.2021.646649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/09/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Juxtaglomerular cell tumor (JGCT) is a very rare disease, and surgical resection is the only possible way to cure this tumor. Open nephrectomy and partial nephrectomy have been reported to manage JGCTs with excellent results in the previous reviews. Laparoscopic surgery has been popularized in recent years, while critical issues associated with laparoscopic surgical management have been seldom reported. We summarized the JGCTs in our center to discover the optimal surgical management and its anatomic foundation. METHODS In this retrospective study, we enrolled a total of 14 JGCT patients. All patients received surgeries and were followed up for up to 11 years. We mainly summarized the size and location of tumors, imaging features, and surgical strategies. A descriptive statistical analysis was performed. RESULTS The JGCTs in this study had a median size of 1.35 cm and all located superficially, mainly in the cortical or subcortical area of the kidney. All 14 patients had hypertension, ten had hypokalemia, and seven had elevated plasma renin activity. Pathologically, JGCT cells were polygonal or spindle shape, with positive CD34 and vimentin immunostaining. All patients received partial nephrectomy; nine were laparoscopic, and five were open. Laparoscopic partial nephrectomy (LPN) was performed in seven out of eight patients over the last nine years. Postoperative blood pressure, serum potassium, and plasma renin activity were normal in all patients. No recurrence occurred within a median follow-up of 60 months. CONCLUSION The small size and superficial location are the characteristic anatomic features of JGCT; they suggest that LPN is the preferred surgical strategy. Laparoscopic ultrasound is helpful for the intraoperative detection of small JGCTs. Longer follow-up is required to examine the biological behavior of JGCTs and the effect of LPN.
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Affiliation(s)
- Zixing Ye
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
| | - Hua Fan
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
| | - Anli Tong
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Beijing, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
- *Correspondence: Yushi Zhang,
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A case of juxtaglomerular cell tumor with an unusual clinical presentation. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
INTRODUCTION Based on existing literature, the juxtaglomerular cell tumor (JGCT) is a rare renal tumor, typically present with hypertension and hypokalemia. Nonfunctioning JGCT, without hypertension or hypokalemia, is extremely rare. PATIENT CONCERNS Herein, we report a case of nonfunctioning JGCT mimicking renal cell carcinoma. The 29-year-old woman with an unremarkable past medical history presented with a left renal tumor without hypertension or hypokalemia. DIAGNOSIS Both CT and 18F-FDG-PET/CT suggested a malignancy, possibly renal cell carcinoma. INTERVENTIONS The tumor was then removed completely via robotic assistant laparoscopic partial nephrectomy; and pathology result was JGCT. Since the patient had no hypertension or hypokalemia, a nonfunctional JGCT was diagnosed. OUTCOMES The patient recovered uneventfully, and was in good health in 6-months' follow-up period. CONCLUSION Preoperative identification of JGCT is very difficult due to the lack of specific clinical manifestations. This case teaches us that for young patients with renal tumors whose CT enhancement is not obvious at the early phase, JGCT should be considered as a differential diagnosis. Radical nephrectomy should be avoided for JGCT in consideration of its relatively good prognosis.
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Jiang S, Yang Y, Wu R, Yang Q, Zhang C, Tang Y, Mo C. Characterization and Management of Juxtaglomerular Cell Tumor: Analysis of 9 Cases and Literature Review. Balkan Med J 2020; 37:287-290. [PMID: 32441904 PMCID: PMC7424182 DOI: 10.4274/balkanmedj.galenos.2020.2019.12.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aims: Juxtaglomerular cell tumor is a rare kidney tumor. This study aimed to report the clinic features of juxtaglomerular cell tumor and our treatment experience. Methods: The medical records of 9 juxtaglomerular cell tumor patients treated in our hospital from 1997 to 2017 were retrospectively reviewed. Clinical characteristics, immunohistochemical findings, treatments and outcomes were collected. Results: The mean age of 9 patients was 24±8.1 years (range: 18-37). All cases had symptoms of hypertension, hyperaldosteronism, high plasma renin, high plasma angiotensin II. Four cases had hypokalemia. The renal masses were found by enhanced contrast tomography in all patients. One case received ultrasound-guided ablation and was clinically diagnosed with juxtaglomerular cell tumor. Among the remaining 8 cases, 2 cases received nephrectomy while 6 underwent partial nephrectomy. The 8 cases were pathologically diagnosed with juxtaglomerular cell tumor. Immunohistochemical findings showed that juxtaglomerular cell tumor was positive for vimentin, CD34, and actin but negative for chromogranin A. After treatment, all the patients had normal levels of blood pressure, serum renin activity, potassium, and aldosterone. No patients had tumor progress or metastasis within a median follow-up period of 94 (range: 33-241) months. Conclusion: Hypertension combined with hyperaldosteronism and hypokalemia secondary to high plasma renin activity are the typical symptoms of juxtaglomerular cell tumor. Partial nephrectomy is an optimal treatment for juxtaglomerular cell tumor.
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Affiliation(s)
- Shuangjian Jiang
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yun Yang
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongpei Wu
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qiyun Yang
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chi Zhang
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yiming Tang
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chengqiang Mo
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Renal hemangiopericytoma in 15 year old female-treated laparoscopically. Urol Case Rep 2020; 31:101132. [PMID: 32195122 PMCID: PMC7076144 DOI: 10.1016/j.eucr.2020.101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 02/18/2020] [Indexed: 11/20/2022] Open
Abstract
Hemangiopericytoma (HPC) is rare in the urogenital system, most frequently occurs in the pelvis, head and neck, and meninges, it is extremely rare in the kidney. US, CT, or MRI do not show any specific sign of renal HPC that might aid in the differential diagnosis with other renal tumors, that's why almost all cases are diagnosed after pathological results. The majority of cases are identified in patients with an unspecific clinical manifestations associated with hematuria or hypertension, hypoglycemia or additional paraneoplastic syndromes. Here we present a rare case of hemangiopericytoma in 15 year old female, with drug refractory hypertension.
