Familial adenomatous polyposis coli and clear cell sarcoma of the kidney

Rare coincidence of familial adenomatous polyposis and a retroperitoneal fibromyxoid sarcoma: report of a case

PURPOSE

Familial adenomatous polyposis is an autosomal-dominant inherited disease with development of as many as thousands of adenomas within colon and rectum. All untreated patients will develop colorectal adenocarcinoma. A variety of extracolonic manifestations can occur, although malignant tumors are rare. An association of familial adenomatous polyposis and sarcomas was reported in a few cases only.

METHODS

We present the exceptional case of a 24-year-old male with genetically verified familial adenomatous polyposis (deletion of 10 base pairs at position 228-237 of exon 15A). The patient underwent prophylactic subtotal proctocolectomy and ileal-pouch rectal anastomosis in 2003. Two years later, an obstruction of the left ureter caused by a retroperitoneal mass was diagnosed.

RESULTS

Histopathologic findings after complete tumor resection showed a low-grade fibromyxoid sarcoma. CT scan and clinical follow-up through 15 months postoperatively revealed no recurrent tumor growth.

CONCLUSIONS

To our knowledge, this is the first reported case of familial adenomatous polyposis with metachronous retroperitoneal fibromyxoid sarcoma. Proctocolectomy or total colectomy and complete tumor resection is the treatment of choice in this case. In addition to more common semimalignant retroperitoneal desmoid tumors in familial adenomatous polyposis patients, a malignant soft-tissue tumor also has to be considered for differential diagnosis.

Gastrointestinal polyposis in childhood: clinicopathologic and genetic features

Gastrointestinal polyps and certain extraintestinal lesions in children may herald a hereditary polyposis syndrome, with an increased risk of neoplasia and other health problems for both children and their relatives. The availability of molecular/genetic screening tests has increased early diagnosis of younger members of known polyposis families. This article reviews the gross and microscopic features of polyposis syndromes of childhood and summarizes the molecular/genetic advances in this field. Clinical management is also briefly discussed.

Ovarian sarcoma with pathologic features of clear cell sarcoma of the kidney

We report a case of an unusual sarcoma arising in the ovary of an infant girl. Histologically, the tumor was composed of clear, undifferentiated cells set in an arborizing vascular stroma. Immunohistochemical staining was positive only for vimentin. Ultrastructural evaluation demonstrated undifferentiated cells with interdigitating broad cell processes that encompassed irregular electron lucent spaces that contained flocculent extracellular material. Light and electron microscopic features of the tumor resembled a clear cell sarcoma of the kidney. Although the cell of origin is unproven, both tumors may arise from primitive mesenchymal cells that may not be restricted to the kidney.

Bone metastasizing renal tumor of childhood. A clinicopathological study of eleven cases from the Prague Pediatric Tumor Registry

Eleven patients with bone metastasizing renal tumor of childhood (BMRTCh) who were diagnosed and treated in our departments over a 20-year period were reviewed. The incidence among all malignant renal tumors in children up to 15 years of age in our files was 3.7%. The male to female ratio was 10:1. The morphology had a uniform, predominantly clear cell finely vascularized pattern in all of them. Various previously recognized variations of the classic pattern such as hyalinization, nuclear palisading and cyst formation were observed in some patients. Electron microscopy showed that coarse vacuolization of the tumor seen at the light microscopic level was due to distended extracellular spaces surrounded by tumor cells and their cytoplasmic processes. Immunohistochemistry of the tumor cells revealed positive vimentin in all cases, and focally positive muscle specific actin in one. A prominent feature was fascicles of perivascular spindle cells. They were considered to be tumor cells rather than stromal elements since their morphology was close to the appearance of the polygonal tumor cells. The follow up data were available for ten patients. Four developed bone metastases, three of them died of the disease progression. Another patient died of lymph node dissemination and gastrointestinal bleeding. Six patients survived for a period of 29 months to 14 years following the diagnosis.