Liposarcoma arising from the renal capsule

Liposarcoma is one of the most common soft tissue sarcomas, but liposarcoma arising from the renal capsule is rare. We report a case of liposarcoma arising from the renal capsule. Preoperative diagnosis was achieved by computerized tomography and and selective renal angiography. The tumor resected with he left kidney which weighed 4,370 g. Postoperative adjuvant chemotherapy with cyclophosphamide, bleomycin, actinomycin D, adriamycin and vinblastine was carried out. Although the patient's general conditions was fine, local recurrence occurred after 24 months postoperatively. Five cases of liposarcoma arising from the renal capsule including our case have been reported in Japan.     

A case of liposarcoma of the renal capsule

A 58-year-old woman was referred to our institution for treatment of a left renal tumor revealed by follow-up computed tomography (CT) of a pancreatic tumor. The CT showed a heterogeneous, perirenal mass containing areas of fat density. Angiography showed no feeding artery. Left nephrectomy was performed and pathological examination revealed a well-differentiated liposarcoma of the renal capsule. At the third-month follow-up, the patient was completely asymptomatic and free of recurrence. Primary tumors of the renal capsule are uncommon and liposarcoma of the renal capsule is distinctly rare. There have been only 17 reports of liposarcoma arising from the renal capsule in Japan. We, herein, report a case of liposarcoma of the renal capsule.     

A case of malignant fibrous histiocytoma arising from the renal capsule

A 62-year-old man was admitted with a chief complaint of general malaise. Computed tomography showed a large mass adjacent to the parenchyma of the left kidney. The mass was 17 x 13 x 12 cm in size. Preoperative diagnosis was left renal cell carcinoma and left radical nephrectomy was performed. Histopathologically, the tumor was diagnosed as malignant fibrous histiocytoma (MFH), and the tumor was considered to have arisen from the renal capsule. There has been no recurrence for 7 months postoperatively. We review 40 cases of MFH arising from the kidney or the renal capsule in the literature.     

Myolipoma arising from the renal capsule: a case report

A 53-year-old female visited us with an asymptomatic renal mass, which was incidentally found on abdominal ultrasonography (US). US showed a heterogeneous renal mass measuring 5 cm in diameter. Computed tomorraphy and magnetic resonance imaging showed that the tumor was mixed with muscle and fat tissue, faintly enhanced, and located at the lower portion of the left kidney. Although renal angiomyolipoma (AML) was suspected from these findings, we could not rule out a malignant tumor. Therefore, she underwent a laparoscopic partial nephrectomy. Histopathological examination revealed the tumor composed of smooth muscle and mature adipose tissue without cytological atypia arising from the renal capsule. The tumor contained no AML-like blood vessels, and was negative for HMB-45 staining. The final diagnosis was myolipoma arising from the renal capsule. Myolipoma is a rare benign neoplasm in the soft tissue of retroperitoneum and abdominal cavity. Since it is difficult to distinguish myolipoma from other benign and malignant tumors with fat tissue only by imaging studies, a surgical approach should be considered.     

A case of retroperitoneal liposarcoma arising from the renal capsule

We treated a case of retroperitoneal liposarcoma arising from the renal capsule by operation and adjuvant radiation. A 61-year-old woman was referred to our department for treatment of a right renal tumor revealed by computed tomography (CT). CT, magnetic resonance imaging and angiography demonstrated a large renal tumor with fat tissue, fed from the renal capsular artery. Right radical nephrectomy was performed on February 4, 2003. The tumor was diagnosed histopathologically as well differentiated liposarcoma arising from the renal capsule. The surgical margin was positive. Therefore, the patient was given 50 Gy of radiation postoperatively. There have been only 18 reports of liposarcoma arising from the renal capsule in Japan.     

Extraosseous osteogenic sarcoma arising from the retroperitoneum: A case report

A 44-year-old housewife with a mass in the left upper quadrant of the abdomen was admitted. The tentative diagnosis was cystadenocarcinoma arising from the pancreatic tail, as determined by CT and selective angiography. Excision of the mass with removal of the spleen, pancreatic tail, left renal capsule and surrounding lymphnodes was performed. Photomicroscopic sections revealed proliferation of malignant cells and malignant osteoids. The final diagnosis was osteogenic sarcoma arising from the retroperitoneum. among the extraosseous osteogenic sarcoma arising from the somatic soft tissue, involvement of the retroperitoneum is rare. Only 12 cases including our own case have been reported as being of retroperitoneal origin. No patient survived for five years and in our patient, there are signs of recurrence one year after the surgery. A part of this study was reported at the 135th meeting of the Kinki Surgical Society on April 28, 1984 at Nishinomiya, Hyogo, Japan     

