1
|
Omiyale AO. Primary vascular tumours of the kidney. World J Clin Oncol 2021; 12:1157-1168. [PMID: 35070735 PMCID: PMC8716994 DOI: 10.5306/wjco.v12.i12.1157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/01/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Primary vascular tumours of the kidney are rare and may pose diagnostic difficulties because of their similar clinical, morphological, and immunohistochemical features. This article summarizes the clinical and pathological features of primary renal angiosarcoma and anastomosing haemangioma of the kidney including epidemiology, genetics, and prognosis. Renal anastomosing haemangiomas are benign neoplasms characterized by anastomosing capillary-sized vascular channels. These tumours are rare, with about 75 cases reported in the literature. Most anastomosing haemangiomas are found incidentally on ultrasound, computed tomography, or magnetic resonance imaging. Common symptoms include abdominal pain, haematuria, and abdominal mass. Renal anastomosing haemangiomas are characterized by recurrent mutations in GNAQ and GNA14 genes. The prognosis of anastomosing haemangioma is excellent. Primary renal angiosarcomas are malignant tumours showing endothelial differentiation. To date, 76 cases have been described in the literature. Primary renal angiosarcomas are frequently symptomatic. The clinical features of renal angiosarcomas are similar to those of renal anastomosing haemangiomas, including abdominal pain, haematuria, and abdominal mass. Angiogenesis-related genes and vascular-specific receptor tyrosine kinases such as KDR, TIE1, SNRK, TEK, and FLT1 are upregulated in angiosarcomas. Primary renal angiosarcomas are highly aggressive neoplasms with a poor prognosis despite surgical treatment, chemotherapy, radiotherapy, or targeted therapy.
Collapse
Affiliation(s)
- Ayo O Omiyale
- Department of Cellular Pathology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, United Kingdom
| |
Collapse
|
2
|
Boni A, Cochetti G, Sidoni A, Bellezza G, Lepri E, Giglio AD, Turco M, Vermandois JARD, Zingaro MD, Cirocchi R, Mearini E. Primary Angiosarcoma of the Kidney: Case Report and Comprehensive Literature Review. Open Med (Wars) 2019; 14:443-455. [PMID: 31410364 PMCID: PMC6689208 DOI: 10.1515/med-2019-0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/24/2019] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Angiosarcoma (AS) is an aggressive malignant tumour of endothelial origin, most frequently compelling the skin. The kidney is a rare site of primary occurrence of AS with a quite challenging diagnosis and poor prognosis, mainly due to its raw metastasising power. We described our first case of AS treatment. A comprehensive literature review in this field is also carried out. PATIENTS AND METHODS We report the case of a 56-years-old man with radiological appearance of an 11 cm poor vascularised left renal mass. The pre-operative imaging ruled out distant metastases and inferior vena cava thrombosis. Thus, after radioembolization, we performed a transperitoneal open radical nephrectomy with regional lymphadenectomy with the removal of the middle portion of the ileo-psoas muscle, followed by two lines of adjuvant chemotherapy. We analysed all the papers concerning primary kidney AS until December 2018. RESULTS Estimated intraoperative blood loss was 200 mL with an operative time of 100 minutes. No postoperative complications were recorded, with the patient discharge in the 8th postoperative day. The pathological assessment showed a pT3a N0, M0 tumour compatible with AS of the kidney. An immune-histochemical study showed a vascular positive for CD31, CD34, Fli-1 with a Ki-67/Mib 1 of 50%. One month after surgery the patient began adjuvant chemotherapy with gemcitabine. After 45 days from surgery, a Computed Tomography scan showed lung and liver metastases with disease relapse in the left kidney lodge. The response to the first-line treatment was excellent, unlike the second-line, encountering a chemo-refractory disease. The cancer-specific survival was of 15 months. We included 66 cases in our review. CONCLUSION This is the first case of treatment of kidney AS performed at our Institute. Our findings added new information about the unclear biology and progression of this subset of tumours, demonstrating an abysmal prognosis.
