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Kunugitani K, Ogiso S, Fujimoto M, Yoh T, Shirai H, Okumura S, Hirao H, Ishii T, Yoshida A, Hatano E. Malignant perineurioma derived from the retroperitoneum with an aggressive clinical course: a case report. Surg Case Rep 2024; 10:121. [PMID: 38739347 DOI: 10.1186/s40792-024-01915-9] [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: 04/02/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Malignant perineurioma is a rare malignant counterpart of perineurioma derived from perineural cells. Resection is the primary option for the treatment of malignant perineuriomas; however, patients often develop recurrence after resection, and effective treatment for advanced or recurrent lesions needs to be established. This report describes a 51-year-old female with a rare malignant perineurioma in the retroperitoneum, which contributing valuable insights to the literature. CASE PRESENTATION The patient presented with abdominal distension and the imaging work-up revealed a huge hemorrhagic tumor in the retroperitoneum and obstruction of inferior vena cava by the tumor. The patient underwent surgery retrieving the tumor combined with left hemiliver and retrohepatic vena cava, which confirmed the diagnosis of a malignant perineurioma based on histopathological and immunohistochemical examination. Cancer gene panel testing identified mutations in NF2. Radiotherapy was administered for peritoneal dissemination 2 months after surgery, and the patient died from disease progression 6 months after surgery. CONCLUSIONS This rare case highlights the challenges in managing retroperitoneal malignant perineuriomas. The aggressive characteristics and limited treatment options for advanced malignant perineuriomas underscore the need for understanding the pathogenesis and developing effective systemic therapies. The identification of an NF2 mutation provides significant insights into potential therapeutic target.
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Affiliation(s)
- Ken Kunugitani
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Satoshi Ogiso
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Tomoaki Yoh
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Hisaya Shirai
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shinya Okumura
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Hirofumi Hirao
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Takamichi Ishii
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Surgery for Abdominal Oncology and Organ Regeneration, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Etsuro Hatano
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
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Ma TS, Zhou L, Zhou Q, He XL, Zhao M. Soft tissue perineurioma involving the kidney: a report of two cases with an emphasis on differential diagnosis. Diagn Pathol 2021; 16:87. [PMID: 34592995 PMCID: PMC8482618 DOI: 10.1186/s13000-021-01149-5] [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: 05/13/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Soft tissue perineurioma of the kidney is rare, with only a few reported cases. We report two additional cases with histologic, immunohistochemical and genetic analyses. CASE PRESENTATION Both tumors were from adults (1 female aged 49 years and 1 male aged 42 years) and grossly had maximum diameters of 6.5 and 10 cm, respectively. The tumors were overall well circumscribed but unencapsulated, with focally entrapped benign native renal tubules in one case; both tumors seemed to arise in the capsular areas. The tumors had histologic and immunohistochemical profiles consistent with soft tissue perineurioma. Fluorescence in situ hybridization analyses demonstrated that the tumors were negative for amplification of MDM2 and rearrangements of ESWR1, FUS, and KMT2A. Targeted next-generation sequencing revealed a low tumor mutation burden and likely pathogenic mutations (CYP2B6 and FLT1 mutations for 1 each). Follow-up data were available for both patients; neither had tumor recurrence or metastasis. CONCLUSIONS In conclusion, renal perineurioma is rare, usually arises in the capsular areas, and is cured by resection. Low-grade dedifferentiated liposarcoma and low-grade fibromyxoid sarcoma as well as other spindle cell lesions should be considered in the differential diagnosis.
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Affiliation(s)
- Tian-Shi Ma
- Department of Pathology, Laboratory Medicine Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 310014, Hangzhou, Zhejiang, China
| | - Ling Zhou
- Department of Pathology, People's Hospital of Lichuan, 445499, Lichuan, Hubei, China
| | - Quan Zhou
- Department of Pathology, Jiaxing Second Hospital, 314099, Jiaxing, Zhejiang, China
| | - Xiang-Lei He
- Department of Pathology, Laboratory Medicine Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 310014, Hangzhou, Zhejiang, China
| | - Ming Zhao
- Department of Pathology, Laboratory Medicine Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 310014, Hangzhou, Zhejiang, China. .,Department of Pathology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, 310014, Hangzhou, Zhejiang, China.
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Abstract
RATIONALE Deep benign fibrous histiocytoma (BFH) is relatively rare in contrast to superficial BFH involving the skin. Moreover, it was extremely rare for deep BFH occurring in the solid organ. To our knowledge, so far, only one case of deep BFH of the kidney was reported in English literature. PATIENT CONCERNS Herein, we report another case of deep BFH located in the kidney in a 88-year-old female. She was referred to our hospital for a severe pain in the right upper abdomen. Computed tomography revealed a round low-density shadow measuring 6 cm in the kidney. DIAGNOSIS The lesion was diagnosed as a deep BFH of the kidney, as the tumor was histologically predominately composed of bland ovoid cells arranged in a storiform pattern. INTERVENTION The patient underwent the total resection of the right kidney with the tumor in our hospital. OUTCOMES The postoperative course was uneventful. The patient was alive with no tumor recurrence or metastasis within 6 months of follow-up. LESSONS We present another case of deep BFH of the kidney. Because of the rarity, the tumor may be poorly recognized. The typical storiform pattern in histology may be helpful for diagnosis. This report serves to remind that deep BFH is also a differential diagnosis for a tumor with storiform pattern in the kidney.
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