Severe hypertension in an adolescent girl

Juxtaglomerular Cell Tumor of the Kidney

We present a case of juxtaglomerular cell tumor (JGCT) that developed in a 44-year-old woman with hypertension, which subsided after the tumor was removed. The tumor was 8.5 cm in greatest dimension and is thought to be the largest such tumor reported to date. Ultrastructural study confirmed the diagnosis of JGCT by the demonstration of the typical cytoplasmic rhomboidal secretory granules on electron microscopy. The tumor cells were also strongly reactive for CD34, a finding that has not been previously reported and that may be an adjunct to the diagnosis of JGCT in a patient with hypertension, hyperreninemia, and/or hypokalemia. At present, however, further studies on additional cases for CD34 expression will be necessary to fully evaluate the diagnostic utility of this marker in the diagnosing of JGCT.

Hypertension secondary to renin-secreting juxtaglomerular cell tumor: case report and review of 38 cases

A 15-year-old girl with severe high renin hypertension caused by a juxtaglomerular cell tumor (JCT) was successfully treated with the calcium channel blocker nifedipine until surgical removal effected a permanent cure. This case was incorporated into a review of the 37 cases previously published. Comparison of the children and adolescents with the adult population showed that the features of JCT were similar in the two groups except for the average duration of symptoms prior to diagnosis (pediatric group 2.6 years vs. 6.0 years for the adult group). Analysis of all 38 cases demonstrated the following: 1. Teenagers constituted the largest single population with JCT (39%) and approximately two-thirds of the entire population were female. 2. Many patients failed to show persistent hypokalemia despite high plasma renin activity and secondary hyperaldosteronism. 3. Renal angiography was initially negative in more than half the cases. 4. Renal vein renin failed to show lateralization to the affected kidney in 52% of the cases. 5. Computerized tomography demonstrated a renal mass in all of the cases in which it was performed, even when other imaging studies were negative. 6. Calcium channel blockers may evolve as the preferred treatment for the high renin hypertension of JCT.

Pathologic characterization of a renin-secreting juxtaglomerular cell tumor in a child and review of the pediatric literature

We describe a rare case of renal hypertension in a 15-year-old caused by juxtaglomerular cell tumor and compare our findings with those of 20 children reported in the literature. These tumors are usually encapsulated and composed microscopically of polyhedral cells with bland nuclei separated by fibrovascular septa. Characteristic renin granules can be demonstrated by Bowie's stain or electron microscopy. These tumors are benign. Pathologists should recognize the morphologic characteristics of these tumors when dealing with renin-producing neoplasia.