1
|
Omiyale AO. Primary vascular tumours of the kidney. World J Clin Oncol 2021; 12:1157-1168. [PMID: 35070735 PMCID: PMC8716994 DOI: 10.5306/wjco.v12.i12.1157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/01/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Primary vascular tumours of the kidney are rare and may pose diagnostic difficulties because of their similar clinical, morphological, and immunohistochemical features. This article summarizes the clinical and pathological features of primary renal angiosarcoma and anastomosing haemangioma of the kidney including epidemiology, genetics, and prognosis. Renal anastomosing haemangiomas are benign neoplasms characterized by anastomosing capillary-sized vascular channels. These tumours are rare, with about 75 cases reported in the literature. Most anastomosing haemangiomas are found incidentally on ultrasound, computed tomography, or magnetic resonance imaging. Common symptoms include abdominal pain, haematuria, and abdominal mass. Renal anastomosing haemangiomas are characterized by recurrent mutations in GNAQ and GNA14 genes. The prognosis of anastomosing haemangioma is excellent. Primary renal angiosarcomas are malignant tumours showing endothelial differentiation. To date, 76 cases have been described in the literature. Primary renal angiosarcomas are frequently symptomatic. The clinical features of renal angiosarcomas are similar to those of renal anastomosing haemangiomas, including abdominal pain, haematuria, and abdominal mass. Angiogenesis-related genes and vascular-specific receptor tyrosine kinases such as KDR, TIE1, SNRK, TEK, and FLT1 are upregulated in angiosarcomas. Primary renal angiosarcomas are highly aggressive neoplasms with a poor prognosis despite surgical treatment, chemotherapy, radiotherapy, or targeted therapy.
Collapse
Affiliation(s)
- Ayo O Omiyale
- Department of Cellular Pathology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, United Kingdom
| |
Collapse
|
2
|
Komoto H, Kitajima K, Kawanaka Y, Yoshimura N, Kunimoto R, Yokoyama H, Shinkai Y, Kaizuka Y, Yamamoto S, Kihara T, Kimura N, Hirota S, Yamakado K. CT Findings of Primary Renal Angiosarcoma. Case Rep Oncol 2021; 14:212-216. [PMID: 33776706 PMCID: PMC7983682 DOI: 10.1159/000512015] [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: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
Primary angiosarcomas of the kidney are very rare but highly aggressive tumors showing poor prognosis. We present a case of primary renal angiosarcoma occurring in a 60-year-old man with left flank pain. CT images depicted a huge exophytic mass (14 cm in diameter) in the left kidney, exhibiting central extensive hemorrhage or necrosis without contrast enhancement. The mass showed centripetal peripheral nodular enhancement on dynamic contrast-enhanced CT images. We suggest its inclusion in the differential diagnosis of cases of hemorrhagic renal tumors with prominent vasculature.
Collapse
Affiliation(s)
- Hisashi Komoto
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhiro Kitajima
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yusuke Kawanaka
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nahomi Yoshimura
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryo Kunimoto
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroyuki Yokoyama
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yukako Shinkai
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yohei Kaizuka
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takako Kihara
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Neinei Kimura
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| |
Collapse
|
3
|
Boni A, Cochetti G, Sidoni A, Bellezza G, Lepri E, Giglio AD, Turco M, Vermandois JARD, Zingaro MD, Cirocchi R, Mearini E. Primary Angiosarcoma of the Kidney: Case Report and Comprehensive Literature Review. Open Med (Wars) 2019; 14:443-455. [PMID: 31410364 PMCID: PMC6689208 DOI: 10.1515/med-2019-0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/24/2019] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Angiosarcoma (AS) is an aggressive malignant tumour of endothelial origin, most frequently compelling the skin. The kidney is a rare site of primary occurrence of AS with a quite challenging diagnosis and poor prognosis, mainly due to its raw metastasising power. We described our first case of AS treatment. A comprehensive literature review in this field is also carried out. PATIENTS AND METHODS We report the case of a 56-years-old man with radiological appearance of an 11 cm poor vascularised left renal mass. The pre-operative imaging ruled out distant metastases and inferior vena cava thrombosis. Thus, after radioembolization, we performed a transperitoneal open radical nephrectomy with regional lymphadenectomy with the removal of the middle portion of the ileo-psoas muscle, followed by two lines of adjuvant chemotherapy. We analysed all the papers concerning primary kidney AS until December 2018. RESULTS Estimated intraoperative blood loss was 200 mL with an operative time of 100 minutes. No postoperative complications were recorded, with the patient discharge in the 8th postoperative day. The pathological assessment showed a pT3a N0, M0 tumour compatible with AS of the kidney. An immune-histochemical study showed a vascular positive for CD31, CD34, Fli-1 with a Ki-67/Mib 1 of 50%. One month after surgery the patient began adjuvant chemotherapy with gemcitabine. After 45 days from surgery, a Computed Tomography scan showed lung and liver metastases with disease relapse in the left kidney lodge. The response to the first-line treatment was excellent, unlike the second-line, encountering a chemo-refractory disease. The cancer-specific survival was of 15 months. We included 66 cases in our review. CONCLUSION This is the first case of treatment of kidney AS performed at our Institute. Our findings added new information about the unclear biology and progression of this subset of tumours, demonstrating an abysmal prognosis.