Malignant fibrous histiocytoma arising from the renal capsule: report of a case

Malignant fibrous histiocytoma (MFH) is now considered the most common soft tissue sarcoma in adults, but MFH arising from the renal capsule is very rare. A 77-year-old woman was admitted with a painful mass in the left flank region on September 10, 1986. Preoperative diagnosis was hypovascular retroperitoneal tumor in contact with the upper pole of the right kidney. The tumor was removed together with the right kidney on December 18, 1986, and the specimen weighted 640 gm. Histological examination revealed storiform-pleomorphic malignant fibrous histiocytoma. No postoperative adjuvant therapy was carried out. Local recurrence of the disease was found about 9 months after the operation, and the patient died on February 23, 1988. Fifteen cases with MFH arising from the kidney reported in the Japanese literatures are reviewed, and the diagnosis, treatment, prognosis and tumor marker are discussed.     

Giant fibrosarcoma arising in dermatofibrosarcoma protuberans on the scalp during pregnancy

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a low-grade malignant soft tissue tumor of subcutaneous tissues that has a propensity for local recurrence; however, it seldom metastasizes. Most lesions occur over the trunk or proximal extremities, and there is slight male preponderance. DFSP is rare on the head and neck. Less than 5% tumors are located on the scalp. OBJECTIVE: To describe a case of giant fibrosarcoma arising in DFSP on the scalp during pregnancy. METHOD: In our patient, the tumor was on scalp and measured 15 x 11 x 7 cm. The recurrent tumor that developed in the same region was measured 33 x 30 x 15 cm. Histopathologic examination of this mass revealed fibrosarcoma. The mass was excised from the subperiosteal plane with a 3-cm free margin. Because of the high possibility of recurrence, the defect site was reconstructed with a split-thickness skin graft. RESULTS: After 1 year of follow-up, no recurrence or metastasis was detected. CONCLUSION: We present a unique case in which the person has a giant fibrosarcoma on her scalp arising from DFSP with fibrosarcomatous change during pregnancy.     

Non-traumatic retroperitoneal hemorrhage from renal adenoma]

A 37-year-old woman presented to our hospital with the chief complaints of stroke and sudden onset of pain in the left flank. An abdominal ultrasonogram showed a solid tumor and abdominal CT revealed a tumor 3 cm in diameter and a capsule with a heterogeneous interior at the left lower pole of the kidney. This tumor was accompanied by retroperitoneal hemorrhage. Selective left angiogram showed an avascular tumor with an artery entering the region surrounding the tumor itself. Based on the above mentioned findings, rupture of a renal angiomyolipoma was suspected. However, renal cancer could not be ruled out. Surgery was performed. At operation, a frozen section showed no malignancy, and partial nephrectomy was performed. The tumor measured 3.0 x 3.5 x 3.5 cm, and had a capsule that was 3 mm thick; its interior was filled with brown necrotic tissue mixed with red-brown coagulated blood. The histological diagnosis was a tubulo-papillary renal adenoma, but since the inside of the tumor had undergone extensive necrosis a well-differentiated adenocarcinoma could not be excluded. A renal adenoma manifesting clinical symptoms is rare, and this case of pain caused by retroperitoneal hemorrhage is the first to be reported in Japan. It is difficult to diagnose renal adenoma by preoperative imaging and intraoperative frozen section examination. Diagnosis is considered to be difficult in some cases even when examining permanent specimens. Therefore, the type of surgery used in affected patients should also be investigated in the future.     

Leiomyosarcoma of kidney – a case report with long term result after radiotherapy and chemotherapy

Leiomyosarcoma of the kidney is a rare entity with poor prognosis. Among renal sarcomas, it is the most common histologic subtype amounting to 50–60% of all cases. The tumors usually arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall. We describe a case of renal leiomyosarcoma that presented with history of left flank pain. Physical examination was normal. Abdominal ultrasound showed a solid lesion of 38 × 36 mm arising from the left kidney. Intravenous urography showed cut off of both major and minor calyces of the left kidney from its pelvis with a normal right kidney. Exploratory laparotomy revealed a well-encapsulated mass confined to the renal parenchyma for which radical nephrectomy was performed. Histopathology showed a Grade I leiomyosarcoma arising from the renal capsule. Adjuvant chemotherapy and sandwich radiotherapy was given and he is disease free after six and half years of follow up. The rarity of this disease, its severity and poor prognosis, uncommon form of presentation, resulting delay in diagnosis and difficulty in management is highlighted and reported.     

