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Wang XT, Fang R, He HY, Zhang W, Li Q, Sun SA, Wang X, Zhang RS, Teng XD, Zhou XJ, Xia QY, Zhao M, Rao Q. Recurrent Tuberous Sclerosis Complex/Mammalian Target of Rapamycin Mutations Define Primary Renal Hemangioblastoma as a Unique Entity Distinct From Its Central Nervous System Counterpart. Am J Surg Pathol 2024:00000478-990000000-00309. [PMID: 38501656 DOI: 10.1097/pas.0000000000002211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
ABSTRACT Renal hemangioblastoma (HB) is a rare subset of HBs arising outside of the central nervous system (CNS), with its molecular drivers remaining entirely unknown. There were no significant alterations detected in previous studies, including von Hippel-Lindau gene alterations, which are commonly associated with CNS-HB. This study aimed to determine the real molecular identity of renal HB and better understand its relationship with CNS-HB. A cohort of 10 renal HBs was submitted for next-generation sequencing technology. As a control, 5 classic CNS-HBs were similarly analyzed. Based on the molecular results, glycoprotein nonmetastatic B (GPNMB) immunohistochemistry was further performed in the cases of renal HB and CNS-HB. Mutational analysis demonstrated that all 10 renal HBs harbored somatic mutations in tuberous sclerosis complex 1 (TSC1, 5 cases), TSC2 (3 cases), and mammalian target of rapamycin (2 cases), with the majority classified as pathogenic or likely pathogenic. The CNS-HB cohort uniformly demonstrated somatic mutations in the von Hippel-Lindau gene. GPNMB was strong and diffuse in all 10 renal HBs and completely negative in CNS-HBs, reinforcing the molecular findings. Our study reveals a specific molecular hallmark in renal HB, characterized by recurrent TSC/mammalian target of rapamycin mutations, which defines it as a unique entity distinct from CNS-HB. This molecular finding potentially expands the therapeutic options for patients with renal HB. GPNMB can be considered for inclusion in immunohistochemical panels to improve renal HB identification.
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Affiliation(s)
- Xiao-Tong Wang
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing
| | - Ru Fang
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing
| | - Hui-Ying He
- Department of Pathology, School of Basic Medical Sciences, Peking University Third Hospital, Peking University Health Science Center, Beijing
| | - Wei Zhang
- Department of Pathology, the 971 Hospital of People's Liberation Army Navy, Qingdao
| | - Qing Li
- Department of Pathology, the First People's Hospital of Changzhou, Changzhou
| | - Su-An Sun
- Department of Pathology, Huai'an First People's Hospital, Huai'an
| | - Xuan Wang
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing
| | - Ru-Song Zhang
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing
| | - Xiao-Dong Teng
- Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Xiao-Jun Zhou
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing
| | - Qiu-Yuan Xia
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing
| | - Ming Zhao
- Department of Molecular Pathology, Ningbo Clinical Pathology Diagnosis Center, Ningbo, China
| | - Qiu Rao
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing
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2
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Lee Y, Cheng SM, Hwang DY, Chiu YL, Chou YH. Polycythemia Secondary to Renal Hemangioblastoma: A Case Report and Literature Review. Int J Surg Pathol 2024; 32:140-144. [PMID: 37150964 DOI: 10.1177/10668969231171133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Secondary polycythemia is a paraneoplastic syndrome observed in tumors with excessive erythropoietin (EPO) production. Renal cell carcinoma (RCC) and cerebellar hemangioblastoma are the 2 most well-known tumors to induce secondary polycythemia. Hemangioblastomas occurring in the kidney are rare. In this work we present a case of renal hemangioblastoma that caused erythrocytosis in a 19-year-old man. We demonstrated intratumoural EPO production by immunohistochemistry, and conducted whole-exome sequencing to evaluate possible genetic alterations that reported to induce tumor-related polycythemia. In spite of an indolent clinical behavior, renal hemangioblastoma is difficult to differentiate from RCC not only clinically, but also histopathologically. Given that RCC is the most well-known renal tumor to induce erythrocytosis, the uncommon manifestation of polycythemia in renal hemangioblastoma, as shown in our case, can cause further diagnostic challenges. Renal hemangioblastoma should be listed in the differential diagnoses of renal tumors presenting with erythrocytosis, apart from the most common RCC.