Collapse
Affiliation(s)
- Andrea Boni
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Angelo Sidoni
- Department of Experimental Medicine, Section of Anatomic Pathology and Histology, Perugia Medical School, University of Perugia, Perugia, Italy
| | - Guido Bellezza
- Department of Experimental Medicine, Section of Anatomic Pathology and Histology, Perugia Medical School, University of Perugia, Perugia, Italy
| | - Emanuele Lepri
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Andrea De Giglio
- Department of Experimental Medicine, Section of Oncology, University of Perugia, Perugia, Italy
| | - Morena Turco
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia - S.M. della Misericordia Hospital, P.le Menghini 1, 06132, Perugia, Italy
| | - Jacopo Adolfo Rossi De Vermandois
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| |
Collapse
|
4
|
Heo SH, Shin SS, Kang TW, Kim GE. Primary renal angiosarcoma with extensive hemorrhage: CT and MRI findings. Int Braz J Urol 2019; 45:402-405. [PMID: 30735338 PMCID: PMC6541118 DOI: 10.1590/s1677-5538.ibju.2018.0375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/19/2018] [Indexed: 12/24/2022] Open
Abstract
Primary angiosarcomas of the kidney are very rare, but highly aggressive tumors showing poor prognosis. Patients frequently complain of flank pain, hematuria, or a palpable mass. We present a case of primary renal angiosarcoma occurring in a 61-year-old man. CT images depicted a huge exophytic mass (16 cm in diameter) in the right kidney, exhibiting extensive hemorrhage. The mass showed centripetal peripheral nodular enhancement on dynamic contrast-enhanced images. Furthermore, MR imaging revealed a tangled mesh of tumor vessels in the periphery of the mass. We suggest its inclusion in the differential diagnosis of cases of hemorrhagic renal tumors with prominent vasculature.
Collapse
Affiliation(s)
- Suk Hee Heo
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, South Korea
| | - Ga Eon Kim
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| |
Collapse
|
5
|
Lodhi HT, Inayat F, Munir A, Ilyas G. Primary renal angiosarcoma: a diagnostic and therapeutic challenge. BMJ Case Rep 2018; 2018:bcr-2018-225484. [PMID: 30244222 DOI: 10.1136/bcr-2018-225484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Primary renal angiosarcoma is an exceedingly rare and aggressive neoplasm. Although it may occur in youth, this tumour is frequently reported in the sixth and seventh decades of life. The clinical presentation is frequently varied. Pathogenesis remains largely unknown and it has overlapping features with other tumours of the kidney. Current treatment options include variable combinations of surgery, chemotherapy and radiotherapy. Reports regarding the disease prognosis and natural history are limited. In this article, we chronicle the case of a patient with primary renal angiosarcoma presenting at an advanced stage as a widely metastasised tumour. Additionally, we undertake here a brief literature review highlighting the rarity and aggressiveness of this condition, its poor prognosis, and the lack of specific management guidelines.
Collapse
Affiliation(s)
| | | | - Ahmed Munir
- Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Ghulam Ilyas
- SUNY Downstate Medical Center, Brooklyn, New York, USA
| |
Collapse
|
6
|
Iannaci G, Crispino M, Cifarelli P, Montella M, Panarese I, Ronchi A, Russo R, Tremiterra G, Luise R, Sapere P. Epithelioid angiosarcoma arising in schwannoma of the kidney: report of the first case and review of the literature. World J Surg Oncol 2016; 14:29. [PMID: 26842370 PMCID: PMC4739400 DOI: 10.1186/s12957-016-0789-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 01/26/2016] [Indexed: 12/24/2022] Open
Abstract
Background Schwannoma and angiosarcoma are infrequent pathologies that have been rarely reported in the kidney. Angiosarcoma is an uncommon malignant tumor presenting a recognizable vascular differentiation. It can develop in any site but the most common locations include the skin, soft tissues, breast, bone, liver, and spleen while renal localization has been very rarely reported in the literature. Schwannoma is a benign peripheral nerve sheath tumor composed of cells with the immunophenotype and ultrastructural features of differentiated Schwann cells. It has a wide anatomical distribution but the most frequent locations include subcutaneous tissues of the extremities and the head and neck region and the retroperitoneal and mediastinal soft tissues. The occurrence of an angiosarcoma in a pre-existing schwannoma is an extremely rare event with <20 cases reported in worldwide literature. In the present study, a renal case of angiosarcoma arising in schwannoma is presented with a detailed review of the pertinent literature. Case Presentation A 56-year-old man was admitted with a few days history of lower back pain and hematuria. Abdominal ultrasound showed a mass inside the left renal medulla. Subsequent imaging investigations with computed tomography and magnetic resonance confirmed the presence of the lesion and showed a pulmonary metastasis. Conclusions The final histopathological examination led to the diagnosis of epithelioid angiosarcoma arising in a schwannoma. The patient came to death a few months later due to a massive hemothorax. To the best of our knowledge, the present is the first case of an angiosarcoma arising in a schwannoma of the kidney.