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Mezoued M, Habouchi MA, Azzoug S, Mokkedem K, Meskine D. JUXTAGLOMERULAR CELL CAUSE OF SECONDARY HYPERTENSION IN AN ADOLESCENT. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:359-361. [PMID: 33363660 DOI: 10.4183/aeb.2020.359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Reninoma (juxtaglomerular cell tumor) is a rare cause of renin-mediated hypertension. We reported a 18 year old woman with history of hypertension for 3 years. Laboratory findings showed severe hypokalemia and markedly increased levels of renin and aldosterone. Kidney ultrasonography, abdominal computed tomography and magnetic resonance imaging revealed a small mass in the middle region of the right kidney. The patient underwent nephron-sparing surgery; immunohistochemical results demonstrated typical features of reninoma. Postoperatively, blood pressure and potassium levels were normal at 1 month follow-up.
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Affiliation(s)
- M Mezoued
- University of Algiers, Faculty of Medical Sciences - Department of Endocrinology and Metabolism, Alger, Algeria
| | - M A Habouchi
- University of Algiers, Faculty of Medical Sciences - Department of Radiology, Alger, Algeria
| | - S Azzoug
- University of Algiers, Faculty of Medical Sciences - Department of Endocrinology and Metabolism, Alger, Algeria
| | - K Mokkedem
- University of Algiers, Faculty of Medical Sciences - Department of Pathology, Alger, Algeria
| | - D Meskine
- University of Algiers, Faculty of Medical Sciences - Department of Endocrinology and Metabolism, Alger, Algeria
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18
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Qiuyang LMD, Ying ZMD, Yong SMD, Aitao GMD, Nan LBS, Yukun LMD, Jie TMD. Clinical Application of Ultrasound in the Diagnosis and Treatment of Reninoma. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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19
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“Hey! Whatever happened to hemangiopericytoma and fibrosarcoma?” An update on selected conceptual advances in soft tissue pathology which have occurred over the past 50 years. Hum Pathol 2020; 95:113-136. [DOI: 10.1016/j.humpath.2019.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 12/29/2022]
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20
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Zhang M, Guo CC. Neuroendocrine Kidney Tumors. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Juxtaglomerular Cell Tumor: A Rare, Curable Cause of Hypertension in a Young Patient. Urology 2019; 134:42-44. [DOI: 10.1016/j.urology.2019.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 11/21/2022]
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22
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Arianayagam R, Kench JG, Elder GJ, Thanigasalam R. Laparoscopic partial nephrectomy for Juxtaglomerular apparatus tumour: A rare cause of hypertension. Urol Case Rep 2019; 26:100910. [PMID: 31372343 PMCID: PMC6658994 DOI: 10.1016/j.eucr.2019.100910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 11/23/2022] Open
Abstract
We report on the case of a partial nephrectomy for a Juxtaglomerular apparatus (JGA) tumour in a 28 year old female who presented with fatigue and symptomatic hypertension, and a normal serum renin level on pre-operative work-up.
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23
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Hagiya A, Zhou M, Hung A, Aron M. Juxtaglomerular Cell Tumor With Atypical Pathological Features: Report of a Case and Review of Literature. Int J Surg Pathol 2019; 28:87-91. [DOI: 10.1177/1066896919868773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Juxtaglomerular cell tumor (JGCT) is a rare renal tumor with a predominantly benign clinical course. It affects young adults, who often present with hypertension, hypokalemia, and hyperaldosteronism. The tumor cells are round to spindle-shaped with occasional mild to moderate atypia, but mitotic figures are usually absent. Surgical resection is the treatment of choice. Typically, the blood pressure and renin levels normalize after removal of the tumor. Rare cases of metastatic and recurrent JGCT have been reported including cases with vascular invasion. These cases typically occur in older adults and present with larger tumor size (9-15 cm). We report a case of JGCT, 5.5 cm in greatest dimension, with atypical pathological features including invasion of the renal vein, lymphovascular invasion, and significant pleomorphism with rhabdoid morphology, along with a brief review of the literature.
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Affiliation(s)
- Ashley Hagiya
- University of Southern California, Los Angeles, CA, USA
| | - Ming Zhou
- UT Southwestern Medical Center, Dallas, TX, USA
| | - Andrew Hung
- University of Southern California, Los Angeles, CA, USA
| | - Manju Aron
- University of Southern California, Los Angeles, CA, USA
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Renin-producing Tumour in the Kidney of a Cat. J Comp Pathol 2019; 170:70-73. [PMID: 31375161 DOI: 10.1016/j.jcpa.2019.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/09/2019] [Accepted: 05/17/2019] [Indexed: 11/22/2022]
Abstract
Clinical and post-mortem examination of an adult neutered male cat with immune-mediated haemolytic anaemia revealed suspected nodules of tumour tissue in the cortex of the right kidney. Cytology and histopathology indicated a malignant renal tumour of undetermined type. Immunohistochemistry confirmed renin production by a proportion of the tumour cells. The lesion may represent a renal adenocarcinoma producing renin or a tumour of juxtaglomerular cells ('reninoma').