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Affiliation(s)
- Yueh Lee
- Department of Anatomy and Pathology, Taipei City Hospital Heping Branch, Taipei, Taiwan
| | - Siao-Muk Cheng
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Daw-Yang Hwang
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Yen-Ling Chiu
- Graduate Institute of Medicine, Yuan-Ze University, Taoyuan, Taiwan
- Department of Medical Research, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Yueh-Hung Chou
- Department of Anatomical Pathology, Far Eastern Memorial Hospital, New Taipei, Taiwan
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3
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Kojima F, Matsuzaki I, Musangile FY, Kinoshita Y, Otani T, Abe K, Asai A, Kohjimoto Y, Kondo T, Hara I, Murata SI. Clinicopathological and molecular features of renal cell carcinomas with haemangioblastoma-like features distinct from clear cell renal cell carcinoma. Histopathology 2024; 84:539-549. [PMID: 37988260 DOI: 10.1111/his.15098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023]
Abstract
AIMS Haemangioblastomas arise in the central nervous system. Rarely, haemangioblastomas may develop in extra-neural sites, such as the kidneys. A few reported cases of renal cell carcinomas (RCCs) with haemangioblastoma-like features have exhibited both clear cell renal cell carcinoma (CCRCC)- and haemangioblastoma-like components. The clinicopathological and molecular characteristics of RCCs with haemangioblastoma-like features were analysed, focusing on VHL alterations, in comparison with CCRCCs partially resembling haemangioblastoma. METHODS AND RESULTS Four RCCs with haemangioblastoma-like features and five CCRCCs partially resembling haemangioblastoma were included. The RCCs with haemangioblastoma-like features were indolent and lacked adverse prognostic factors. All RCCs with haemangioblastoma-like features had a well-circumscribed appearance and a thick fibromuscular capsule, with fibromuscular bundles extending into the tumour to varying degrees in the three tumours. Each RCC with haemangioblastoma-like features exhibited CCRCC-like areas with indistinct tubular structures and foci of haemangioblastoma-like areas, in which vessels and short spindle cells overwhelmed tumour cells. Whereas haemangioblastoma-like areas in the CCRCCs partially resembling haemangioblastoma exhibited sparse vessels and spindle cells and distinct clear cells. The RCCs with haemangioblastoma-like features exhibited a unique immunohistochemical profile, with positive staining for inhibin-α, S100, carbonic-anhydrase-9, keratin7, and high molecular weight keratin and negative staining for (alpha-methylacyl-CoA racemase) AMACR. RCC with haemangioblastoma-like features did not display any VHL alterations, including VHL mutation, 3p LOH, and methylation of the VHL promoter region, and the two tumours harboured a likely oncogenic missense variant of MTOR (c.7280T>G). CONCLUSION The histopathological, immunohistochemical, and molecular findings suggest that RCC with haemangioblastoma-like features is a distinct entity from CCRCC.
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Affiliation(s)
- Fumiyoshi Kojima
- Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
| | - Ibu Matsuzaki
- Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
| | | | - Yuichi Kinoshita
- Department of Clinical Laboratory, Wakayama Medical University, Wakayama, Japan
| | - Toshinori Otani
- Department of Pathology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kuniko Abe
- Department of Diagnostic Pathology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Akihiro Asai
- Department of Urology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Tetsuo Kondo
- Department of Human Pathology, University of Yamanashi, Yamanashi, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Shin-Ichi Murata
- Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
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4
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Kojima F, Musangile FY, Matsuzaki I, Yorita K, Kuroda N, Nagashima Y, Murata SI. Current Knowledge and Prospects for Renal Hemangioblastoma and Renal Cell Carcinoma with Hemangioblastoma-like Features. Biomedicines 2023; 11:biomedicines11051467. [PMID: 37239138 DOI: 10.3390/biomedicines11051467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Tumors exhibiting histopathological findings similar to those of hemangioblastoma of the central nervous system (CNS-HB) rarely develop in the kidneys. Currently, renal hemangioblastoma (RHB) is considered analogous to CNS-HB; however, they differ in gross appearance, as well as immunohistochemical and molecular findings. In contrast, some renal cell carcinomas reportedly comprise distinct, clear cell renal cell carcinoma (CCRCC)- and hemangioblastoma (HB)-like areas. Initially, renal cell carcinomas with HB-like features (RCC-HBs) were considered a morphological variant of CCRCC owing to their diverse histological findings. However, the immunohistochemical and molecular findings of RCC-HBs suggest that RCC-HB is distinct from CCRCC. Additionally, one of the RCC-HBs had a focal leiomyomatous stroma and TSC2 variant, suggesting that RCC-HB and RCC with fibromyomatous stroma (RCC-FMS) might belong to the same disease entity. Therefore, we comprehensively reviewed the clinical, pathological, and molecular features of RHB, RCC-HB, and the related tumors and discussed the similarities, differences, and relationships between them. We believe that our review would serve as a foundation for further investigation on elucidating the relationship between CNS-HB, RHB, RCC-HB, and RCC-FMS.
