Gastrointestinal stromal tumor of the stomach mimicking adrenal tumor: a case report

A gastrointestinal stromal tumor of the stomach mimicking an adrenal tumor in a 67-year-old woman is reported. The patient sought medical attention for left flank pain in December 2001. A spherical calcification was evident in the left hypochondrium in an abdominal radiography, and computed tomography revealed a mass 8 cm in diameter at the upper pole of the left kidney. She then was admitted to our hospital. Physical examination and laboratory screening showed hypertension, diabetes mellitus and slight hemoconcentration. Endocrine examination showed normal serum adrenal hormone concentrations. Magnetic resonance imaging again demonstrated the mass, which showed enhancement along its margins after intravenous contrast administration. With a preoperative diagnosis of adrenal tumor, we performed total resection. The pediculated tumor, arising from the stomach, showed c-kit immunohistochemical staining permitting a histopathological diagnosis of gastrointestinal stromal tumor.     

Pseudo kyste géant de la surrénale, à propos d'une nouvelle observation

IntroductionAdrenal pseudocysts are rare benign lesions. Mostly, these are small lesions discovered incidentally by imaging. The giant forms are rare. Through a new observation, we describe the different epidemiological, clinical, pathological features and treatment of this entity.ObservationA patient of 52 years old, without notable medical history, suffered left flank pain associated with bilious vomiting of 15 days duration. Abdominal examination revealed a voluminous mass at the left hypochondrium. Imaging revealed a huge heterogeneous mass, located between the spleen and kidney, compressing adjacent organs. Given the diagnostic difficulty, a laparotomy was undertaken to excise the mass. Histological examination revealed a giant benign adrenal pseudocyst.CommentGiant adrenal pseudocysts are very rare. Clinical and radiological signs are not specific. Only pathological study can confirm the diagnosis and exclude malignancy. The treatment is based on surgery for large or symptomatic cysts.     

Case of radiation treatment in retroperitoneal hemangiopericytoma

A 48-year-old woman came to our hospital with complaint of macroscopic hematuria and left lower abdominal pain, on January, 27, 1982. She complained of lower abdominal oppressive pain, but no abdominal tumor was palpated on physical examination. Vaginal examination revealed a stony hard and nodular tumor which was not movable, and as large as a man's fist, on the left side of uterine cervix. IVP revealed left nonfunctioning kidney. Cystoscopy revealed no abnormal finding but left ureteral catheterization could not be done. CTscan revealed intrapelvic homogenous mass which could not be identified from uterus. Pelvic angiography revealed an encasement of the left uterine artery, and moderate hypervascular tumor which deviated the obturatorius artery. Under the diagnosis of retroperitoneal tumor, operation was done on March, 8, 1982. The tumor existed in the retroperitoneal space, and was as large as a man's fist. It was not a movable mass, venous dilatation was found on its surface, and severe adhesion was found between the lateral side of the tumor and the left external iliac artery. So only biopsy was done. Histopathological diagnosis of the specimen was hemangiopericytoma. She received postoperative radiation therapy with total dose 5,000rad in 5 weeks. Now about 2 years have passed, vaginal examination revealed no tumor, and CTscan revealed diminishment of the tumor. Generally radiotherapy is not considered to be effective for hemangiopericytoma, but sometimes it is. Thus preoperative vascular embolization with surgical resection and postoperative radiotherapy or chemotherapy are considered to be necessary for successful treatment of hemangiopericytoma.     

Burned-out testicular tumor: a case report

A 29-year-old man was referred to our hospital with loss of appetite and a left lower abdominal mass. A small nodule was palpable in his left testis and ultrasonographic examination demonstrated that the nodule was low echoic. Computed tomography showed a large mass in his left retroperitoneal space. We thought the mass was a metastatic lesion from a testicular tumor. Left orchiectomy was done and microscopic examination revealed no viable tumor cells. Only fibrous tissue, small calcified areas, and hyaline bodies were found. As tumor markers were normalized after 3 courses of chemotherapy with bleomycin, etoposide, and cisplatine, the retroperitoneal mass was removed with the left kidney. It consisted of embryonal carcinoma, mature teratoma, and yolk sac tumor. One course of adjuvant chemotherapy was done and the patient has since been free from recurrence. We suppose that the tumor was a so-called 'burned-out' testicular tumor.     

