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Adeniran AJ, Shuch B, Humphrey PA. Sarcomatoid and Rhabdoid Renal Cell Carcinoma: Clinical, Pathologic, and Molecular Genetic Features. Am J Surg Pathol 2024; 48:e65-e88. [PMID: 38736105 DOI: 10.1097/pas.0000000000002233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Renal cell carcinoma (RCC) with sarcomatoid and rhabdoid morphologies has an aggressive biological behavior and a typically poor prognosis. The current 2022 WHO classification of renal tumors does not include them as distinct histologic entities but rather as transformational changes that may arise in a background of various distinct histologic types of RCC. The sarcomatoid component shows malignant spindle cells that may grow as intersecting fascicles, which is reminiscent of pleomorphic undifferentiated sarcoma. The rhabdoid cells are epithelioid cells with eccentrically located vesicular nuclei with prominent nucleoli and large intracytoplasmic eosinophilic inclusions. Studies have shown that RCCs with sarcomatoid and rhabdoid differentiation have distinctive molecular features. Sarcomatoid RCC harbors shared genomic alterations in carcinomatous and rhabdoid components, but also enrichment of specific genomic alterations in the sarcomatoid element, suggesting molecular pathways for development of sarcomatoid growth from a common clonal ancestor. Rhabdoid differentiation also arises through clonal evolution although less is known of specific genomic alterations in rhabdoid cells. Historically, treatment has lacked efficacy, although recently immunotherapy with PD-1/PD-L1/CTLA-4 inhibitors has produced significant clinical responses. Reporting of sarcomatoid and rhabdoid features in renal cell carcinoma is required by the College of American Pathologists and the International Collaboration on Cancer Reporting. This manuscript reviews the clinical, pathologic, and molecular features of sarcomatoid RCC and rhabdoid RCC with emphasis on the morphologic features of these tumors, significance of diagnostic recognition, the molecular mechanisms of tumorigenesis and differentiation along sarcomatoid and rhabdoid lines, and advances in treatment, particularly immunotherapy.
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Affiliation(s)
| | - Brian Shuch
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - Peter A Humphrey
- Department of Pathology, Yale University School of Medicine, New Haven, CT
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Periasamy K, Dey T, Goyal S, Madan R, Kumar S, Devana SK, Elumalai T, Giridhar P, Ghoshal S, Kapoor R, Das CK. Primary renal leiomyosarcoma in adult patients: a systematic review and individual patient data analysis. AFRICAN JOURNAL OF UROLOGY 2024; 30:15. [DOI: 10.1186/s12301-024-00418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 03/04/2024] [Indexed: 09/05/2024] Open
Abstract
Abstract
Purpose
The optimal management of primary renal leiomyosarcomas is unknown owing to its rarity and minimal available information about their primary, adjuvant treatment and clinical outcomes. This study systematically reviews treatment evidence and effects in terms of survival for leiomyosarcomas arising primarily from kidney, renal pelvis and renal vessels.
Method
PubMed and Embase databases were searched from inception to March 2023, with manual searches of reference lists. Two investigators independently reviewed the studies reporting management and survival outcomes of renal leiomyosarcomas.
Results
A total of 85 publications met inclusion criteria, reporting on 188 cases. The median age was 55.5 years, predominantly female [52.7%]. Pain was the most common presenting symptom [41.5%], and most tumors were high grade [45.8%]. Complete surgical resection with negative margins forms definitive treatment. The median disease-free survival and overall survival (OS) for all reviewed patients were 24 months [95%CI 4.1–43.9] and 42 months [95%CI 32.5–51.4], respectively. The OS of 1 year, 2 year, 3 year and 5 year was 78.8%, 64.4%, 53.8% and 38.9%, respectively. On univariate analysis, favorable factors for OS included tumor size ≤ 5 cm, low-grade histology, tumors of renal vascular origin and non-metastatic disease at presentation. Neoadjuvant or adjuvant treatment with either radiotherapy or chemotherapy has been shown to improve OS (NR vs. 36 months, p < 0.001), especially for high-grade tumors > 5 cm in size.