Collapse
Affiliation(s)
- G Iannaci
- Division of Pathology, S. Maria del Popolo degli Incurabili Hospital ASL Na1, Naples, Italy.
| | - M Crispino
- Division of Urology, S. Maria del Popolo degli Incurabili Hospital ASL Na1, Naples, Italy
| | - P Cifarelli
- Division of Urology, S. Maria del Popolo degli Incurabili Hospital ASL Na1, Naples, Italy
| | - M Montella
- Division of Pathology, School of Medicine, University Federico II, Naples, Italy
| | - I Panarese
- Division of Pathology, School of Medicine, University Federico II, Naples, Italy
| | - A Ronchi
- Division of Pathology, School of Medicine, University Federico II, Naples, Italy
| | - R Russo
- Division of Pathology, School of Medicine, University Federico II, Naples, Italy
| | - G Tremiterra
- Division of Pathology, School of Medicine, University Federico II, Naples, Italy
| | - R Luise
- Division of Pathology, School of Medicine, University Federico II, Naples, Italy
| | - P Sapere
- Division of Pathology, S. Maria del Popolo degli Incurabili Hospital ASL Na1, Naples, Italy
| |
Collapse
|
7
|
Omiyale AO. Clinicopathological features of primary angiosarcoma of the kidney: a review of 62 cases. Transl Androl Urol 2016; 4:464-73. [PMID: 26816844 PMCID: PMC4708591 DOI: 10.3978/j.issn.2223-4683.2015.05.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Angiosarcoma (AS) is a malignant tumor occurring in less than 2% of soft tissue sarcomas. Primary involvement of the kidney is rare, its pathogenesis remains largely unknown and it has overlapping features with other tumors of the kidney. The objective of this paper is to review the case reports of primary AS of the kidney in the literature. The search terms were primary AS of the kidney, primary renal AS and primary renal hemangiosarcoma. The total cohort of the cases reviewed was 62. The mean age of presentation was 61 years old with a predilection for the male sex. Metastatic disease at the time of diagnosis accounted for 44.9% (22/49) of the cases reported and 44.4% (12/27) of patients with non-metastatic disease at diagnosis, subsequently developed metastasis. Primary AS of the kidney is a rare malignant tumor with a poor prognosis. Local recurrence and distant metastasis is common. Primary AS of the kidney shares similar clinical presentation with other renal tumors and imaging does not allow for tumor specific diagnosis. Histopathological examination and immunohistochemistry is very important for the confirmation of the diagnosis. Current treatment options include a variable combination of surgery, radiotherapy and chemotherapy.
Collapse
|
8
|
Zhang W, Wang Q, Liu YL, Yu WJ, Liu Y, Zhao H, Zhuang J, Jiang YX, Li YJ. Anastomosing hemangioma arising from the kidney: a case of slow progression in four years and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:2208-2213. [PMID: 25973131 PMCID: PMC4396249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/23/2015] [Indexed: 06/04/2023]
Abstract
Reported herein is a renal anastomosing hemangioma which developed slowly in the past four years. A 25-year-old woman was found a mass localized in the upper portion four years ago, and only slow progression in the past four years. She underwent a laparoscopic partial nephrectomy of right kidney and diagnosed as anastomosing hemangioma. On histology the vascular components of the tumor had an anastomosing pattern without well-definite margins. Immunohistochemically, only endothelial markers (CD31, CD34) were expressed on the vascular components of tumor cells. Smooth muscle actin (SMA), cytokeratin (CK), EMA and S-100 and so on were all negative in the epithelioid tumor cells. The patient was alive at 16 months after operation, without any evidence recurrence or metastasis. Anastomosing hemangioma is an extremely rare vascular neoplasm; only 23 cases were previously described until now. Our report of anastomosing hemangioma arising from the kidney with slow progression will improve the knowledge of primary vascular tumors arising in the kidney.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Pathology, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Qiang Wang
- Department of Pathology, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Yu-Lin Liu
- Department of Clinical Laboratory, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Wen-Juan Yu
- Department of Pathology, Affiliated Hospital of Medical College, Qingdao UniversityQingdao 266003, China
| | - Yan Liu
- Department of Pathology, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Hui Zhao
- Department of Pathology, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Jie Zhuang
- Department of Pathology, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Yan-Xia Jiang
- Department of Pathology, Affiliated Hospital of Medical College, Qingdao UniversityQingdao 266003, China
| | - Yu-Jun Li
- Department of Pathology, Affiliated Hospital of Medical College, Qingdao UniversityQingdao 266003, China
| |
Collapse
|