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.     

Metanephric Adenoma Treated with Laparoscopic Nephrectomy

A 31-year-old-female presented with a left renal mass detected incidentally during an abdominal ultrasound examination. Computed tomography and angiography revealed a hypovascular solid tumor 4.5 cm in diameter at the middle portion of the left kidney. Laparoscopic left nephrectomy was performed and macroscopic examination of the specimen revealed encapsulated tumor with grayish yellow cut surface. Histological examination demonstrated that the tumor cells were small scant cytoplasms, containing round and regular nuclei, forming a glomerular-like structure. There was no mitosis nor cellular atypia indicating a malignant structure. The histological diagnosis was metanephric adenoma.     

Bilateral renal cell carcinoma: report of two cases

Two cases of bilateral renal cell carcinoma are reported. The first case is of a 54-year-old male who visited our hospital on March 7, 1984 complaining of colicky pain in his left flank. Intravenous urography showed a large mass in the upper pole of the left kidney causing deformity and dislocation of the upper calyces. There were no remarkable findings in the right kidney. Abdominal CT-scan and arteriography revealed a round and hypervascular tumor with soft tissue mass density in the upper pole of both kidneys. Nephrectomy of the left and segmental resection of the upper pole of the right kidney were performed on April 11, 1984. The second case is a 47-year-old male who visited our hospital complaining of total gross hematuria. Intravenous urography showed a large soft tissue mass at the lower pole of the left kidney. Abdominal CT-scan revealed a large tumor mass associated with central necrosis in the left kidney and also a small tumor lesion at the center of the contralateral kidney. Bilateral nephrectomy was performed on December 19, 1984, and the patient was referred to hemodialysis treatment. The cut section of the nephrectomized right kidney specimen revealed multiple minor accessory tumors. Both patients have been doing well without any evidence of recurrence or metastasis.     

A case of perirenal encysted hematoma secondary to renal cell adenocarcinoma

Herein we report a case of perirenal encysted hematoma secondary to renal cell adenocarcinoma. A 57-year-old woman was hospitalized because of a palpable mass in the left flank. She had had an episode of left flank pain. X-ray studies demonstrated a tumor in the left kidney and a large cystic mass beneath the left kidney. The cyst was excised by nephrectomy. Histological examination of the large cyst revealed perirenal encysted hematoma secondary to renal cell adenocarcinoma. Six months postoperatively, she is now free from left lumbar pain, and alive with lung and liver metastasis.     

A case of renal cell carcinoma in a horseshoe kidney

A-50-year-old patient visited our hospital to have further examination for left renal mass. Drip infusion pyelography revealed a cluster of calculi in the upper pole of the left kidney. Computed tomography and magnetic resonance imaging revealed a heterogeneous mass on the left side of a horseshoe kidney. Left nephrectomy was performed through an abdominal transperitoneal approach. An operation for dividing isthmus was simultaneously done using a microwave tissue coagulator. Histopathological findings showed grade 1 > 2, pT1aN0M0, clear cell subtype, renal cell carcinoma. Convalescence was uneventful and the patient was free of tumor at one year postoperatively.     