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25
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Young RH, Eble JN. The history of urologic pathology: an overview. Histopathology 2019; 74:184-212. [PMID: 30565309 DOI: 10.1111/his.13753] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/07/2018] [Indexed: 12/25/2022]
Abstract
This article begins with the testis and a legendary figure, Sir Astley Cooper, who wrote an early text on the organ. The early 20th century saw the first major development, the description of the seminoma by the French investigator Maurice Chevassu, but the pace of knowledge did not accelerate until after World War II with a major article from the Armed Forces Institute of Pathology (AFIP) by Nathan B. Friedman and Robert A. Moore, soon followed by the first series testis fascicle by Frank J. Dixon and Moore. Other noteworthy contributions were made by two masters of gonadal pathology, Gunnar Teilum and Robert E. Scully. In the 1970s, Niels E. Skakkebaek played a seminal role in elaborating in-situ neoplasia of the testis. The school of British testicular tumour authored, in the mid-1970s, under the editorship of Roger C. B. Pugh, one of the best texts on testicular pathology. Advances in more recent years have been largely spearheaded by Thomas M. Ulbright of the Indiana University School of Medicine. Observations on the prostate gland date back to Andreas Vesalius and William Cheselden, the latter appearing to have introduced the word for the gland. Note is made of contributions on the anatomy and histology of the gland by Oswald Lowsley, L. M. Franks, and John McNeal. Diagnosing carcinoma of the prostate was brought into the modern age in a landmark 1953 article by Robert S. Totten et al. In the 1960s, Donald F. Gleason introduced a grading system that is now in use worldwide. The topic of premalignant lesions has been well established only for approximately three decades, based initially on the work of Dr McNeal and David G. Bostwick. One of the first to write a book on the bladder was the remarkable British surgeon-pathologist Sir Henry Thompson. Workers at the AFIP, including Colonel James E. Ash and Fatallah K. Mostofi, wrote many outstanding articles on bladder pathology. The roles of other institutions, such as Johns Hopkins University, the Mayo Clinic, and St Peter's Hospital Institute of Urology, London, and those who worked there are noted. Knowledge of the pathology of the urachus dates largely back to the remarkable book on the topic in 1916 by the Hopkins investigator Thomas S. Cullen. Information on renal tumours dates largely to the work of Paul Grawitz, but awareness of the many variants of renal cell carcinoma in general was slow to evolve, and has only accelerated in recent years. The AFIP group of Dr Mostofi, ably assisted by Colonel Charles J. Davis and Isabell A. Sesterhenn, has contributed to knowledge of renal neoplasia with articles of note on oncocytoma, metanephric adenoma, and medullary carcinoma. In the mid-1980s, the German workers Wolfgang Thoenes and Stephan Störkel recognised the distinctive tumour known as chromophobe renal cell carcinoma. Work on renal tumours in the young owes much to J. Bruce Beckwith. The observational talents of numerous investigators have, in just over a century, advanced our knowledge of diseases of the urinary tract and testis remarkably.
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Affiliation(s)
- Robert H Young
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John N Eble
- Indiana University Medical Center, Indianapolis, IN, USA
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Faucon AL, Bourillon C, Grataloup C, Baron S, Bernadet-Monrozies P, Vidal-Petiot E, Azizi M, Amar L. Usefulness of Magnetic Resonance Imaging in the Diagnosis of Juxtaglomerular Cell Tumors: A Report of 10 Cases and Review of the Literature. Am J Kidney Dis 2019; 73:566-571. [DOI: 10.1053/j.ajkd.2018.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/07/2018] [Indexed: 11/11/2022]
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27
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Liu K, Wang B, Ma X, Li H, Zhang Y, Li J, Yao Y, Tang L, Xuan Y, Guo A, Zhang X. Minimally Invasive Surgery-Based Multidisciplinary Clinical Management of Reninoma: A Single-Center Study. Med Sci Monit 2019; 25:1600-1610. [PMID: 30822300 PMCID: PMC6407327 DOI: 10.12659/msm.913826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background This article presents our experience in managing a rare kidney tumor – reninoma – by analyzing a relatively large series of cases from a single center. Material/Methods Nine cases of reninoma were reviewed. Clinical manifestations, imaging examinations, laboratory examinations, perioperative data, and pathological findings were summarized. A 58.8-month follow-up was performed to evaluate patient survival and recrudescence. Results The main clinical manifestations were hypertension, hypokalemia, headache, dizziness, nausea, vomiting, palpation, and sweating. Three patients had hypertensive end-organ damage, including brain hemorrhage, gestation termination, and grade III ocular fundus changes. All patients underwent retroperitoneal laparoscopic partial nephrectomy successfully. The mean warm ischemic time was 23.4 min. The median operation time was 95.1 min, with a median estimated blood loss of 60 ml. The median hospital stay was 6 days. No serious intraoperative or postoperative complications occurred. The histology and electron microscopy findings confirmed the diagnosis of reninoma in all cases. After 58.8 months of follow-up, symptoms involving hypertension were relieved in all patients, and no tumor recurrence or metastasis was detected. Conclusions Reninoma may have severe consequences despite being a benign tumor. Retroperitoneal laparoscopic partial nephrectomy is a feasible and effective method for the surgical removal of reninoma. Multidisciplinary cooperation plays an important role in improving the diagnosis and enabling the early surgical treatment of reninoma. Especially in cases of reninoma with moderate and high RENAL scores, an accurate diagnosis of reninoma based on multidisciplinary cooperation facilitates the selection of less invasive surgical approaches.
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Affiliation(s)
- Kan Liu
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Baojun Wang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Xin Ma
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Hongzhao Li
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Yu Zhang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Jinlong Li
- Department of Pathology, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Yuanxin Yao
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Lu Tang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Yundong Xuan
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Aitao Guo
- Department of Pathology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
| | - Xu Zhang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland)
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Su PJ, Huang PW, Lin YC, Wu KF, Sheng TW. Juxtaglomerular cell tumor with lung metastases in a young male patient. JOURNAL OF CANCER RESEARCH AND PRACTICE 2019. [DOI: 10.4103/jcrp.jcrp_19_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kim JH, Kim JH, Cho MH, Park E, Hyun HS, Ahn YH, Kang HG, Moon KC, Ha IS, Cheong HI. Reninoma: a rare cause of curable hypertension. KOREAN JOURNAL OF PEDIATRICS 2018; 62:144-147. [PMID: 30376707 PMCID: PMC6477550 DOI: 10.3345/kjp.2018.06926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/29/2018] [Indexed: 11/27/2022]
Abstract
The most common type of refractory hypertension found in children is secondary hypertension, which is a potentially curable disease. Reninoma, a renin-secreting juxtaglomerular cell tumor, is a rare cause of severe hypertension that is usually diagnosed in adolescents and young adults. Surgical resection of the tumor completely cures the hypertension of patients with reninoma. The typical clinical presentation of reninoma includes hypokalemia, metabolic alkalosis, and features secondary to the increased activation of the renin-angiotensin system without renal artery stenosis. We report a case of reninoma in a female adolescent with a typical clinical presentation, in which surgical removal of the tumor completely cured hypertension. We discuss here the clinical features, imaging studies, and immunohistochemical examination of the tumor used to establish the diagnosis of reninoma and for the management of the condition.