Conclusion
Radical nephrectomy with en bloc tumor resection with negative margins forms the mainstay of treatment for renal leiomyosarcomas. Adjuvant radiotherapy or chemotherapy appears to improve OS. To validate this treatment strategy, prospective multicentric efforts are required to acquire reliable data from randomized trials.
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Musthafa TM, Balagobi B, Weerasinghe N, Munasinghe MADN, Jenil A, Priyatharsan K. A rare case of bilateral synchronous renal cancer, characterized by distinct histologies; leiomyosarcoma and clear cell renal cancer. Int J Surg Case Rep 2023; 111:108879. [PMID: 37776688 PMCID: PMC10556767 DOI: 10.1016/j.ijscr.2023.108879] [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: 09/13/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023] Open
Abstract
INTRODUCTION Renal cancer is a significant global cause of death and clear cell being the most common subtype. Bilateral synchronous renal cancers with different histologies are extremely rare and less reported. Managing bilateral renal cancer is challenging. CLINICAL PRESENTATION A 51-year-old woman with a history of hypertension and hypothyroidism presented with right loin pain, leading to the discovery of a 7 cm right renal mass and a 2.3 × 2.6 cm mass on the upper pole of the left kidney, associated with reactive right para-aortic lymph nodes. The right kidney mass was identified as leiomyosarcoma with liver metastasis while the left kidney mass was diagnosed as clear cell renal carcinoma. Patient was managed with right side nephrectomy, left side microwave ablation and follow-up chemotherapy. DISCUSSION Primary leiomyosarcoma of kidney is extremely rare and aggressive, leading to poor outcome. Synchronous bilateral renal cancer pose surgical challenges due to potential loss of renal function. In this case of differing histologies in synchronous bilateral renal masses, a nephron-sparing approach was taken, but despite aggressive treatment, the patient developed metastases in the liver and peritoneum. CONCLUSION Bilateral synchronous renal cancer, particularly with differing histologies in each kidney, are exceptionally uncommon, making their management challenging. Despite the limited guidance available due to their rarity, addressing these cases aggressively and promptly is crucial, as their prognosis is generally unfavorable, necessitating further research to advance management strategies.
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Affiliation(s)
- Thaha M Musthafa
- Genitourinary Surgical Unit, District General Hospital, Nuwara Eliya, Sri Lanka.
| | - B Balagobi
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
| | - N Weerasinghe
- Genitourinary Surgical Unit, District General Hospital, Nuwara Eliya, Sri Lanka
| | - M A D N Munasinghe
- Department of Pathology, District General Hospital, Nuwara Eliya, Sri Lanka
| | - Anton Jenil
- Department of Interventional Radiology, Teaching Hospital Jaffna, Sri Lanka
| | - K Priyatharsan
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
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Poombal F, Ahsan M, Noor R, Nasir S, Khan A. Renal Leiomyosarcoma: Unraveling the Mysteries of a Rare Malignancy. Cureus 2023; 15:e45476. [PMID: 37859906 PMCID: PMC10583859 DOI: 10.7759/cureus.45476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Primary leiomyosarcoma is a rare malignant kidney tumor. The diagnosis of this disease is usually made on the basis of histological examination because it lacks specific clinical or radiological characteristics. Differentiation between leiomyosarcoma and sarcomatoid renal cell carcinoma can be challenging because spindle cell morphology is observed in both tumors. Therefore, caution should be exercised when making a diagnosis of primary renal leiomyosarcoma. Both renal sarcoma and sarcomatoid renal cell carcinoma have a worse prognosis, and nephrectomy is the treatment of choice in locally resectable tumors. An example of such a tumor is discussed in relation to its diagnostic challenges. We report a case of a 35-year-old female who presented with a left renal mass. A left radical nephrectomy was performed, and a firm, tan-white, lobulated tumor (14x8x7.5 cm) was present on gross examination. A histological diagnosis of high-grade leiomyosarcoma was made on the basis of histology, positivity for caldesmon and desmin, and negative cytokeratin immunostaining. Sarcomatoid renal cell carcinoma was ruled out based on morphological findings after extensive sampling of the tumor along with negativity for CK, CD-10, and carbonic anhydrase IX immunostaining.