Systemic non-Hodgkin lymphoma initially presented with visual disturbance due to intrasellar lymphoma--a case report

A case with systemic non-Hodgkin lymphoma involving the sella turcica and kidney is reported. A 69-year-old man presented with a progressive two month history of visual disturbance and headache. Neurological examination revealed bilateral visual disturbance and right optic atrophy. MRI showed a contrast-enhancing mass in the sella turcica. The tumor extended to the right optic nerve. Without extensive studies for systemic disease, the patient immediately underwent transsphenoidal surgery. The slightly firm, fibrous and vascular-rich tumor was subtotally removed. The histopathological examination revealed a malignant lymphoma, diffuse-large-cell type with B-cell phenotype. The postoperative course was uneventful and the patient's symptoms subsided gradually. The patient received radiation therapy and the tumor disappeared. Postoperative CT examinations of the abdomen and pelvis revealed a large mass at the upper portion of the left kidney. Ga-scan also suggested the mass to be consistent with the abdominal CT. However, the patient suddenly died of acute heart failure with unknown cause just before starting chemotherapy for systemic lymphoma. Patients presenting primary central nervous system lymphoma (PCNSL) may have systemic non-Hodgkin lymphoma. To exclude systemic non-Hodgkin lymphoma, systemic investigation is essential for the initial management of patients presenting PCNSL.     

A case of renal cell carcinoma found in traumatic ruptured kidney

A case of traumatic kidney rupture with pre-existing renal cell carcinoma in a 38-year-old male is reported. Macrohematuria appeared 48 hours after left precordial trauma in a traffic accident. Initial diagnosis at the emergency clinic was 9th rib fracture of his left chest alone and no other injury was recorded. A large mass in left abdomen was palpable at urologic OPD, however, and X-ray examination revealed a non-visualizing left kidney in IVP. After the ECHO, CT and arteriography findings gave an impression of left kidney rupture. Left nephrectomy accompanied by partial colectomy of descending colon by transperitoneal approach was performed 25 days after initial trauma. This delay was mainly due to disagreement of patient for surgical treatment because there were no subjective symptom except microhematuria and subsiding fever after transfer to the urologic section. En bloc removed specimen showed ruptured kidney with adhesiveness laterally to descending colon and harder core portion was found in midst of renal mass. Coronal slice of the specimen exhibited a renal parenchymal tumor with necrotic spots. Pathologic findings were complete kidney rupture in upper pole and clear cell type renal cell tumor was found in mid and lower pole. Also lymph nodes which obtained from left renal pedicle and para aortic margin proved no metastasis of tumor cell. Post operative clinical course was favourable without any recurrence for 15 months after surgery. Clinical incidence of type I and type II kidney trauma with pre-existing neoplastic change is considerably high, but the kidney ruptured case bearing renal cell carcinoma as a core shape is very rare.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case of xanthogranulomatous pyelonephritis probably derived from a renal injury

A 56-year-old women was admitted for examination of glycosuria. She had had a blunt trauma onto the left abdomen 2 years ago that could have caused renal injury. Incidentally a left renal mass was detected by ultrasonography as a low echogenic mass. CT scan revealed a 2.5 X 2.5 cm mass with lower density than the kidney. IVP and renal angiography showed no abnormal findings. Under the diagnosis of renal tumor, left nephrectomy was performed. A 2 X 2 cm butter-yellow tumor, was seen in the renal parenchyma including the renal capsule of the upper and lateral part of the kidney. The renal pelvis was normal and there were no suppurative lesions in the kidney. Histopathological diagnosis was xanthogranuloma of the kidney partly containing a subcapsular hematoma. The previous blunt trauma, presence of hematoma and no evidence of suppurative lesions suggested that the etiology of xanthogranuloma in this case was related to renal injury.     

A case of retroperitoneal venous aneurysm]

A case of retroperitoneal venous aneurysm is reported. A 73-year-old woman was referred to us with the chief complaint of left abdominal mass. A giant abdominal mass was palpable and diagnostic imaging examination including ultrasound tomography, excretory pyelography, computed tomography, magnetic resonance imaging and angiography revealed a giant cystic mass encircled by calcification in the left retroperitoneal space. Operation for this cystic mass was performed under the preoperative diagnosis of a giant left renal cyst. During operation the mass was located between the left kidney and the left adrenal gland. Because it was difficult to separate the mass from the left kidney the mass was removed with the left kidney. The extirpated tumor measured 15.5 x 15.0 x 9.5 cm and contained old blood clots and red-yellow colored fluid. A histological examination revealed that the tumor wall was composed of smooth muscle and elastic fibers. Therefore, pathological diagnosis was retroperitoneal venous aneurysm. Retroperitoneal venous aneurysm is very rare. To our knowledge, this is the 8th case of retroperitoneal venous aneurysm reported in Japan.     