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Affiliation(s)
- Ji Hye Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hyun Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Myung Hyun Cho
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eujin Park
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Hye Sun Hyun
- Department of Pediatrics, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.,Research Coordination Center for Rare Diseases, Seoul National University Hospital, Seoul, Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.,Research Coordination Center for Rare Diseases, Seoul National University Hospital, Seoul, Korea.,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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Case Report of Atypical Juxtaglomerular Cell Tumor. Case Rep Pathol 2018; 2018:6407360. [PMID: 30473900 PMCID: PMC6220404 DOI: 10.1155/2018/6407360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/14/2018] [Accepted: 10/17/2018] [Indexed: 11/17/2022] Open
Abstract
Juxtaglomerular cell tumor (JGCT) is a rare renal tumor, producing renin and behaving almost in a benign fashion. So far, only three cases have been reported as malignant. We report a rare case with atypical JGCT. A 74-year-old male was referred to our hospital due to hypertension, proteinuria, and hematuria. Abdominal CT revealed a mass measured in 9.7×7.0 cm in the lower portion of the right kidney. Right kidney was removed laparoscopically. Grossly, white to tan tumor with massive hemorrhage and necrosis occupied the lower portion of the right kidney. Microscopically, tumor grew in a solid fashion. Tumor cells were polygonal to ovoid cells with round nuclei and clear to eosinophilic cytoplasm. Mitosis was found in 5 per 10 HPF. Immunohistochemically, tumor cells were stained by vimentin and CD34. Some tumor cells were also positive for renin. Electron micrograph showed near rhomboid crystalline structure in the tumor cells. Because of massive necrosis and mitotic figures, diagnosis of atypical (potentially malignant) JGCT was rendered. Gene mutations for IDH1, PIK3CA, K-ras, N-ras, Braf, and EGFR were not found by MBP-QP system.
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31
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Secondary hypertension due to a juxtaglomerular cell tumor. ACTA ACUST UNITED AC 2018; 12:637-640. [DOI: 10.1016/j.jash.2018.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/08/2018] [Accepted: 05/17/2018] [Indexed: 11/21/2022]
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Maiolino G, Battistel M, Barbiero G, Bisogni V, Rossi GP. Cure With Cryoablation of Arterial Hypertension Due to a Renin-Producing Tumor. Am J Hypertens 2018. [PMID: 29522074 DOI: 10.1093/ajh/hpx213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We herein report on a 20 years old woman with stage I hypertension, who was found to carry a renin-producing tumor (RPT). METHODS Due to her young age, the patient underwent screening measurement of plasma renin and aldosterone, abdominal computed tomography (CT) angiography, and selective renal vein renin assessment to identify secondary hypertension. RESULTS The patient was screened for secondary causes of hypertension and was diagnosed with secondary aldosteronism. Therefore, she underwent an abdominal computed tomography (CT) angiography that was reported as unremarkable. Selective renal vein renin studies showed overproduction of renin in the right kidney and a re-evaluation of her CT allowed detection of an 8-mm mass in her right kidney, suggesting the presence of a RPT. Considering the technical difficulty of renal sparing surgery a CT-guided cryoablation was undertaken, which provided long-term cure of arterial hypertension and normalization of plasma active renin concentration. CONCLUSIONS RPTs usually present with a clinical phenotype featuring stage III and/or malignant hypertension and are held to be exceptionally rare. This case is unique in that it presented with stage I hypertension and a mild clinical phenotype. Moreover, to our knowledge this is the first case of RPTs shown to be safely treated with CT-guided cryoablation and found to be cured at long-term.
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Affiliation(s)
- Giuseppe Maiolino
- Clinica dell’Ipertensione Arteriosa, Department of Medicine – DIMED, University of Padua, Italy
| | - Michele Battistel
- Institute of Radiology, Department of Medicine – DIMED, University of Padua, Italy
| | - Giulio Barbiero
- Institute of Radiology, Department of Medicine – DIMED, University of Padua, Italy
| | - Valeria Bisogni
- Clinica dell’Ipertensione Arteriosa, Department of Medicine – DIMED, University of Padua, Italy
| | - Gian Paolo Rossi
- Clinica dell’Ipertensione Arteriosa, Department of Medicine – DIMED, University of Padua, Italy
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Wang F, Shi C, Cui Y, Li C, Tong A. Juxtaglomerular cell tumor: Clinical and immunohistochemical features. J Clin Hypertens (Greenwich) 2017; 19:807-812. [PMID: 28317244 DOI: 10.1111/jch.12997] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/28/2017] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Abstract
Juxtaglomerular cell tumor (JGCT) is a rare tumor, with approximately 100 cases reported in the literature. The authors respectively studied the clinical data of 11 patients diagnosed with JGCT in Peking Union Medical College Hospital from 2004 to 2014, and investigated the immunohistochemical profiles in 10 tumors. Nine of the 11 patients were diagnosed before the age of 40 years. Hypertension was present in all patients, while hypokalemia occurred in seven of 11 patients. Computed tomography detected JGCTs with a sensitivity of 100%. Immunoreactivities for CD34 and vascular endothelial growth factor were observed in most tumor specimens, suggesting that JGCTs express a variety of vessel-related immunohistochemical markers, although JGCTs are considered a tumor without abundant blood supply. Nuclear accumulation of cyclin D1 was common in JGCTs. Results from immunohistochemistry were negative for BRAF, HER2, and TFE3, suggesting that BRAF, HER2, and TFE3 genes might not play a part in tumorigenesis in JGCTs.
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Affiliation(s)
- Fen Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chuan Shi
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yunying Cui
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chunyan Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Anli Tong
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Xue M, Chen Y, Zhang J, Guan Y, Yang L, Wu B. Reninoma coexisting with adrenal adenoma during pregnancy: A case report. Oncol Lett 2017; 13:3186-3190. [PMID: 28521424 DOI: 10.3892/ol.2017.5802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 12/20/2016] [Indexed: 11/05/2022] Open
Abstract
Reninoma is a rare form of secondary hypertension. The present study reported a case of reninoma that coexisted with an adrenal adenoma in a young female with secondary hypertension during pregnancy. The patient, a 31-year-old female exhibiting hypertension for >1 year, developed a mass in the right adrenal gland, which was detected by an ultrasound scan in the 33rd gestational week. In addition, a well-defined solid mass on the left kidney was detected by a magnetic resonance imaging scan1 month subsequent to the termination of the pregnancy. The blood pressure (BP) of the patient did not change subsequent to the laparoscopic right adrenalectomy. The patient subsequently underwent laparoscopic left partial nephrectomy 2 months later. The BP levels demonstrated a significant reduction from 177/115 to 125/80 mmHg in the same day postoperatively, and stabilized to be within the normal range. The BP level of the patient remained within the normal range subsequent to a 6-month follow-up. Pathological analysis revealed reninoma on the left kidney. The present study aimed to provide information for radiologists who may encounter this type of benign tumor in the future, which exhibits elevated BP levels.