A case of retroperitoneal fibrosarcoma

A case of retroperitoneal fibrosarcoma is reported. An 81-year-old man was admitted to our hospital with gross hematuria. X-ray examination of intravenous pyelography, computed tomography and angiography revealed left hydronephrosis and left renal tumor. Excisional surgery was carried out. The tumor and left kidney were completely removed. Pathological diagnosis was retroperitoneal fibrosarcoma. Five months later, he died of lung and liver metastasis.     

Malignant fibrous histiocytoma arising from the renal capsule: report of a case

We report a case of malignant fibrous histiocytoma arising from the renal capsule. The tumor was found during screening ultrasonography. Surgical excision and adjuvant chemotherapy consisting of cyclophosphamide, vincristine, adriamycin and actinomycin D were performed. There has been no recurrence as of 2 years and 4 months after the operation. We reviewed the 5 other cases of malignant fibrous histiocytoma arising from the renal capsule.     

Bilateral renal cell carcinoma: report of a case

A case of asynchronous bilateral renal cell carcinoma is reported. The patient was a 71-year-old man who visited our clinic with complaints of asymptomatic macrohematuria and fever on November 20, 1960. Clinical diagnosis was left renal tumor and left nephrectomy was performed on December 4, 1960. Histological diagnosis was renal cell carcinoma (common type, clear cell subtype, alveolar type and G1). The postoperative course was uneventful until complaints of diarrhea and weight loss in November, 1983. He visited our clinic again with a right abdominal mass on January, 1984. Right renal selective angiography revealed an enlargement and abnormal vascularity with tumor stain, hypervascularity and pooling in the whole kidney except for the upper pole lesion. CT scan revealed a space occupying lesion. Right radical nephrectomy was performed on March 6, 1984. Histological diagnosis was renal cell carcinoma (common type, mixed subtype, alveolar and tubular type, G2). He was treated by hemodialysis and steroid therapy after right nephrectomy but he died of massive gastro-intestinal bleeding on April 22, 1984. The paper is the 15th report of a bilateral renal cell carcinoma in Japan.     

Perinephric liposarcoma mimicking cystic renal tumor

Liposarcoma is one of the most common primary retroperitoneal neoplasms, and the perinephric region is a frequent location for them. Liposarcomas show a variety of radiographic features in terms of histological types and tumor sizes, so the specific diagnosis of liposarcoma is often difficult. We present a unique case of perinephric dedifferentiated liposarcoma mimicking cystic renal tumor. A 71-year-old man presented himself at our hospital with a palpable mass in his upper right abdomen. Abdominal computerized tomography (CT) revealed a well-defined cystic mass at the lower pole of the right kidney that contained heterogeneous solid components and small foci of fat. There were no signs of lymphadenopathy or tumor thrombus in the renal vein. Metastatic evaluation by chest x-ray and bone scan was negative. The probable diagnosis was cystic renal cell carcinoma or atypical angiomyolipoma. Because we could not exclude the possibility of cystic malignancy, a right radical nephrectomy was performed. Grossly, the tumor was predominantly encapsulated by a unilocular fibrous capsule and was filled with bloody fluid and debris. The anterior portion of the tumor was composed of various-sized soft and rubbery masses covered with necrotic tissue. The histological diagnosis was dedifferentiated liposarcoma arising in the perinephric retroperitoneum with extensive necrosis, and the cyst wall was composed of a necrotic tumor with a well differentiated liposarcoma and a fibrous capsule. Although the tumor widely covered the right kidney, there was no microscopic invasion of the kidney. No signs of tumor recurrence were noted six months after the operation.     

Extraosseous osteogenic sarcoma arising from the retroperitoneum: a case report

A 44-year-old housewife with a mass in the left upper quadrant of the abdomen was admitted. The tentative diagnosis was cystadenocarcinoma arising from the pancreatic tail, as determined by CT and selective angiography. Excision of the mass with removal of the spleen, pancreatic tail, left renal capsule and surrounding lymphnodes was performed. Photomicroscopic sections revealed proliferation of malignant cells and malignant osteoids. The final diagnosis was osteogenic sarcoma arising from the retroperitoneum. Among the extraosseous osteogenic sarcoma arising from the somatic soft tissue, involvement of the retroperitoneum is rare. Only 12 cases including our own case have been reported as being of retroperitoneal origin. No patient survived for five years and in our patient, there are signs of recurrence one year after the surgery.     

The first case of renal lipoma in a child

Lipoma of the kidney is a rare benign renal tumor that previously had been reported only in adults. We present a case of this tumor in a 2-year-old boy. Serial imaging studies revealed a tumor with high fat content arising from the right kidney. Radical nephrectomy was performed for tumor excision. Macroscopically, the tumor consisted of a yellow fatty mass, which was surrounded by a thin fibrous capsule. The tumor was about 600 g, and the kidney was compressed laterally by the tumor. Microscopically, the tumor consisted of large fat cells that did not express human melanoma black-45 (HMB-45). It was diagnosed as a renal lipoma. Postoperatively, there has been no recurrence of tumor in the 10 months since the surgical excision.     