Two cases of retroperitoneal functioning paraganglioma

We report two cases of retroperitoneal functioning paraganglioma. Case 1: A 52-year-old male patient was admitted to our hospital for further examination of pulsating abdominal pain with chest pain and headache. Overfist-size smooth-surfaced hard mass was palpated at the right upper abdominal quadrant. Catecholamine levels in serum and urine showed marked elevation. Computed tomographic (CT) scan, magnetic resonance imaging (MRI) and angiography revealed a large tumor between the right kidney and aorta. He underwent surgical removal of the tumor and histological examination revealed paraganglioma. His chief complaints disappeared postoperatively. Case 2: A 68-year-old female patient was admitted to our hospital for control of diabetes. An abnormal mass was shown ultrasonically at the left renal region by routine screening examination. A marked increase of noradrenaline in serum and urine was observed. Abdominal CT scan, MRI and angiography revealed a retroperitoneal tumor which was located adjoining to the lower pole of the left kidney. The tumor was removed transabdominally. Histopathological studies showed paraganglioma. After the operation her blood sugar and noradrenaline levels decreased to the normal range.     

Adrenal myelolipoma: report of a case

We report a case of adrenal myelolipoma occurring in a 56-year-old man. The patient complained of lumbago and gross hematuria in October, 1981 and consulted a local doctor who pointed out a right ureteral stone and downward deviation of the left kidney. The patient was referred to our hospital for further examination. An echogram showed a high echogenic mass in the left flank which was compressing the spleen and the kidney. A CT scan revealed a large mass with heterogeneous low density contents. The mass was lobulated into several parts and their density suggested fat tissue. An aortogram showed an avascular mass and an adrenal venogram showed multiple veins which radiated to the periphery. Judging from these findings, a tentative diagnosis of adrenal myelolipoma was made and left adrenalectomy was performed. Histological examination revealed that this tumor was composed of adrenal tissues, fatty tissues and myeloid tissues. The postoperative course was uneventful. We discuss the necessity of aortography and selective adrenal venography to evaluate the origin of the tumor. To our knowledge, this is the tenth case report of adrenal myelolipoma in Japan and we have made a brief review of Japanese literature of adrenal myelolipoma.     

Retroperitoneal liposarcoma: a report of 2 cases and review of 163 cases in Japan

Two cases of retroperitoneal liposarcoma are reported. Case I was a 71-year-old-male presenting with a mass in the left abdomen. On X-ray examination, a large extrarenal tumor was found in the left retroperitoneal space. The tumor appeared to invade the psoas muscle and the aorta. Exploratory laparotomy was carried out. The histological diagnosis of the tumor was myxoid-type liposarcoma. He died of the disease. Case 2 was a 44-year-old-male who presented with a mass in the left abdomen. On X-ray examination, a large tumor was found in the left retroperitoneal space, and left kidney and the descending colon were markedly displaced by the tumor. Excisional surgery was carried out. The tumor was almost completely removed. The histological diagnosis was myxoid-type liposarcoma. A combination chemotherapy (actinomycin D, vincristine, cyclophosphamide) was started. but soon switched to radiation therapy because of liver dysfunction. Four months following the operation, there is no evidence of residual disease. One hundred sixty three cases of retroperitoneal liposarcoma reported in Japan are reviewed.     