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Affiliation(s)
- Mei Xue
- Department of Diagnostic Radiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China
| | - Yan Chen
- Department of Diagnostic Radiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China
| | - Jin Zhang
- Department of Diagnostic Radiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China
| | - Youyan Guan
- Department of Urology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China
| | - Lin Yang
- Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China
| | - Bing Wu
- Department of Diagnostic Radiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China
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Kang S, Chen F, Zhong Y, Han B, Cheng G, Guo A, Tian Y, Tong X, Dou J, Ye H. Preoperative Diagnosis of Juxtaglomerular Cell Tumors in Eight Patients. J Clin Hypertens (Greenwich) 2016; 18:982-990. [PMID: 27012170 PMCID: PMC8031485 DOI: 10.1111/jch.12810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 01/21/2023]
Abstract
The aim of this study was to improve the diagnostic efficiency for juxtaglomerular cell tumors (JCTs) and to determine whether clinical and magnetic resonance imaging features can help to differentiate JCTs from clear cell renal cell carcinoma (ccRCC). The clinical features of eight patients with JCTs and 27 patients with ccRCCs were analyzed. A flow diagram for young people with hypertension was applied to facilitate the diagnosis. Clinical presentations were analyzed, including age, hypertension, and hypokalemia. The results of our study produced a flow diagram that narrowed the scope of diagnosis. The statistical results demonstrated that patients with a renal mass aged 14 to 30 years, had grade 3 hypertension, or had moderate hypokalemia had a greater possibility of having a JCT than a ccRCC (P<.0000, P<.01, P<.0005, respectively). In addition, the flow diagram and magnetic resonance imaging features were useful to distinguish JCTs from other renal tumors.
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Affiliation(s)
- Suhai Kang
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Fang Chen
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Yan Zhong
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Baiyu Han
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Guanghe Cheng
- Department of Radiology, Chinese PLA 322 Hospital, Datong, Shanxi Province, China
| | - Aitao Guo
- Department of Pathology, Chinese PLA General Hospital, Beijing, China
| | - Yuan Tian
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xinyuan Tong
- Department of Statistical Teaching and Research Section, Chinese PLA General Hospital, Beijing, China
| | - Jingtao Dou
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Huiyi Ye
- Department of Radiology, Chinese PLA General Hospital, Beijing, China.
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Laparoscopic nephro-sparing surgery of juxtaglomerular cell tumor in a child. J Pediatr Urol 2016; 12:321-322. [PMID: 27296787 DOI: 10.1016/j.jpurol.2016.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/13/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To report a case of juxtaglomerular cell tumour of the kidney (reninoma) in a child treated with laparoscopic nephron-sparing surgery. PATIENTS AND RESULTS A 14-year-old girl was incidentally found to have hypertension (180/114 mmHg) at the time of adenotonsillectomy. Pre-operative investigations revealed a plasma renin level of 225.9 ng/dl (4.4-46), normal aldosterone, cortisol and urinary catecholamine. Abdominal ultrasound detected a 1.9 × 1.5-cm hypoechoic lesion in the right kidney lower pole; CT scan confirmed the presence of a 1.5-cm, circumscribed, solid, hypoenhancing cortical lesion in the right lower pole. Laparoscopic nephron-sparing surgery was accomplished by clamping the renal artery for 30 min; after excision, the tumour bed was closed using barbed V-loc sutures. The procedure was completed laparoscopically in 150 min with no peri-operative complications. The patient was discharged home on day 4 postoperatively. Histology confirmed the diagnosis of a juxtaglomerular cell tumour that was completely excised. The J-J stent was removed 1 month later. At follow-up, the patient's blood pressure was normalized and medications were stopped. A DMSA scan confirmed 36% residual right kidney function. CONCLUSION Laparoscopic nephron-sparing surgery should be considered in children with juxtaglomerular tumours. This technique allows prompt recovery with preservation of significant renal function.
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Oei L, van den Meiracker AH, Oei EHG, Moelker A, van Leenders GJLH, Rikken B, Verhagen P, Clahsen-van Groningen MC, van der Wiel HE. Reninoma: A Rare Cause of Curable Hypertension and Hypokalemia. Am J Med 2016; 129:e131-2. [PMID: 27103051 DOI: 10.1016/j.amjmed.2016.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Ling Oei
- Department of Internal Medicine, IJsselland Hospital, Capelle aan den IJssel, The Netherlands.
| | | | - Edwin H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Berend Rikken
- Department of Urology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Paul Verhagen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Hans E van der Wiel
- Department of Internal Medicine, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
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Kim CH, Park YW, Ordonez NG, Ayala AG, Burroughs JF, Ro JY. Juxtaglomerular Cell Tumor of the Kidney. Int J Surg Pathol 2016. [DOI: 10.1177/106689699900700208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a case of juxtaglomerular cell tumor (JGCT) that developed in a 44-year-old woman with hypertension, which subsided after the tumor was removed. The tumor was 8.5 cm in greatest dimension and is thought to be the largest such tumor reported to date. Ultrastructural study confirmed the diagnosis of JGCT by the demonstration of the typical cytoplasmic rhomboidal secretory granules on electron microscopy. The tumor cells were also strongly reactive for CD34, a finding that has not been previously reported and that may be an adjunct to the diagnosis of JGCT in a patient with hypertension, hyperreninemia, and/or hypokalemia. At present, however, further studies on additional cases for CD34 expression will be necessary to fully evaluate the diagnostic utility of this marker in the diagnosing of JGCT.