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Affiliation(s)
- Fumiyoshi Kojima
- Department of Human Pathology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Fidele Y Musangile
- Department of Human Pathology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Ibu Matsuzaki
- Department of Human Pathology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Kenji Yorita
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hataminami-cho, Kochi-shi, Kochi 780-8562, Japan
| | - Naoto Kuroda
- Department of Internal Medicine, Kinrou Hospital, 3-2-28 Azounokitamachi, Kochi 781-0011, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University Hospital, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Shin-Ichi Murata
- Department of Human Pathology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
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5
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Chung RT, Cheung YY, Henderson ER, Linos K, Kerr DA. Extraneuraxial Hemangioblastoma: An Unusual Soft Tissue Neoplasm that Mimics More Common Entities but Carries Distinct Clinical Implications. Int J Surg Pathol 2022; 31:419-426. [PMID: 35651303 DOI: 10.1177/10668969221102560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hemangioblastoma, one of the characteristic tumors associated with Von Hippel-Lindau (VHL) disease, most often presents in the central nervous system (CNS) but can uncommonly arise in extraneuraxial, or previously referred to as peripheral, locations. Without the clinical context of known VHL disease, hemangioblastoma may not enter the differential for a soft tissue mass outside the CNS. Here, we present two patients with diagnostically challenging extraneuraxial hemangioblastoma to highlight the importance of considering this entity within the differential diagnosis of soft tissue neoplasms containing clear cells and delicate vasculature. We review the relevant diagnostic features, including a suggested immunohistochemical panel, along with the potential associated clinical implications of making this diagnosis. It is recommended that affected patients be offered genetic counseling to assess for underlying VHL disease.
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Affiliation(s)
- Robert T Chung
- 12285Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Yvonne Y Cheung
- 12285Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Radiology, 22916Dartmouth-Hitchcock Medical Center, NH, Lebanon
| | - Eric R Henderson
- 12285Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Orthopaedics, 22916Dartmouth-Hitchcock Medical Center, NH, Lebanon
| | - Konstantinos Linos
- 12285Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Pathology and Laboratory Medicine, 22916Dartmouth-Hitchcock Medical Center, NH, Lebanon
| | - Darcy A Kerr
- 12285Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Pathology and Laboratory Medicine, 22916Dartmouth-Hitchcock Medical Center, NH, Lebanon
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6
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Zhang X, Huang B, Jiang H, Wei H. Case Report: Hemangioblastoma- Like Clear Cell Stromal Tumor of the Left Lower Lung. Front Med (Lausanne) 2022; 9:836012. [PMID: 35510252 PMCID: PMC9058074 DOI: 10.3389/fmed.2022.836012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hemangioblastoma-like clear cell stromal tumor (HLCCST) is a recently reported neoplasm of the lung. Only 13 cases have been reported in four recent studies. Because HLCCST is very rare, it has not been included in the 2021 WHO classification of lung tumors. Case Presentation We report a case of HLCCST of the left lower lung in a 40-year-old female who was admitted to our hospital after pulmonary nodules were discovered. A plain chest CT scan showed a nodular high-density shadow measuring approximately 8 mm in diameter in the left lower lung. The lesion had clear borders, uneven internal density, and a low-density central vacuolar area. The left lower lung was partially resected by video-assisted thoracic surgery. Post-operative histopathologic diagnosis “hemangioblastoma-like clear cell stromal tumor” of the left lower lung. Conclusion The HLCCST is an extremely rare tumor and needs long-term follow-up after operation. Clinically, it may be easily confused with other benign and malignant tumors of the lung, and diagnosis is solely determined by histopathologic examination. This case suggests that immunohistochemical CD34 can be a strong positive marker.