Large expanding splenic pseudocyst: A case report and review of literature

Introduction and importanceSplenic pseudocysts are extremely uncommon. Most of these cysts are asymptomatic and may result from previous blunt abdominal trauma. We report an interesting uncommon case of large splenic pseudocyst without history of previous abdominal trauma.Case presentationA 56 year old male patient, presented with symptoms of pain in the left side of middle back and discomfort in the left hypochondrium for few months. His physical examination was unremarkable. The abdominal Ultrasound and contrast-enhanced Computed tomography showed a large splenic cyst occupying most of the splenic parenchyma. Echinococcus multilocularis antibody test was negative. The differential diagnosis of this case included non-parasitic splenic cysts. The patient underwent elective exploratory laparoscopy which was converted to laparotomy with total splenectomy. Histopathological examination of the specimen revealed a splenic pseudocyst.Clinical discussionThe splenic cyst in this case was symptomatic due to its large size. It was hard to elicit an etiology as there was no history of abdominal trauma, infection, or degenerative disease. The main factors in selecting either conservative or radical surgical approach for such cases are the cyst location, cyst size, and the residual splenic parenchyma.ConclusionThe goal of splenic pseudocysts treatment is to relieve symptoms and avoid complications. Partial splenectomy is the recommended procedure when the size and location of the cyst allow preservation of at least 25% of splenic parenchyma. Otherwise, Total splenectomy is unavoidable.     

Case of leiomyosarcoma of the renal pelvis

A 54-year-old man presented at the Mibayashi clinic with bowel discomfort. Ultrasonography showed a left renal mass and the patient was referred to Noto General Hospital for urological evaluation. Results of the physical examination were unremarkable, but computed tomography and magnetic resonance imaging demonstrated a large tumor in the middle of the left kidney. The patient underwent left nephrectomy. On hemisection of the kidney, a firm tumor, measuring 8 x 7.5 cm, was seen occupying the renal pelvis. The histological diagnosis was leiomyosarcoma arising from the right renal pelvis. No treatment was provided after surgery and no recurrence was observed 6 months postoperatively.     

Inguinal lymph node metastasis of seminoma 18 years after initial treatment: a case report

Late relapse of testicular tumor is rare. We report a case of recurrence of seminoma at left inguinal lymph node 18 years after initial treatment. A 63-year-old man had a left orchiectomy for left testicular tumor (T1N0M0) in February 1985, with no past history of scrotal or inguinal surgery. Histological examination revealed seminoma (pT1), and prophylactic radiotherapy (34.2 Gy) to para-aortic and left hemi-pelvic regions was perfomed. In November 2003, the patient presented with left inguinal swelling, and was referred to our hospital with suspicion of metastasis to left inguinal lymph nodes. Serum markers (AFP, hCG, hCGbeta and LDH) were normal. Computerized tomography (CT) showed three masses in the left inguinal region, but no other abnormal mass was detected at chest, abdomen or pelvis. Lymphoidectomy of the left inguinal region was perfomed in January 2004, and the mass revealed to be metastasis of seminoma by histological examination.     

Metastatic renal tumor from esophageal carcinoma

A 65-year-old woman, who had undergone total esophagectomy for cancer one year prior to admission, noted asymptomatic gross hematuria. Therefore, she was referred to our department in July, 1983. Physical examination revealed a hard, irregular and nontender mass in the left upper abdomen. Excretory urography revealed a space-occupying lesion in the lower pole of the left kidney. Selective renal angiography revealed a hypovascular mass and encasement of the renal artery. Percutaneous renal artery embolization was performed two weeks prior to nephrectomy. At surgery, the left kidney was adhered to the surrounding tissue and it was hard to dissect. Paraaortic lymph nodes were swollen and a couple of them were biopsied. The histopathological report of the tumor was squamous cell carcinoma. The patient was treated with systemic chemotherapy, but the postoperative course was poor and the patient emaciated gradually. She did ten weeks after operation and autopsy was refused. Metastases of malignant tumor to the kidney are rarely encountered in clinical cases and, to our knowledge, this case seems to be the forth metastatic renal tumor from esophageal cancer in the Japanese literature.