|Year : 2001 | Volume
| Issue : 1 | Page : 69-70
Bilateral cystic presentation of renal malignant fibrous histiocytoma
Sanel Varghese Chandapillai, Prakash Sharma, George P Abraham
Department of Urology, Medical Trust Hospital, Cochin, India
Sanel Varghese Chandapillai
Department of Urology, Medical Trust Hospital, M.G. Road,Cochin - 682 017
Source of Support: None, Conflict of Interest: None
| Abstract|| |
We report on a 53-year-old male patient with malignant fibrous histiocytoma of the kidney.
This malignant mesenchymal tumor presented as a large mass lesion arising from the upper pole of the right kidney. Indistinguishable clinically and radiologically from a renal cell carcinoma, a few unusual. features were the predominantly cystic areas interspersed with non-central calcification and complex cyst of the contralateral kidnei:.
The dilenuna of adjuvant therapy after radical nephrectomy continues.
Keywords: Renal M.F.H; Bilateral Renal Cysts
|How to cite this article:|
Chandapillai SV, Sharma P, Abraham GP. Bilateral cystic presentation of renal malignant fibrous histiocytoma. Indian J Urol 2001;18:69-70
| Introduction|| |
Though malignant fibrous histiocytoma is considered the most common soft tissue sarcoma of adult life, primary involvement of the kidney is quite rare. Less than a dozen cases of tumour arising from the kidney have been reported the world over. Herein we describe an additional patient with primary malignant fibrous histiocytoma, who had a bilateral cystic presentation.
| Case Report|| |
A 53-year-old male patient presented with dull aching pain in right loin of 13 months' duration and a mass since one month. On examination an ill-defined right renal mass was palpable. Routine urine analysis, hematologic and biochemical investigations were normal. Ultrasound and CT scan of abdomen revealed a large mass lesion arising from the upper pole of the right kidney.
Cystic areas interspersed with non-central calcification. No regional lymph nodes or involvement of adjacent vascular structures. The left kidney also showed areas of what appeared to be complex cysts. Right radical nephrectomy was made through a transperitoneal thoracoabdominal approach. At surgery it was a very large 15cm x 10cm x 8cm tumour adherent to the under surface of the right lobe of the liver and hepatic vessels. There were no regional lymph nodes or venous thrombosis.
| Results|| |
Microscopically the tumour was composed of spindle cells in a storiform pattern with mitosis, typical of Malignant Histiocytoma. Patient was advised locoregional radiotherapy and follow-up for the cysts of the left kidney. Patient has had no regional or distant metastasis after 3 months.
Patient did not agree for further evaluation of the left renal complex cysts.
We advised the patient postoperative radiotherapy. However, patient did not receive it, due to differing opinion on its effectiveness on consultation at Tata Cancer Hospital, Mumbai.
| Discussion|| |
Malignant fibrous histiocytoma is considered the most common soft tissue sarcoma of late adult life, especially of the limbs. A review of literature however reveals less than a dozen cases of primary renal fibrous histiocytoma reported worldwide. The histological hallmark is a "storiform" arrangement of spindle cells with admixtures of histiocyte-like cells, while the presence of marked nuclear pleomorphism and numerous mitoses including atypical forms indicate malignant behaviour.
This tumour could not be differentiated clinically or radiologically from renal carcinoma in a greater number of the previously reported cases. It was the same in this reported case, though the peculiar feature of predominantly bilateral cystic lesions was observed.
The right kidney showed a large renal tumour with areas of cysts and peripheral calcification. Uninvolved lower polar region appears compressed by the tumour and the opposite kidney shows complex cysts.
Singh et al reported synchronously occurring malignant fibrous histiocystoma of the kidney with contralateral renal cell carcinoma.
The present case would perhaps be the second such reported case of malignant fibrous histiocytoma with contralateral complex renal cyst.
Malignant fibrous histiocytoma has a strong predilection for local recurrence and lung metastasis, though our patient had no recurrence 3 months after surgery. As a consequence of the very few cases worldwide, the role of adjuvant modality remains controversial, though postoperative radiotherapy has been found beneficial. However the prognosis remains poor.
| References|| |
|1.||Weiss S, Ebenezer FM. Malignant Fibrous Histiocytoma- An analysis of 200 cases. Cancer 1978; 41: 2250-2266. |
|2.||Scriven RR, Thrasher TV, Smith DC. Stewart SC. Primary Renal Malignant Fibrous Histiocytoma: Case report and literature review. J Urol 1984; 131: 948. |
|3.||Osamura RY, Watanabe K, Yoneyama Hayashi. MFH-pathology. Virchows Arch Path Anat 1978: 380: 327. |
|4.||Habib W. Gislason GJ. Malignant Histiocytic tumor of the kidney. Cancer 1965; 94: 208. |
|5.||Singh EO. Barrett DM, Adams VI. Synchronously Occurring Malignant Fibrous Histiocytoma of the kidney with contralateral renal cell carcinoma. J Urol 1982; 128: 586-588. |
|6.||Raghavaiah NV, Mayer RE Hagitt R, Soloway MS. Malignant Fibrous Histiocytoma of the kidney. J Urol 1980: 123: 951-953. |
[Figure - 1], [Figure - 2]