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Affiliation(s)
- Fnu Poombal
- Pathology, Nishtar Medical University, Multan, PAK
| | - Muhammad Ahsan
- Histopathology, Chughtai Institute of Pathology, Lahore, PAK
| | - Rida Noor
- Pathology, Faisalabad Medical University, Faisalabad, PAK
| | - Saira Nasir
- Pathology, Chughtai Institute of Pathology, Lahore, PAK
| | - Anam Khan
- Histopathology, Chughtai Institute of Pathology, Lahore, PAK
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Chen C, Jiang X, Xia F, Chen X, Wang W. Clinicopathological Characteristics and Survival Outcomes of Primary Renal Leiomyosarcoma. Front Surg 2021; 8:704221. [PMID: 34746221 PMCID: PMC8566676 DOI: 10.3389/fsurg.2021.704221] [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: 05/02/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Primary renal leiomyosarcoma (LMS) is an exceedingly rare entity with a poor prognosis. We summarized the clinicopathological characteristics, treatment choice, and survival outcomes of LMS from the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Renal LMS and kidney renal clear cell carcinoma (KIRC) data from 1998 to 2016 were collected from the SEER database. The continuous variables were analyzed using t-tests, while the categorical variables were analyzed using Pearson's chi-squared or Fisher's exact tests. Propensity score matching (PSM) was also performed. The cancer-specific survival (CSS) and overall survival (OS) curves were estimated using Kaplan-Meier analyses and compared by log-rank tests. The risk factors for CSS and OS were estimated using univariable and multivariable Cox proportional hazard regression models. Results: A total of 140 patients with renal LMS and 75,401 patients with KIRC were enrolled. These groups differed significantly in sex, race, tumor size, grade, SEER stage, surgery, radiation, and chemotherapy. Renal LMS exhibited poorer CSS and OS compared with KIRC before and after PSM. For renal LMS, the univariate Cox proportional hazard regression model indicated that larger tumor size, higher tumor grade, higher SEER stage, and chemotherapy were risk factors for CSS and OS, while surgery appeared to be a protective factor. However, only tumor grade, SEER stage, and receiving surgery remained independent prognostic factors in the multivariable Cox proportional hazard regression model. In addition, subgroup analyses indicated that surgery remained a protective factor for advanced renal LMS. However, there was no survival benefit for patients receiving chemotherapy. Conclusions: Primary renal LMS is an exceedingly rare entity with distinct clinicopathological features and a poor prognosis. A higher tumor grade and late stage may indicate a poor prognosis. Complete tumor resection remains to be the first treatment choice, while chemotherapy may be a palliative treatment for patients with advanced disease.