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Affiliation(s)
| | | | | | - Alberto G. Ayala
- Departments of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Jae Y. Ro
- Department of Pathology, Box 85, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030, USA
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39
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Hypertension due to juxtaglomerular cell tumor of the kidney. Kaohsiung J Med Sci 2016; 32:276-7. [PMID: 27316587 DOI: 10.1016/j.kjms.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/11/2016] [Accepted: 03/24/2016] [Indexed: 11/22/2022] Open
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Miyano G, Nagano C, Morita K, Yamoto M, Kaneshiro M, Miyake H, Nouso H, Kitayama H, Wada N, Fukumoto K, Koyama M, Urushihara N. A Case of Juxtaglomerular Cell Tumor, or Reninoma, of the Kidney Treated by Retroperitoneoscopy-Assisted Nephron-Sparing Partial Nephrectomy Through a Small Pararectal Incision. J Laparoendosc Adv Surg Tech A 2016; 26:235-8. [PMID: 26866671 DOI: 10.1089/lap.2015.0397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 15-year-old girl was found to be hypertensive (230-270/140-170 mm Hg) without any subjective symptoms. Magnetic resonance imaging confirmed the presence of a well-defined 22 mm hypodense lesion in the lower pole of the left kidney, located close to the renal hilum. Plasma rennin activity was elevated (75 ng/mL/h), and reninoma was diagnosed. Retroperitoneoscopy-assisted nephron-sparing surgery was planned. The retroperitoneum was accessed through a 4 cm left pararectal upper abdominal incision. Following blunt dissection, the abdominal wall was elevated with a lifting bar and lifting retractor, inserted below the 12th rib in the anterior axillary line to create sufficient working space in the retroperitoneal cavity without the need for pneumoperitoneum. Three 5 mm trocars were introduced above the superior iliac crest for the camera and the assistant. Gerota's fascia was opened and the kidney exposed. The surgeon dissected the left kidney through the minilaparotomy incision under both direct vision and using the magnified view on the monitor, which was particularly effective for the lateral and posterior sides of the kidney. The posterior peritoneum was incised intentionally next to the diaphragm to allow further mobilization of the kidney. Diathermy was used to remove the tumor and a layer of surrounding normal parenchymal tissue at least 0.5 cm thick. The histopathologic diagnosis was reninoma. Ischemia time was 14 minutes. Postoperatively, both plasma rennin activity and blood pressure were normal (1.9 ng/mL/h and 90-110/70-80 mm Hg, respectively). After follow-up of 12 months, there is no evidence of recurrence.
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Affiliation(s)
- Go Miyano
- 1 Department of Pediatric Surgery, Shizuoka Children's Hospital , Shizuoka, Japan
| | - China Nagano
- 2 Department of Nephrology, Shizuoka Children's Hospital , Shizuoka, Japan
| | - Keiichi Morita
- 1 Department of Pediatric Surgery, Shizuoka Children's Hospital , Shizuoka, Japan
| | - Masaya Yamoto
- 1 Department of Pediatric Surgery, Shizuoka Children's Hospital , Shizuoka, Japan
| | - Masakatsu Kaneshiro
- 1 Department of Pediatric Surgery, Shizuoka Children's Hospital , Shizuoka, Japan
| | - Hiromu Miyake
- 1 Department of Pediatric Surgery, Shizuoka Children's Hospital , Shizuoka, Japan
| | - Hiroshi Nouso
- 1 Department of Pediatric Surgery, Shizuoka Children's Hospital , Shizuoka, Japan
| | - Hirotsugu Kitayama
- 2 Department of Nephrology, Shizuoka Children's Hospital , Shizuoka, Japan
| | - Naohiro Wada
- 2 Department of Nephrology, Shizuoka Children's Hospital , Shizuoka, Japan
| | - Koji Fukumoto
- 1 Department of Pediatric Surgery, Shizuoka Children's Hospital , Shizuoka, Japan
| | - Mariko Koyama
- 1 Department of Pediatric Surgery, Shizuoka Children's Hospital , Shizuoka, Japan
| | - Naoto Urushihara
- 1 Department of Pediatric Surgery, Shizuoka Children's Hospital , Shizuoka, Japan
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Kang S, Guo A, Wang H, Ma L, Xie Z, Li J, Tonge X, Ye H. Magnetic Resonance Imaging Features of a Juxtaglomerular Cell Tumor. J Clin Imaging Sci 2015; 5:68. [PMID: 26900492 PMCID: PMC4736060 DOI: 10.4103/2156-7514.172976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/24/2015] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To retrospectively determine whether magnetic resonance imaging (MRI) findings can help differentiate a juxtaglomerular cell tumor (JCT) from clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS Eight patients with JCTs and 24 patients with pathologically proven ccRCC were included for image analysis. All patients underwent unenhanced MRI and dynamic contrast-enhanced MRI. Fat-suppressed T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), in- and opposed-phase imaging, and fat-suppressed preliver acquisitions with volume acceleration sequences were performed before enhancement. After the administration of contrast, dynamic imaging was performed in the corticomedullary, nephrographic, and excretory phases. Student's t-test, t'-test, Chi-square test, and nonparametric Kruskal-Wallis H-test were used to determine the significance of the difference between the two groups. The sensitivity and specificity of the MRI findings were calculated. RESULTS In patients with a JCT, a cystic part of the lesion of <10%, isointensity or mild hyperintensity on T2WI, heterogeneous hyperintensity on DWI, less signal drop (<10%) in in- and opposed-phase imaging, and a degree of enhancement <200% in the corticomedullary phase showed statistically significant differences compared with those of ccRCC (P < 0.05). After combining a lower apparent diffusion coefficient (ADC) value (heterogeneous hyperintensity) on DWI and a degree of enhancement <200% in the corticomedullary phase using a parallel test, the sensitivity and specificity were 90.9% and 91.7%, respectively. CONCLUSIONS Isointensity or mild hyperintensity on T2WI, a lower ADC value (heterogeneous hyperintensity) on DWI, and a degree of enhancement <200% in the corticomedullary phase are the major MRI findings for JCTs, combined with relative clinical manifestations and excluding other renal masses. A main solid tumor, less signal drop (<10%) in in- and opposed-phase imaging, and a less-washout pattern of <10% in the delayed phase are secondary MRI findings for JCTs.