Nephron-sparing radical excision of a giant perirenal liposarcoma involving a solitary kidney

We describe our experience in a patient with a congenital solitary kidney encased by a perirenal liposarcoma managed by nephron-sparing excision. The best predictor of survival with liposarcoma is complete resection of the tumor. Generally a diffuse peri-renal liposarcoma arising within Gerota's fascia would necessitate a radical nephrectomy. Having a congenitally solitary kidney, this patient refused nephrectomy, therefore a kidney-sparing excision of his liposarcoma was attempted. To obtain negative margins and to provide a nephron-sparing excision, the capsule of the kidney was resected with the mass. Direct extension into the diaphragm necessitated an en bloc resection of 4 x 6 cm of the left hemidiaphragm. The defect was reconstructed with a Gortex patch graft. Pathology revealed a 32 x 22 x 8-cm liposarcoma with areas of sclerosing liposarcoma and poorly differentiated spindle cell sarcoma, focally Grade 3 of 3, with the remaining tumor being Grade 1. There was diaphragmatic invasion, but all surgical margins were negative. At 22 months CT follow-up, the patient has no radiographic evidence of disease. Excision of this mass with the renal capsule allowed our patient to be margin negative and maintain normal renal function. This is the only report in the literature describing nephron-sparing resection of a giant perirenal liposarcoma involving a solitary kidney.     

Malignant fibrous histiocytoma originating in a renal capsule: a case report]

We report a case of malignant fibrous histiocytoma originating in a renal capsule. A 43-year-old woman was admitted with a chief complaint of right lower abdominal pain. Physical examination was unremarkable. Serum C-reactive protein and erythrocyte sedimentation rate increased to 3.8 mg/dl and 60 mm/hr., respectively. Computed tomography (CT) and magnetic resonance image (MRI) showed a heterogeneous enhanced mass, 4 x 9 x 13 cm in size, in contact with the lateral part of the right kidney. Selective right renal arteriography revealed a hypovascular tumor, the main feeding artery of which was the right adrenal artery. Preoperative clinical diagnosis was a retroperitoneal sarcoma and transabdominal tumor resection was performed. The adhesion between the tumor and the right kidney was so severe that right nephrectomy was also necessary for a radical surgery. The tumor, measuring 13 x 9 x 6 cm, was located laterally adhering to the right renal capsule. Microscopic examination of the tumor demonstrated spindle-shaped fibroblast-like cells arranged in a storiform pattern with fibrous stroma and clusters of rounded histiocyte-like cells and pleomorphic giant cells with bizarre nuclei. Histopathological diagnosis was malignant fibrous histiocytoma arising from the renal capsule and there was no tumor invasion to renal parenchyma. No adjuvant therapy was performed but she has remained well for 31 months since the operation without evidence of disease.     

A case of renal capsular leiomyoma

A 50-year-old woman was admitted for the treatment of retroperitoneal tumor. Enhanced comtuted tomography showed a low density mass between the left kidney and psoas muscle. Magnetic resonance imaging revealed a high intensity and homogeneous mass on T1-weighted sequence, and a low intensity and heterogeneous mass on T2-weighted sequence. Surgical exploration revealed that the tumor was adherent to the left kidney and en bloc excision of the tumor and the left kidney was performed. Histopathological diagnosis was leiomyoma originating from the renal capsule.     

A case of leiomyosarcoma of the renal vein

A 54-year-old woman presented with a 6-month history of left back pain. She had undergone left mastectomy for breast cancer in 1993 and hysterectomy for cervical cancer in 1997. Excretory urography showed no abnormality in the left collecting system, but right hydronephrosis caused by a midureteral stone. She was treated by transurethral ureterolithotripsy first. Computerized tomography showed a 4 x 3 cm. mass enhanced slightly by contrast medium at the left renal hilus. The tumor was bordered laterally by the left kidney and posteriorly by the left renal vein which appeared normal on magnetic resonance imaging. Selective left renal angiography revealed no abnormality. Radical en bloc excision of the tumor with the left kidney and adrenal gland was performed. Pathological examination showed a well differentiated leiomyosarcoma arising from the renal vein; the tumor cells stained positive for alpha-smooth muscle actin, vimentin and desmin and negative for S 100-protein. She was free of symptoms and there was no evidence of local recurrence or distant metastases 22 months postoperatively.