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Affiliation(s)
- Cheng Chen
- Department of Urology, Xiangya Changde Hospital, Changde, China
| | - Xinjie Jiang
- Department of Urology, Xiangya Changde Hospital, Changde, China
| | - Fei Xia
- Department of Urology, Xiangya Changde Hospital, Changde, China
| | - Xudong Chen
- Department of Urology, Xiangya Changde Hospital, Changde, China
| | - Weiguo Wang
- Department of Urology, Xiangya Changde Hospital, Changde, China
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Leinwand GZ, Greenberg JW, Sholl AB, Krane LS. Synchronous Urothelial Bladder and Renal Malignancies. Case Report and Review of Urologic Cancers in Patients With Familial Rb Mutations. Urology 2019; 131:89-92. [DOI: 10.1016/j.urology.2019.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
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Darlington D, Anitha FS. Atypical Presentation of Renal Leiomyosarcoma: A Case Report. Cureus 2019; 11:e5433. [PMID: 31632881 PMCID: PMC6797020 DOI: 10.7759/cureus.5433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/17/2019] [Indexed: 11/15/2022] Open
Abstract
Primary renal sarcomas are rare comprising from 0.8 to 2.7% of adult renal tumours. They cannot be distinguished clinically or radiologically from the more common renal cell carcinomas. Leiomyosarcoma is the most common histological subtype accounting for around 50-60% of renal sarcomas. Leiomyosarcomas arise from the renal capsule, renal vein or the renal pelvis. They present with nonspecific clinical symptoms and signs and usually have a dismal outcome. Rarely atypical presentations such as acute tumour rupture and hematuria are encountered. We report a 27-year-old woman who presented with malignant hypertension. The hypertension was controlled emergently with antihypertensive agents. In view of the young age, a thorough workup was conducted to identify the cause of hypertension. Imaging studies revealed a solid enhancing renal tumour compressing the renal vasculature. As the staging workup did not reveal any evidence of metastases, the patient underwent right-sided open radical nephrectomy after adequate control of hypertension. The histological examination uncovered the renal tumour to be a leiomyosarcoma. Postoperative period was uneventful and she was doing well on one year follow up. Surprisingly the blood pressure normalised postoperatively and the patient was weaned off of her antihypertensive medications. This case is presented to highlight the atypical acute presentation of primary renal leiomyosarcoma with relatively good prognosis. Timely diagnosis and meticulous surgical resection improved the prognosis of this aggressive renal malignancy.
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Affiliation(s)
- Danny Darlington
- Urology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | - Fatima Shirly Anitha
- Pediatrics, Church of South India Kalyani Multispeciality Hospital, Chennai, IND
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Vasquez Ciriaco S, García Espinoza JA, Garcia Pedro EE. Primary leiomyosarcoma of kidney with metastasis to contralateral kidney. Case report. Interv Med Appl Sci 2018; 10:98-101. [PMID: 30363298 PMCID: PMC6167618 DOI: 10.1556/1646.10.2018.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 02/08/2018] [Accepted: 02/18/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Renal leiomyosarcoma is a rare entity in the world and its understanding is based on reports and various cases; however, the prognosis is bleak for its malignant potential and an average survival of 18 months. CLINICAL CASE A 54-year-old woman with a clinical picture of 6 months of pain in the right flank and a tomographic image of a bilateral renal lesion underwent right radical nephrectomy and left conservative surgery. The definitive histopathological study reported right primary renal leiomyosarcoma with left metastasis. CONCLUSION Renal leiomyosarcoma is an entity of low incidence and high mortality; however, our case represents the minority of patients with contralateral kidney metastasis reported in the literature.
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Affiliation(s)
- Sergio Vasquez Ciriaco
- Department of Oncological Surgery, Regional Hospital of High Specialty of Oaxaca, Oaxaca, Mexico
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Li X, Gao H, Tang C, Liu X. Oral administration of sunitinib malate for long-term survival of a patient with multiple lung metastases from renal leiomyosarcoma. Onco Targets Ther 2016; 9:4753-6. [PMID: 27536137 PMCID: PMC4973714 DOI: 10.2147/ott.s96473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Sunitinib, an oral tyrosine kinase inhibitor, has been approved by the US Food and Drug Administration for the treatment of metastatic renal cell carcinoma and imatinib-refractory gastrointestinal stromal tumor. In non-gastrointestinal stromal tumor soft tissue sarcomas, the activity of this small-molecule drug has been rarely reported. Herein, we report a patient with lung metastases from renal leiomyosarcoma who responded favorably to sunitinib after the failure of conventional chemotherapy. Adverse effects of sunitinib, which include fatigue, hand-foot syndrome, and stomatitis were observed following its administration. Withdrawal of sunitinib led to progression of disease, and resuming use of sunitinib was still effective for multiple lung metastases. Sunitinib might be an effective treatment for renal leiomyosarcoma, especially when conventional chemotherapy fails.