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Affiliation(s)
- Xiaowei Zhang
- Department of Pathology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Bifei Huang
- Department of Pathology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
- *Correspondence: Bifei Huang,
| | - Hongquan Jiang
- Department of Thoracic Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Hangping Wei
- Department of Medical Oncology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
- Hangping Wei,
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7
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Wang X, Haines GK, Mehrotra M, Houldsworth J, Si Q. Primary hemangioblastoma of the kidney with molecular analyses by next generation sequencing: a case report and review of the literature. Diagn Pathol 2022; 17:34. [PMID: 35220972 PMCID: PMC8883690 DOI: 10.1186/s13000-022-01213-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022] Open
Abstract
Background Hemangioblastoma is an indolent mesenchymal tumor most frequently occurring in the central nervous system (CNS), but can also arise extraneuraxially, as part of Von Hippel-Lindau (VHL) disease or in sporadic tumors. Extraneuraxial hemangioblastomas occur outside the central nervous system. It includes tumors arising from the nervous paraneuraxial structures and visceral organs. Sporadic hemangioblastoma of the kidney, a rare subset of extraneuraxial hemangioblastomas, is an under-recognized renal neoplasm. There have been only 25 cases described to date in the English language literature. We report herein one additional sporadic tumor in a patient without VHL disease. Case presentation A 61 year old male presenting with gross hematuria was found to have a 3.5 cm renal mass at the lateral mid to lower pole of the left kidney on computed tomography urogram. The patient underwent a partial nephrectomy for the mass. Pathological examination showed a well-circumscribed non-encapsulated tumor composed of sheets of large polygonal cells traversed by a rich vascular network. The tumor cells showed clear to eosinophilic cytoplasm and overall bland nuclei. The diagnosis of hemangioblastoma was confirmed by positive immunostaining for alpha-inhibin, S100, neuron-specific enolase, and PAX8. No significant gene mutations, including VHL gene and copy number changes were detected in the tumor using next generation sequencing supporting the diagnosis of sporadic renal hemangioblastoma. Conclusion Sporadic renal hemangioblastoma is a rare subset of extraneuraxial hemangioblastomas. We report one such tumor in a patient without clinical or molecular evidence of VHL disease. The literature was reviewed to better understand the clinical, radiological, pathological, and molecular features of this neoplasm. The majority of renal hemangioblastomas showed positive immunostaining for PAX8, which supports the idea that the immunoprofiles of extraneuraxial hemangioblastomas can vary depending on sites of origin. Diagnosis of renal hemangioblastoma is challenging because of its rarity and overlapping microscopic and immunophenotypic features with other renal tumors, including clear cell renal cell carcinoma. In some cases, molecular or genetic studies may be necessary to obtain an accurate diagnosis. Since renal hemangioblastoma is clinically benign, recognition of this pathological entity is important to avoid unnecessary over-treatment.
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8
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Agaimy A, Stoehr R, Michal M, Christopoulos P, Winter H, Zhang L, Stenzinger A, Michal M, Mechtersheimer G, Antonescu CR. Recurrent YAP1-TFE3 Gene Fusions in Clear Cell Stromal Tumor of the Lung. Am J Surg Pathol 2021; 45:1541-1549. [PMID: 33899786 PMCID: PMC8516668 DOI: 10.1097/pas.0000000000001719] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clear cell (hemangioblastoma-like) stromal tumor of the lung (CCST-L) is a recently described distinctive rare pulmonary neoplasm of unknown histogenesis and molecular pathogenesis. Only 7 cases have been reported in 2 recent studies, although additional cases might have been reported under the heading of extraneural pulmonary hemangioblastoma. We herein describe 4 CCST-L cases, 3 of them harboring a YAP1-TFE3 fusion. The fusion-positive tumors occurred in 3 women, aged 29, 56, and 69 years. All presented with solitary lung nodules measuring 2.3 to 9.5 cm. Histologically, all tumors showed similar features being composed of relatively uniform medium-sized epithelioid to ovoid cells with clear cytoplasm and small round monomorphic nuclei. Scattered larger cells with enlarged hyperchromatic nuclei and marked pleomorphism were noted in 2 cases. The tumors were associated with a hypervascularized stroma with variable but essentially subtle resemblance to capillary hemangioblastoma and perivascular epithelioid cell tumor (PEComa). Immunohistochemistry was negative for all lineage-specific markers. Targeted RNA sequencing showed a YAP1-TFE3 fusion in 3 of 4 cases. All 3 tumors showed