Unusual renal sarcoma in a young adult: its similarities to clear cell sarcoma of the kidney

Case Report: Primary osteosarcoma of the kidney

Extraosseous osteosarcoma is a rare malignant tumor, most commonly occurring in the thigh, upper limbs, and retroperitoneum. However, there are only a few reported cases of renal osteosarcoma. Herein, we present the case of a 54-year-old woman with malignant extraosseous osteosarcoma of the left kidney. CT and MR imaging revealed a soft tissue mass originating from the left kidney.

Primary renal osteosarcoma: A case report and review of literature

Primary renal osteosarcoma is an exceedingly rare tumor with poor prognosis. It tends to spread to distant sites and has a low survival rate. In this report, we present a case of a 43-year-old female patient presented with flank pain, gross hematuria, weakness, and weight loss. The patient was diagnosed with primary renal osteogenic sarcoma. This case report aimed to describe the clinical and pathological features, pathogenesis, and treatment modalities of this neoplasm.

Primary Osteosarcoma of the Kidney with Retroperitoneal Hemorrhage. Case Report and Review of the Literature

Primary osteosarcoma of the kidney is a very rare neoplasm with a very poor prognosis and unclear histogenesis. Only 20 cases have been reported in the literature. It has a strong tendency to recur locally and spread to distant sites. We present the clinical case of a 79-year-old man affected by a primary osteosarcoma of the kidney presenting with substantial retroperitoneal tumor hemorrhage. Laparotomy revealed a massive retroperitoneal hematoma due to a bleeding large stony renal mass with multiple bizarre calcifications. The diagnosis of primary renal osteosarcoma was made on the basis of hematoxylin-eosin staining and confirmed by electron microscopy. Hematoma drainage and radical nephrectomy were performed. To our knowledge this is the first case of bleeding renal osteosarcoma reported in the literature. The most important clinical findings, the pathogenesis and the treatment modalities of this rare neoplasm are discussed.

Primary renal osteosarcoma

OBJECTIVES

To investigate primary osteosarcoma (osteogenic sarcoma) of the kidney, a rare and aggressive neoplasm.

METHODS

We present clinical and pathologic features of three female patients, aged 50, 66, and 78 years, affected by primary osteosarcoma of the kidney. The diagnosis was made by H&E-stained samples from totally (cases 1 and 2) or partially (case 3) embedded tumors.

RESULTS

Reported cases showed histologic features of low-grade (n = 1), chondroblastic (n = 1), and osteoblastic (n = 1) osteosarcoma. Tumor size ranged from 3 to 7 cm, and pT category was pT1a (n = 1), pT1b (n = 1), and pT3a (n = 1). Immunohistochemistry gave focal positive results with PAX2 and CD10 in case 1 and S100 in case 2. On follow-up, two patients were disease free at 25 and 68 months and one died of metastases.

CONCLUSIONS

Surgically treated primary renal osteosarcoma might not be as aggressive as previously thought if diagnosed early with low pT status.

Clear cell sarcoma of kidney in an adolescent and in young adults: a report of four cases with ultrastructural, immunohistochemical, and DNA flow cytometric analysis

Clear cell sarcoma of the kidney is a distinct, highly malignant pediatric neoplasm. Its occurrence in adults is extremely rare and the subject of isolated case reports. We present a series of four cases (three males and one female) identified in an adolescent and in young adults (16, 18, 20, and 25 years) with flank mass (three cases), hematuria (two cases), flank pain (two cases), and hypertension (one case). Three patients had stage III disease and one had stage I disease (National Wilms' Tumor Study staging system). All tumors had predominantly or exclusively the classic histology of a monotonous proliferation of uniform small round cells with evenly distributed fine chromatin, although focal microcyst formation (two cases) and spindled architecture (one case) (variant patterns) were also noted. Therapy in all cases consisted of surgery and chemotherapy with or without radiation. Follow-up data (29-202 months) showed distant metastases in all four cases, including the lung (four cases), bone (two cases), and the liver (two cases). Three patients died of disease at 29, 59, and 63 months (mean, 50.3 months), and one patient is alive with no evidence of disease at 202 months. Ultrastructural features included scattered primitive junctions, short and irregular cytoplasmic extensions, and scant to a moderate amount of mitochondria. Immunohistochemical study (three cases) showed immunoreactivity with vimentin (two cases) and no reaction with cytokeratin, epithelial membrane antigen, S-100 protein, or desmin. Flow cytometric analysis showed diploid DNA content in three primary tumors and tetraploidy in one metastatic tumor. The proliferative activity (S-phase fraction) was low to intermediate (mean, 9.8%). Our data suggest that clear cell sarcoma of the kidney in the young adult age group resembles its pediatric counterpart in ultrastructural and immunohistochemical characteristics, proclivity for skeletal and visceral metastasis, DNA diploid status with relatively low S-phase, and aggressive clinical course. Clear cell sarcoma of the kidney in adult patients, although rare, must be differentiated from sarcomatoid carcinoma, sarcomas, and round cell tumors because of its unique characteristics in comparison to other renal neoplasms.

[Clear cell renal carcinoma outside of the usual age group]

We report a case of a 17 year old woman with a clear cell sarcoma of kidney treated at the Division of Urology of Hospital General de Agudos Dr. José M. Ramos Mejía dependent of Government of Buenos Aires City. This report is based on the unusual age of tumor presentation and its good course and results after radiotherapy and chemotherapy, with 10 years survival after surgery.

Clear cell sarcoma of the kidney in an adult

An adult case of clear cell sarcoma of the kidney is described. The clinical, histological, immunohistochemical and electron microscopical features of the tumour are described.

Clear cell sarcoma of kidney. Two cases in adults

BACKGROUND

Clear cell sarcoma of kidney (CCSK) is an aggressive renal tumor occurring most frequently in the second and third years of life. Although it has been reported in the literature in patients as old as 21 years of age, there has been no report focusing on adults with CCSK. The authors describe two cases of CCSK in men and the findings at autopsy.

METHODS AND RESULTS

Histologically, the renal tumors consisted of a homogeneous proliferation of polygonal or short spindle cells with faintly eosinophilic cytoplasm supported by a network of small vessels. Ultrastructurally, clusters of tumor cells were surrounded by collagen bundles. Elongated cytoplasmic processes, dilated rough endoplasmic reticulum, and intermediate filaments in the cytoplasm; primitive desmosome-like junctional structures; and incomplete basal lamina were observed. Immunohistochemically, tumor cells had positive results only for vimentin. Cytokeratins, epithelial membrane antigen, desmin, myoglobin, S-100 protein, neuron-specific enolase, and chromogranin A were not detected in the tumor cells. Both patients died within 2 years of onset of disease, and autopsy showed widespread metastases, especially in the soft tissue and bone.

CONCLUSIONS

Morphologic findings and an aggressive clinical course with metastasis to the bone and soft tissue are supportive of the diagnosis of CCSK in these patients.