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Affiliation(s)
- Xiaoyan Li
- Department of Lung Cancer, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Hongjun Gao
- Department of Lung Cancer, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Chuanhao Tang
- Department of Lung Cancer, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Xiaoqing Liu
- Department of Lung Cancer, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
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Abstract
Objectıve To investigate the clinical characteristics, prognosis, survival and diagnosis of high-grade primary renal leiomyosarcoma. Materıals and Methods From January 2003 to April 2013, 10 cases of high-grade primary renal leiomyosarcoma were retrospectively reviewed. We analyzed clinical manifestations, treatment and prognosis of our group and correlated to the literature. Results Ten cases (five male and five female patients; age range 43–77 years, mean=57±std d:12.3 ) were enrolled. The mean diameter of the tumor masses was 9.35±4.5 cm (range 3-18 cm). 40% of the patients were asymptomatic while the major symptom of 60% patients was lumbar pain. Nephrectomy was performed in 90% of patients. Partial nephrectomy surgery was preferred for only one patient. Pleomorphism and necrosis with high-grade, pink spindle cell cytoplasm were viewed in all patients. All patients were high-grade, pink spindle cell cytoplasm and pleomorfism and necrosis were observed in all. In an immunohistochemical examination, vimentin was seen in 100%, desmin in 90% and smooth muscle actin in 80% of the patients. CD117 was negative in all patients. All of the cases were followed-up, and the time of survival varied from 6 to 68 months (mean 23.9±std d:20.1). No patient received adjuvant CTx and/or RTx. Conclusıon High-grade primary renal leiomyosarcomas (LMSs) are rare and highly malignant and the prognosis is poor. Early diagnosis and radical nephrectomy can prolong the patient’s life. Surgery is the main treatment modality for renal (leiomyosarcoma) LMS.
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Affiliation(s)
- Hakan Ozturk
- Department of Urology, School of Medicine, Sifa University, Izmir, Turkey
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Kwon YS, Salmasi A, Han CS, Hon JDC, Singer EA. Renal Leiomyosarcoma: Case Report and Review of the Literature. ACTA ACUST UNITED AC 2015; 4:213-217. [PMID: 27087881 DOI: 10.14740/wjnu214w] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Leiomyosarcoma of the kidney is a rare entity, and our understanding of this type of renal sarcomas is limited. A 46-year-old Caucasian male presented with a chief complaint of right flank pain for one month. He came to our facility for an additional opinion regarding the management of his renal mass. Computed tomography (CT) of the abdomen showed an enhancing, heterogeneous right renal mass, consistent with the features of renal cell carcinoma (RCC). Robotic-assisted total nephrectomy of the right kidney revealed a tan mass with central necrosis that involved the upper pole of the kidney. Based on gross specimen observation and immunochemical analysis, the patient was diagnosed with high-grade leiomyosarcoma. While the prognosis is poor, radical nephrectomy remains the treatment of choice. The potential benefits of adjuvant therapy should be discussed with selected patients.
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Affiliation(s)
- Young Suk Kwon
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Amirali Salmasi
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Jane Date C Hon
- Department of Pathology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Chan G, Kroczak T, Drachenberg D. Leiomyosarcoma of the inferior vena cava with renal metastasis: An unusual case and diagnostic challenge. Can Urol Assoc J 2014; 8:358-60. [PMID: 25408804 DOI: 10.5489/cuaj.2119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Leiomyosarcomas are exceedingly rare malignant tumours with a very poor prognosis. We present a 78-year-old patient with a small renal and paracaval mass. Surgery included right open partial nephrectomy and resection of the paracaval mass to treat the presumed renal cell carcinoma. Pathology revealed the tumour to be leiomyosarcoma (LMS). This is only the second documented report of an inferior vena cava LMS presenting along with an ipsi-lateral renal mass.
