Indian Journal of Urology
CASE REPORT
Year
: 2003  |  Volume : 20  |  Issue : 1  |  Page : 62--63

Hemangiopericytoma of pelvis: A case report


Vishwajeet Singh, M Raghavendran, Rakesh Kapoor 
 Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Correspondence Address:
Rakesh Kapoor
Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014
India




How to cite this article:
Singh V, Raghavendran M, Kapoor R. Hemangiopericytoma of pelvis: A case report.Indian J Urol 2003;20:62-63


How to cite this URL:
Singh V, Raghavendran M, Kapoor R. Hemangiopericytoma of pelvis: A case report. Indian J Urol [serial online] 2003 [cited 2020 Aug 10 ];20:62-63
Available from: http://www.indianjurol.com/text.asp?2003/20/1/62/37129


Full Text

 Case Report



A 40-year-old female presented with recurrent suprapu­bic and right flank pain, dysuria and mild hematuria for 3 months. She had a history of total abdominal hysterec­tomy for dysfunctional uterine bleeding one and half years earlier. Her general physical examination revealed right lower limb lymphedema. Abdominal examination showed an 8x8 cm hard, irregular pelvic mass. On per vaginal examination, a hard, mild tender mass was felt on the right side of the vaginal vault and per rectal examination re­vealed a hard, nodular, extraluminal mass. The ultrasound of abdomen showed a 7.9x8.2x8.0 cm. mass of mixed echogenicity lying posterolateral to the urinary bladder with gross hydroureteronephrosis on the right side. The CECT scan of the abdomen and pelvis [Figure 1] showed a 9.7x5.9x13 cm moderately enhancing heterogenous mass arising from the pelvis posterior to the urinary bladder. 99m Tc DTPA scan showed a very poorly functioning right kidney and a normal left kidney. Fine needle aspiration cytology of this mass revealed mesenchymal neoplasm. Cystopanendoscopy showed the bulging of the posterior wall of the urinary bladder. There was no other associated finding. On exploratory laparotomy, a densely adherent retroperitoneal mass was present between the bladder and rectosigmoid with right gross hydroureteronephrosis. The mass was resected almost completely with right nephrou­retrectomy. The histopathological examination of tumor mass showed tightly packed small spindle cells distrib­uted around small, thin walled, compressed irregular en­dothelium lined vascular channels. Occasional, less than 4 mitotic figures/10 hpf, were seen [Figure 2]. Immunohis­tochemical stain was suggestive of hemangiopericytoma. The right kidney had changes of chronic pyelonephritis. At one-and-half-year follow-up there was no evidence of regrowth.

 Comments



Clinically, hemangiopericytoma usually presents as a painless growing mass. However pain may result from pressure upon adjacent nerves. [1] Hemangiopericytoma of pelvis may cause urinary symptoms, hydroureteronephro­sis or even urinary retention. [2] In some cases dysuria hematuria or constipation are reported. [1] The hemangio­pericytoma is a vascular tumor, but differentiating heman­gipericytoma from other richly vascular soft tissue neoplasms remains a diagnostic dilemma. [2] Positive im­munohistochemical staining of tumor biopsy with factor 8-R Ag is suggestive of but not specific for hemangio­pericytoma. [3] There have been great problems in formulating reliable criteria for distinguishing malignant and benign hemangiopericytoma. [1] Enzinger and Smith de­scribed the characteristic features of the malignant form as increased cellularity, prominent mitotic activity and foci of hemorrhage and necrosis. Local and distant recurrences are seen in 19-52% cases. [1] All resectable hemangio­pericytoma should be treated with wide local excision. Radiotherapy and chemotherapy have traditionally been reserved for non-resectable and metastatic diseases. Hemangiopericytoma is a diagnosis of exclusion and sur­gical resection is the only method of achieving cure. [2] Hemangiopericytoma is often a painless tumor. The pres­entation with pain and urological symptoms are uncom­mon. [1] In our patient the histopathological examination showed few mitotic figures, suggesting benign nature of the tumor. If residual tumor is left, it usually does not cause any problem.

References

1Hobarth K, Hofbauer J, Wrba F. Malignant hemangiopericytoma of the pelvis. Report of a case with urological implications and im­munohistochemical analysis. Urol Int 1991; 47: 94.
2Rosenblatt SG. Walsh JC, Basile JJ. Pelvic hemangiopericytoma in a patient with mixed germ cell tumor of the testis. J Urol 2001; 166: 1824-1825.
3Pandey M, Kothari KC. Patel DD. Hemangiopericytoma: current status, diagnosis and management. Eur J Surg Oncol 1997; 23: 282.