homogeneous nuclear TFE3 immunoreactivity. Two patients were disease free at 36 and 12 months. The third patient had biopsy-proven synchronous renal and hepatic metastases, but extended follow-up is not available (recent case). The fourth case lacking the fusion affected a 66-year-old woman and showed subtle histologic differences from the fusion-positive cases, but had comparable TFE3 immunoreactivity. CCST-L represents a distinctive entity unrelated to hemangioblastoma and likely driven by recurrent YAP1-TFE3 fusions in most cases. The relationship of our cases to the recently reported "hemangioblastoma-like" CCST-L remains to be determined. Analysis of larger series is paramount to delineate the morphologic spectrum and biological behavior of this poorly characterized entity.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Friedrich Alexander University Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Robert Stoehr
- Institute of Pathology, Friedrich Alexander University Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Michael Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Czech Republic
- Bioptical Laboratory, Ltd., Plzen, Czech Republic
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik, National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany, and Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Hauke Winter
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany, and Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Lei Zhang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Czech Republic
- Bioptical Laboratory, Ltd., Plzen, Czech Republic
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Piquer-Belloch J, Rodríguez-Mena R, Llácer-Ortega JL, Riesgo-Suárez P, Rovira-Lillo V, Flor-Goikoetxea Gamo A, Cremades-Mira A, Llopis-San Juan E. A pure extradural hemangioblastoma mimicking a dumbbell nerve sheath tumor in cervical spine: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE2192. [PMID: 36131580 PMCID: PMC9563648 DOI: 10.3171/case2192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/10/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Spinal extradural hemangioblastomas (HBs) are quite uncommon, with most reported cases involving the thoracic and lumbar areas. Therefore, the presence of a dumbbell-shaped pure extradural cervical HB is exceptional, making preoperative diagnosis particularly challenging. OBSERVATIONS The authors report a case of a 27-year-old woman who presented to their outpatient clinic with progressive cervicobrachialgia and numbness in the left arm. Magnetic resonance imaging showed a C5–6 intradural extramedullary lesion, and, despite some atypical features, the diagnosis of a possible neurogenic tumor was made. A multidetector computed tomography scan and angiography confirmed the expansion and remodeling of the left neural foramen as well as the highly vascularized nature of the mass. Preoperative embolization of the lesion was performed. Complete tumor resection was accomplished, followed by a C5–6 posterior fusion. Histopathology and immunohistochemistry revealed an HB. LESSONS HBs should be considered among the differential diagnosis of cervical extradural tumors. Exhaustive preoperative workup and surgical planning are decisive in order to attain gross-total resection with favorable outcomes.
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10
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Xu Y, Ma X, Ma Y, Li J, Zhang R, Li X. Sporadic hemangioblastoma of the kidney: a clinicopathologic study of three cases and a literature review. J Int Med Res 2021; 49:3000605211027774. [PMID: 34256639 PMCID: PMC8283055 DOI: 10.1177/03000605211027774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Much attention has been paid to renal hemangioblastoma, but there are still challenges in its differential diagnosis. Three cases (2 men, 1 woman; age: 40–56 years) presented with renal tumors. The tumors were surrounded by a thick fibrous capsule, well-demarcated from the surrounding renal parenchyma, and composed of sheets or nests of polygonal to short spindle-shaped tumor cells with a rich capillary network. In cases 1 and 3, the large polygonal tumor cells contained abundant pale or eosinophilic cytoplasm, and some possessed intracytoplasmic lipid vacuoles. In case 2, tumor cells were characterized by a uniform size, mild, clear, or lightly stained cytoplasm, and typical "clear cell" appearance. Immunohistochemistry revealed that the polygonal stromal cells were strongly and diffusely positive for α-inhibin, neuron-specific enolase (NSE), S100 protein, and vimentin. Cluster of differentiation (CD)10 and paired box gene (PAX)8 were positive, while epithelial membrane antigen (EMA) and cytokeratin (CK) were focally positive in case 3. CD34 and CD31 outlined the contours and distribution of the vascular networks. Renal hemangioblastoma is rare and prone to misdiagnosis; more attention should be paid to the morphological features and reasonable application of immunohistochemistry in the diagnosis of hemangioblastoma.