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Affiliation(s)
- Garson Chan
- Division of Urology, St. Joseph's Health Care, Western University, London, ON
| | - Tadeusz Kroczak
- Section of Urology, Department of Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB
| | - Darrel Drachenberg
- Section of Urology, Department of Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB
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Abdou AG, Kandil M, Elshakhs S, El-Dien MS, Abdallah R. Renal cell carcinoma with rhabdoid and sarcomatoid features presented as a metastatic thigh mass with an unusual immunohistochemical profile. Rare Tumors 2014; 6:5037. [PMID: 24711903 PMCID: PMC3977166 DOI: 10.4081/rt.2014.5037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 02/20/2014] [Accepted: 02/26/2014] [Indexed: 01/17/2023] Open
Abstract
Renal cell carcinoma (RCC) may metastasize anywhere in the body and sometimes the primary tumor is missing and necessitates extensive investigations to detect. In this report, we describe a case of RCC metastasizing to the thigh in a 70 year old male with a highly pleomorphic morphology suggesting a high grade sarcoma that showed unequivocal positivity for desmin directing the diagnosis for pleomorphic rhabdomyosarcoma. After completion of 33 cycles of radiotherapy, the patient developed large intraabdominal mass that showed conventional areas of RCC with immunoreactivity for CD10, CK, EMA, carbonic anhydrase IX and vimentin. The tumor cells in other areas resembled that of thigh mass which raised suspicions whether the two masses represented the same tumor or not. Surprisingly, the tumor cells of thigh mass showed diffuse positivity for CD10 and focal expression for CK, EMA and carbonic anhydrase IX. Extensive investigations failed to detect any primary renal lesions. The present case demonstrated that RCC can metastasize to virtually any body site and can have significant morphologic overlap with other non-renal neoplasms. Absence of primary origin of RCC according to radiological and operative data should not hinder the diagnosis of metastatic RCC. RCC with sarcomatoid and rhabdoid features carries aggressive behavior manifested by great metastatic potential and short survival time.
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Affiliation(s)
- Asmaa Gaber Abdou
- Department of Pathology, Faculty of Medicine, Menofiya University , Shebein Elkom, Egypt
| | - Mona Kandil
- Department of Pathology, Faculty of Medicine, Menofiya University , Shebein Elkom, Egypt
| | - Soliman Elshakhs
- Department of Surgery, Faculty of Medicine, Menofiya University , Shebein Elkom, Egypt
| | - Marwa Serag El-Dien
- Department of Pathology, Faculty of Medicine, Menofiya University , Shebein Elkom, Egypt
| | - Rania Abdallah
- Department of Pathology, Faculty of Medicine, Menofiya University , Shebein Elkom, Egypt
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Renal leiomyosarcoma: a diagnostic challenge. Case Rep Oncol Med 2013; 2013:459282. [PMID: 24288636 PMCID: PMC3830810 DOI: 10.1155/2013/459282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 07/07/2013] [Indexed: 12/19/2022] Open
Abstract
Renal leiomyosarcoma is a very rare tumor that clinically and radiographically mimics more common renal malignancies. The infrequency of the condition makes it very difficult to diagnose. A 70-year-old male smoker presented with months of hematuria, right-sided flank pain, and weight loss. Imaging revealed a 3.8-centimeter renal mass that had characteristics similar to renal cell carcinoma. Initial biopsy of the mass was negative for malignancy. Two months later, subsequent imaging revealed what appeared to be metastatic bone lesions. Again, a biopsy of one of the lesions was negative for malignancy. Subsequent ureteral pyeloscopy, ureteroscopic renal pelvis biopsy, and brush cytology were negative for malignancy as well. The decision was made to perform nephrectomy for the removal of the mass. Pathologic analysis revealed renal leiomyosarcoma. This case illustrates the difficulty in diagnosing renal leiomyosarcoma. Repeated pathologic sampling was negative because of the tumor heterogeneity. Prompt diagnosis and treatment are very significant as surgical resection at an early stage offers the best prognosis.
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