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Affiliation(s)
- Suhai Kang
- Department of Radiology, Chinese PLA General Hospital, Beijing, PR China
| | - Aitao Guo
- Department of Pathology, Chinese PLA General Hospital, Beijing, PR China
| | - Haiyi Wang
- Department of Radiology, Chinese PLA General Hospital, Beijing, PR China
| | - Lu Ma
- Department of Radiology, Chinese PLA General Hospital, Beijing, PR China
| | - Zongyu Xie
- Department of Radiology, First Affiliated Hospital of Bengbu Medical College, Anhui Province, PR China
| | - Jinglong Li
- Department of MRI, First Hospital of Qinhuangdao, Hebei Province, PR China
| | - Xinyuan Tonge
- Statistical Teaching and Research Section, Chinese PLA General Hospital, Beijing, PR China
| | - Huiyi Ye
- Department of Radiology, Chinese PLA General Hospital, Beijing, PR China
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Choi JH, Park TH, Kim MH, Kim YD, Rhyou HI, Rha SH, Park KJ, Woo JS. A Rare Cause of Secondary Hypertension in A Young Adult. Korean Circ J 2015; 45:531-4. [PMID: 26617658 PMCID: PMC4661371 DOI: 10.4070/kcj.2015.45.6.531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 01/16/2015] [Accepted: 03/25/2015] [Indexed: 11/24/2022] Open
Abstract
Reninoma is a rare, renin-secreting, benign renal neoplasm that can cause secondary hypertension. We report a case of a 21-year-old man who suffered from progressively worsening headache for 2 months with a history of hypertension for 7 years. Laboratory studies showed normal potassium level, increased basal plasma renin activity, and normal serum aldosterone level. Abdominal computed tomography and magnetic resonance imaging revealed a small mass in the middle region of the right kidney. Partial nephrectomy was performed; immunohistochemical results demonstrated typical features of reninoma. Postoperatively, blood pressure and potassium level were normal at the 2-month follow-up.
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Affiliation(s)
- Jae-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Tae-Ho Park
- Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Moo-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Young-Dae Kim
- Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Hyo In Rhyou
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Seo Hee Rha
- Department of Pathology, Dong-A University College of Medicine, Busan, Korea
| | - Kwon Jae Park
- Department of Cardiovascular Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Jong Soo Woo
- Department of Cardiovascular Surgery, Dong-A University College of Medicine, Busan, Korea
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44
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Rosei CA, Giacomelli L, Salvetti M, Paini A, Corbellini C, Tiberio G, Muiesan ML. Advantages of renin inhibition in a patient with reninoma. Int J Cardiol 2015; 187:240-2. [PMID: 25838223 DOI: 10.1016/j.ijcard.2015.03.280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Laura Giacomelli
- Department of Clinical & Experimental Sciences, University of Brescia, Italy
| | - Massimo Salvetti
- Department of Clinical & Experimental Sciences, University of Brescia, Italy
| | - Anna Paini
- Department of Clinical & Experimental Sciences, University of Brescia, Italy
| | - Claudia Corbellini
- Department of Clinical & Experimental Sciences, University of Brescia, Italy
| | - Guido Tiberio
- Department of Clinical & Experimental Sciences, University of Brescia, Italy
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Magill SB. Pathophysiology, diagnosis, and treatment of mineralocorticoid disorders. Compr Physiol 2015; 4:1083-119. [PMID: 24944031 DOI: 10.1002/cphy.c130042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The renin-angiotensin-aldosterone system (RAAS) is a major regulator of blood pressure control, fluid, and electrolyte balance in humans. Chronic activation of mineralocorticoid production leads to dysregulation of the cardiovascular system and to hypertension. The key mineralocorticoid is aldosterone. Hyperaldosteronism causes sodium and fluid retention in the kidney. Combined with the actions of angiotensin II, chronic elevation in aldosterone leads to detrimental effects in the vasculature, heart, and brain. The adverse effects of excess aldosterone are heavily dependent on increased dietary salt intake as has been demonstrated in animal models and in humans. Hypertension develops due to complex genetic influences combined with environmental factors. In the last two decades, primary aldosteronism has been found to occur in 5% to 13% of subjects with hypertension. In addition, patients with hyperaldosteronism have more end organ manifestations such as left ventricular hypertrophy and have significant cardiovascular complications including higher rates of heart failure and atrial fibrillation compared to similarly matched patients with essential hypertension. The pathophysiology, diagnosis, and treatment of primary aldosteronism will be extensively reviewed. There are many pitfalls in the diagnosis and confirmation of the disorder that will be discussed. Other rare forms of hyper- and hypo-aldosteronism and unusual disorders of hypertension will also be reviewed in this article.
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Affiliation(s)
- Steven B Magill
- Division of Endocrinology, Metabolism, and Clinical Nutrition, Department of Medicine, Medical College of Wisconsin, Menomonee Falls, Wisconsin
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Hu Q, Fang Z, Zhou Z, Zheng J. Renal hemangiopericytoma secondary to refractory hypertension in a child: A case report. Oncol Lett 2014; 8:2493-2495. [PMID: 25364414 PMCID: PMC4214483 DOI: 10.3892/ol.2014.2577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/12/2014] [Indexed: 11/15/2022] Open
Abstract
Hemangiopericytoma is a rare perivascular tumor that often involves the extremities, pelvis, head and neck, and meninges, but rarely occurs in the kidney. The differentiation from renal cancer prior to surgery is extremely challenging; therefore, almost all cases of renal hemangiopericytoma are diagnosed by pathological examination. The majority of cases are identified in patients between the ages of 20 and 50 years of age, and a considerable proportion of patients exhibit hypertension, hypoglycaemia or additional paraneoplastic syndromes. The current study reports a rare case of renal hemangiopericytoma with drug refractory hypertension in a 14-year-old female. Following the complete resection of the tumor, the patient’s blood pressure returned to normal. No evidence of recurrence or metastasis was observed during a follow-up of 12 months following surgery. The present case indicated that surgery provides satisfactory outcomes and appears to be the most effective modality of treatment for renal hemangiopericytoma. Furthermore, this case also demonstrated that secondary hypertension may also recover following tumor excision.
