Spontaneous hypoglycemia associated with hemangiopericytoma of the kidney

[Retroperitoneal pathology]

The retroperitoneum is one of the most complex regions of human anatomy as it contains a variety organs and structures from different systems, in particular those belonging to the urinary and digestive tracts and the vascular systems. The emergence of different diagnostic imaging techniques has made easier to study the retroperitoneum. Thanks to ultrasonography, computerised tomography and magnetic resonance the assessment of retroperitoneal conditions has taken a great leap forwards permitting the anatomical connections and characteristics of the structures in this region to be reliably established. Owing to the location in the retroperitoneal space of the different organs of the digestive tract and the vascular system, a multidisciplinary approach is required involving the different surgical specialties. The urologist performs a large proportion of his surgical activity in this region and must, therefore, have a good knowledge of the different retroperitoneal organs belonging to the urinary tract and also the connections between these and other organs and structures of the retroperitoneal region.

Hepatic and pulmonary metastases from a meningeal hemangiopericytoma and severe hypoglycemia due to abnormal secretion of insulin-like growth factor: a case report

A 42-year-old woman was hospitalized for severe hypoglycemic coma. She had a voluminous hepatic metastasis and multiple small lung metastases from a meningeal hemangiopericytoma initially operated on 11 years earlier. High blood levels of an abnormal form of insulin-like growth factor type 2 (IGF II) associated with low blood levels of insulin, growth hormone, IGF I, and IGF BP3 were observed. After surgical resection of the liver and pulmonary metastases, serum glucose levels and hormonal abnormalities returned to normal.

High-molecular weight IGF-2 expression in a haemangiopericytoma associated with hypoglycaemia

Spontaneous hypoglycaemia is usually caused by an insulin-producing islet-cell tumour of the pancreas. Rarely, it can be caused by non-islet cell tumours. Most of the tumours are of mesenchymal type, large, and slowly growing. One representative is haemangiopericytoma (HAP). The present report describes a case of a large recurrent retroperitoneal HAP associated with severe hypoglycaemia. Blood serum insulin and proinsulin concentrations were low. By means of acid-gel chromatography and dot-blot techniques, an increased amount of a high-molecular-weight IGF-2 peptide was found. By using antigen retrieval procedures, IGF-2-immunoreactive tumour cells were found in specimens of the recent tumour recurrence-but not in the original. When the in situ hybridization technique was used it could be shown that IGF-2 mRNA labelling had already occurred in the original tumour specimen, 11 years before the onset of hypoglycaemic symptoms. These observations confirm the hypothesized hypoglycaemic effects of high-molecular-weight (HMW) IGF-2, but also point to the presence of a prolonged compensation of this effect. A literature review, based on 17 similar cases of haemangiopericytoma with hypoglycaemia, is presented. Our observation and findings in the literature review support the idea that non-islet-cell tumour hypoglycaemia is caused by an overproduction of a HMW IGF-2 peptide. The insulin-like effect is mediated via non-specific binding to the insulin receptors. To anticipate patients at risk of developing this kind of hypoglycaemia, the histopathological investigation should include not only immunohistochemical analyses of the presence of IGF-2 peptide, but also in situ hybridization of the IGF-2 mRNA expression.

Bilateral renal hemangiopericytoma

The first reported case of bilateral renal hemangiopericytoma is presented. The 19 previous renal hemangiopericytomas that have been reported in the world literature are reviewed. This lesion has afflicted patients ranging in age from sixteen to sixty-eight years (mean 41 years) with an equal sex distribution. Mortality from hemangiopericytoma of the kidney has been 50 percent, and the primary mode of therapy remains surgical.

Hemangiopericytoma of the kidney: a case with preoperative ethanol embolization

We report a case of a giant renal hemangiopericytoma that was embolized preoperatively with ethanol. Ultrasound and computerized tomography showed multiple smooth-walled cysts within the tumor. The tumor itself was hypervascular and a vascular pattern specific for hemangiopericytoma was noted upon reinterpretation of the angiograms. The diagnostic and therapeutic aspects are discussed, and the literature is reviewed.

Renal hemangiopericytoma: surgical, radiological and pathological implications

The first case of renal hemangiopericytoma presenting radiologically as a hypovascular mass is described. Preoperative diagnostic evaluation included ultrasonography, retrograde pyeloureterography, computerized tomography and angiography. Electron microscopy is helpful to distinguish this lesion from histologically similar juxtaglomerular cell tumors. Although renal hemangiopericytoma may appear benign on pathological examination it should be treated as a low grade malignancy and followed carefully.