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Affiliation(s)
- Yanmei Xu
- Department of Pathology, Shanxian Central Hospital, Heze, China
| | - Xuehua Ma
- Department of Ultrasound, Shanxian Central Hospital, Heze, China
| | - Yong Ma
- Department of Urinary Surgery, Shanxian Central Hospital, Heze, China
| | - Juan Li
- Department of Pathology, the Fourth Hospital of Jinan, Jinan, China
| | - Renya Zhang
- Department of Pathology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Xiaomei Li
- Department of Pathology, Tai'an Central Hospital, Tai'an, China
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11
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He J, Liu N, Liu W, Zhou W, Wang Q, Hu H. CT and MRI characteristic findings of sporadic renal hemangioblastoma: Two case reports. Medicine (Baltimore) 2021; 100:e24629. [PMID: 33578578 PMCID: PMC7886462 DOI: 10.1097/md.0000000000024629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Hemangioblastomas in the kidney are rare. Although a few cases of renal hemangioblastoma (RH) have been reported, the content of these articles mainly focused on clinical and pathological research, with minimal descriptions of radiologic findings. Moreover, there are no descriptions of magnetic resonance imaging (MRI) with enhancement of this condition. Herein, we report 2 cases of RH with computed tomography (CT) and MRI findings. PATIENT CONCERNS Two patients presented to our institution because of dull pain in the left abdomen, and a mass in the left kidney was found by ultrasound examination in each case. The patient had no special family history. Physical examination revealed no obvious tenderness or percussion pain in the renal and ureteral walking areas, and there was no obvious mass. Routine blood and urine tests were normal, and the serum tumor markers were negative. No obvious lesions were found on imaging of the other body parts. DIAGNOSIS Similar radiologic findings were observed in both cases and mimicked those of cavernous hemangiomas of the liver, including peripheral nodular enhancement in the corticomedullary phase, progressive centripetal enhancement in the nephrographic and delayed phases, and occasional complete "filling in" in the delayed phase. We made a radiologic diagnosis of renal clear cell carcinoma for patient 1 and suspected renal clear cell carcinoma for patient 2, but the pathological results showed RH. INTERVENTIONS Given the suspicion of renal cell carcinoma, both patients underwent partial nephrectomy. OUTCOME The recovery of the two patients was uneventful, and there was no evidence of local recurrence or metastasis many years after surgery. LESSONS RH is a rare benign tumor that can be easily misdiagnosed as clear cell carcinoma. Characteristic CT and MRI manifestations may improve preoperative diagnostic accuracy to avoid surgery or indicate nephron-sparing surgery.
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Affiliation(s)
| | - Nan Liu
- Department of Critical Care Medicine
| | - Wangwang Liu
- Department of Pathology, Sir Run Run Shaw Hospital
| | | | - Qiangfeng Wang
- Department of Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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12
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Segawa K, Sugita S, Aoyama T, Minami S, Nagashima K, Tsuda M, Tanaka S, Hasegawa T. Detection of VHL deletion by fluorescence in situ hybridization in extraneuraxial hemangioblastoma of soft tissue. Pathol Int 2020; 70:473-475. [PMID: 32304124 DOI: 10.1111/pin.12935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/16/2020] [Accepted: 04/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Keiko Segawa
- Department of Surgical Pathology, Kushiro City General Hospital, Hokkaido, Japan
| | - Shintaro Sugita
- Department of Surgical Pathology, School of Medicine, Sapporo Medical University, Hokkaido, Japan
| | - Tomoyuki Aoyama
- Department of Surgical Pathology, School of Medicine, Sapporo Medical University, Hokkaido, Japan
| | - Seiichi Minami
- Department of Breast Surgery, Sapporo Higashi Tokushukai Hospital, Hokkaidō, Japan
| | - Kazuo Nagashima
- Department of Diagnostic Pathology, Sapporo Higashi Tokushukai Hospital, Hokkaidō, Japan
| | - Masumi Tsuda
- Faculty of Cancer Pathology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Shinya Tanaka
- Faculty of Cancer Pathology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, School of Medicine, Sapporo Medical University, Hokkaido, Japan
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Disseminated central nervous system hemangioblastoma in a patient with no clinical or genetic evidence of von Hippel-Lindau disease-a case report and literature review. Acta Neurochir (Wien) 2019; 161:343-349. [PMID: 30652202 DOI: 10.1007/s00701-019-03800-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hemangioblastomas (HB) are benign tumors of the central nervous system (CNS) that can appear sporadic or as part of von Hippel-Lindau (VHL) disease. It is often curable with surgical resection, but upon relapse, the disease exhibits a treatment-refractory course. CASE REPORT A patient treated for sporadic cerebellar HB relapsed 12 years post-surgery. She developed disseminated disease throughout the CNS, including leptomeningeal manifestations. Repeat surgery and craniospinal radiation therapy were unsuccessful. CONCLUSION This case is in line with previous publications on disseminated non-VHL HB. Available treatment options are inefficient, emphasizing the need for improved understanding of HB biology to identify therapeutic targets.
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