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Affiliation(s)
- Qingfeng Hu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Zujun Fang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Zhongwen Zhou
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Jie Zheng
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
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Jo HA, Kwak C, Chul Moon K, Lee JH, Hwan Park J, Lee S, Huh H, Yi Y, Ryu H, Oh KH. A case of reninoma with variant angina. Kidney Res Clin Pract 2014; 33:106-8. [PMID: 26877959 PMCID: PMC4714162 DOI: 10.1016/j.krcp.2014.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/26/2014] [Accepted: 03/26/2014] [Indexed: 11/04/2022] Open
Abstract
Reninoma is a tumor of the renal juxtaglomerular cell apparatus that causes hypertension and hypokalemia because of hypersecretion of renin. We present a case of a 29-year-old female patient with reninoma and concomitant variant angina. The patient had uncontrolled hypertension and elevated plasma renin activity and aldosterone levels. Imaging studies revealed a mass in the left kidney, which was further confirmed as a renin-producing lesion via selective venous catheterization. During the evaluation, the patient had acute-onset chest pain that was diagnosed as variant angina after a provocation test. After partial nephrectomy, the plasma renin activity and plasma aldosterone levels decreased and blood pressure normalized. We report a case of reninoma with variant angina.
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Affiliation(s)
- Hyung Ah Jo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Kyung Chul Moon
- Department of Pathology and Kidney Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jong-Ho Lee
- Department of Internal Medicine, Konkuk University Hospital, Seoul, Korea
| | - Jung Hwan Park
- Department of Internal Medicine, Konkuk University Hospital, Seoul, Korea
| | - Sunhwa Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyuk Huh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - YongJin Yi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - HyunJin Ryu
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Trnka P, Orellana L, Walsh M, Pool L, Borzi P. Reninoma: an uncommon cause of Renin-mediated hypertension. Front Pediatr 2014; 2:89. [PMID: 25177679 PMCID: PMC4133731 DOI: 10.3389/fped.2014.00089] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/04/2014] [Indexed: 11/13/2022] Open
Abstract
Reninoma (juxtaglomerular cell tumor) is a rare cause of renin-mediated hypertension. Reninomas are usually diagnosed in adolescents and young adults with occasional reports in younger children. Patients typically present with a long history of headaches leading to a diagnosis of severe hypertension that responds well to antihypertensive treatment targeting the renin-angiotensin-aldosterone system. The clue to clinical diagnosis is the presence of hypokalemia and metabolic alkalosis on the first blood sample drawn before any treatment is instituted. Elevated blood levels of renin and aldosterone confirm the clinical suspicion of renin-mediated hypertension. Diagnostic imaging is employed to identify the source of excessive renin production. While renal ultrasound can miss reninoma, contrast CT or magnetic resonance imaging of the kidneys are diagnostic modalities of choice leading to the correct diagnosis. Renal vein renin sampling with lateralization might help to identify the site of excessive renin production. Nephron-sparing surgery is curative with maintenance of normal blood pressure after discontinuation of antihypertensive medications in the majority of patients. In this paper, we present the case of reninoma in an adolescent girl emphasizing clinical presentation, diagnostic evaluation, and medical and surgical treatment of this rare tumor. We also discuss important points in the management of children presenting with renin-mediated hypertension.
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Affiliation(s)
- Peter Trnka
- Department of Paediatrics and Child Health, The University of Queensland , Brisbane, QLD , Australia ; Department of Paediatrics, Mater Children's Hospital , Brisbane, QLD , Australia
| | - Luisa Orellana
- Department of Paediatrics, Mater Children's Hospital , Brisbane, QLD , Australia
| | - Mark Walsh
- Department of Medical Imaging, Mater Children's Hospital , Brisbane, QLD , Australia
| | - Louis Pool
- Department of Pathology, Mater Adult Hospital , Brisbane, QLD , Australia
| | - Peter Borzi
- Department of Paediatrics and Child Health, The University of Queensland , Brisbane, QLD , Australia ; Department of Paediatric Surgery, Royal Children's Hospital , Brisbane, QLD , Australia
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Wolley M, Gordon RD, Stowasser M. Reninoma: the importance of renal vein renin ratios for lateralisation and diagnosis. Am J Nephrol 2013; 39:16-9. [PMID: 24401674 DOI: 10.1159/000357410] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM Reninomas are rare juxtaglomerular tumours which can cause severe hypertension and hypokalaemia. Diagnosis can be problematic and these tumours can be difficult to locate on imaging. In this report we aim to demonstrate the value of carefully performed renal vein renin ratios (RVRRs) to assist in locating these tumours. METHOD/RESULTS We report on 3 patients diagnosed with reninoma in our unit. The patients were all female, young (17, 16 and 30 years), severely hypertensive and hypokalaemic (2.5, 2.5 and 3.1 mmol/l). Plasma renin activity (PRA) was elevated (31.9, 274 and 175 ng/ml/h), and aldosterone was high-normal (19.9 ng/dl) or elevated (207 and 109.3 ng/dl). Renal artery stenosis was excluded by renal artery Doppler, DTPA scan and angiography. Renal CT detected the lesion in 2 patients, with one lesion visible on pre- and post-contrast CT and the other on post-contrast CT only. RVRRs were performed several weeks after withdrawing interfering medications, maintaining a <40 mmol/day low-sodium diet and maintaining recumbency overnight the night before and during the procedure. Ratios before and after captopril or enalaprilat administration were obtained and lateralised the tumours in all 3 cases (dominant/non-dominant ratios of 2.3, 4.3 and 3.8). All of the patients underwent nephrectomy yielding a typical juxtaglomerular tumour and resulting in cure of hypertension and hypokalaemia. CONCLUSIONS Reninoma should be suspected in young hypertensives (especially females) with significant hypokalaemia and high PRA or direct renin concentration after renovascular hypertension has been excluded. CT imaging and carefully performed RVRRs provide the highest likelihood of locating these tumours.
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Affiliation(s)
- Martin Wolley
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Qld., Australia
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