|Year : 2001 | Volume
| Issue : 2 | Page : 172-173
Giant renal tumour: Leiomyosarcoma
Girdhar Gopal Gupta, Dharm Raj Singh, Anila Korula, Sanjeev Mehrotra, Nitin S Kekre
Departments of Urology & Histopathology, Christian Medical College & Hospital, Vellore, India
Nitin S Kekre
Department of Urology, Christian Medical College & Hospital, Vellore (Tamil Nadu) - 632 004
Source of Support: None, Conflict of Interest: None
| Abstract|| |
We report a case of a young adult with an enormous mass lesion arising from the left kidney. His performance status was good despite severe constitutional symptoms. Radical nephrectomy was performed and histopathologically it turned out to be an leiomyosarcoma. He made a good recovery. Surgical extirpation should be carried out to palliate the symptoms specially in young patients even though the prognosis is poor provided the patient has good performance status.
Keywords: Renal Tumours; Sarcoma; Leiomyosarcoma
|How to cite this article:|
Gupta GG, Singh DR, Korula A, Mehrotra S, Kekre NS. Giant renal tumour: Leiomyosarcoma. Indian J Urol 2001;17:172-3
| Case Report|| |
A 44-year-old male presented with gradually increasing abdominal mass of 6-months' duration associated with severe constitutional symptoms in the form of significant loss of weight, appetite, breathlessness and difficulty in sitting and walking due to marked distention of abdomen. There was no history of haematuria or flank pain. Physical examination revealed moderate pallor and bilateral pedal oedema. Abdominal examination showed a huge non-tender, firm mass occupying all the quadrants of the abdomen - more on left side. Renal parameters were normal. CT scan showed 27 x 22 X 27 ems heterogenously enhancing mass from left kidney [Figure - 1] with areas of calcification involving left renal vein adherent to left colon and hilar lymphadenopathy. Metastatic work-up was negative. Decision of surgical intervention was taken to palliate his symptoms. After adequate preoperative preparation, radical nephrectomy with left hemicolectomy was performed. Postoperative period was uneventful. Biopsy revealed high grade leiomyosarcoma of the kidney [Figure - 2] involving hilar lymphnodes. Tumour weighed 7 kgs. Immunocytochemistry for smooth muscle actin and vimentin showed strong cytoplasmic and membrane reactivity but was negative for cytokeratin. Patient is doing well at 6 months' follow-up.
| Comment|| |
Renal leiomyosarcoma are rare tumours of the kidney, first reported by Berry.  Till 1997 11 cases have been reported in English literature.  These tumours originate from renal capsule or smooth muscle fibres of renal pelvis or vessels. Common age of onset is 5 th to 8 th decade. Commonest symptoms are flank pain, haematuria, abdominal mass and other constitutional symptoms may or may not be present. Ultrasound and CT scan reveal solid mass in the kidney not distinguishable from renal cell carcinoma. Pathologically this tumour mimics sarcomatoid variety of Renal Cell Carcinoma. Immunohistochemical staining helps in differentiation. Surgery in the form of radical nephrectomy remains the treatment of choice. Pre- and post-operative radio and chemotherapy do not effect the overall survival. , These patients have poor prognosis and rarely survive longer than one year.
This case is reported due to its rare occurrence and to highlight the role of surgical intervention in improving the quality of life even in those patients with large and locally advanced but resectable tumours.
| References|| |
|1.||Berry FB. Report of three cases of combined tumours of the kidney in adults. J Med Res 1919: 40: 459. |
|2.||Chen JH, Lee SK. Renal leiomyosarcoma mimicking transitional cell carcinoma. AJR 1997: 169: 312-313. |
|3.||Thirurnavalavan VS. Kennedy CL, Alrufaie HK. Leiomyosarcoma of kidney. Br J Urol 1991: 68: 659-660. |
|4.||Vogelzang NJ, Fremgen AM, Guinan PD. Primary renal sarcomas in adults. Cancer 1993: 71: 804-810. |
[Figure - 1], [Figure - 2]