Collapse
Affiliation(s)
- Andrea Boni
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Angelo Sidoni
- Department of Experimental Medicine, Section of Anatomic Pathology and Histology, Perugia Medical School, University of Perugia, Perugia, Italy
| | - Guido Bellezza
- Department of Experimental Medicine, Section of Anatomic Pathology and Histology, Perugia Medical School, University of Perugia, Perugia, Italy
| | - Emanuele Lepri
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Andrea De Giglio
- Department of Experimental Medicine, Section of Oncology, University of Perugia, Perugia, Italy
| | - Morena Turco
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia - S.M. della Misericordia Hospital, P.le Menghini 1, 06132, Perugia, Italy
| | - Jacopo Adolfo Rossi De Vermandois
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Urologic Clinic, University of Perugia, University Hospital of Perugia, Perugia, Italy
| |
Collapse
|
3
|
Iannaci G, Crispino M, Cifarelli P, Montella M, Panarese I, Ronchi A, Russo R, Tremiterra G, Luise R, Sapere P. Epithelioid angiosarcoma arising in schwannoma of the kidney: report of the first case and review of the literature. World J Surg Oncol 2016; 14:29. [PMID: 26842370 PMCID: PMC4739400 DOI: 10.1186/s12957-016-0789-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 01/26/2016] [Indexed: 12/24/2022] Open
Abstract
Background Schwannoma and angiosarcoma are infrequent pathologies that have been rarely reported in the kidney. Angiosarcoma is an uncommon malignant tumor presenting a recognizable vascular differentiation. It can develop in any site but the most common locations include the skin, soft tissues, breast, bone, liver, and spleen while renal localization has been very rarely reported in the literature. Schwannoma is a benign peripheral nerve sheath tumor composed of cells with the immunophenotype and ultrastructural features of differentiated Schwann cells. It has a wide anatomical distribution but the most frequent locations include subcutaneous tissues of the extremities and the head and neck region and the retroperitoneal and mediastinal soft tissues. The occurrence of an angiosarcoma in a pre-existing schwannoma is an extremely rare event with <20 cases reported in worldwide literature. In the present study, a renal case of angiosarcoma arising in schwannoma is presented with a detailed review of the pertinent literature. Case Presentation A 56-year-old man was admitted with a few days history of lower back pain and hematuria. Abdominal ultrasound showed a mass inside the left renal medulla. Subsequent imaging investigations with computed tomography and magnetic resonance confirmed the presence of the lesion and showed a pulmonary metastasis. Conclusions The final histopathological examination led to the diagnosis of epithelioid angiosarcoma arising in a schwannoma. The patient came to death a few months later due to a massive hemothorax. To the best of our knowledge, the present is the first case of an angiosarcoma arising in a schwannoma of the kidney.
Collapse
Affiliation(s)
- G Iannaci
- Division of Pathology, S. Maria del Popolo degli Incurabili Hospital ASL Na1, Naples, Italy.
| | - M Crispino
- Division of Urology, S. Maria del Popolo degli Incurabili Hospital ASL Na1, Naples, Italy
| | - P Cifarelli
- Division of Urology, S. Maria del Popolo degli Incurabili Hospital ASL Na1, Naples, Italy
| | - M Montella
- Division of Pathology, School of Medicine, University Federico II, Naples, Italy
| | - I Panarese
- Division of Pathology, School of Medicine, University Federico II, Naples, Italy
| | - A Ronchi
- Division of Pathology, School of Medicine, University Federico II, Naples, Italy
| | - R Russo
- Division of Pathology, School of Medicine, University Federico II, Naples, Italy
| | - G Tremiterra
- Division of Pathology, School of Medicine, University Federico II, Naples, Italy
| | - R Luise
- Division of Pathology, School of Medicine, University Federico II, Naples, Italy
| | - P Sapere
- Division of Pathology, S. Maria del Popolo degli Incurabili Hospital ASL Na1, Naples, Italy
| |
Collapse
|
4
|
Omiyale AO. Clinicopathological features of primary angiosarcoma of the kidney: a review of 62 cases. Transl Androl Urol 2016; 4:464-73. [PMID: 26816844 PMCID: PMC4708591 DOI: 10.3978/j.issn.2223-4683.2015.05.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Angiosarcoma (AS) is a malignant tumor occurring in less than 2% of soft tissue sarcomas. Primary involvement of the kidney is rare, its pathogenesis remains largely unknown and it has overlapping features with other tumors of the kidney. The objective of this paper is to review the case reports of primary AS of the kidney in the literature. The search terms were primary AS of the kidney, primary renal AS and primary renal hemangiosarcoma. The total cohort of the cases reviewed was 62. The mean age of presentation was 61 years old with a predilection for the male sex. Metastatic disease at the time of diagnosis accounted for 44.9% (22/49) of the cases reported and 44.4% (12/27) of patients with non-metastatic disease at diagnosis, subsequently developed metastasis. Primary AS of the kidney is a rare malignant tumor with a poor prognosis. Local recurrence and distant metastasis is common. Primary AS of the kidney shares similar clinical presentation with other renal tumors and imaging does not allow for tumor specific diagnosis. Histopathological examination and immunohistochemistry is very important for the confirmation of the diagnosis. Current treatment options include a variable combination of surgery, radiotherapy and chemotherapy.
Collapse
|
5
|
Fukunaga M. Angiosarcoma of the kidney with minute clear cell carcinomas: a case report. Pathol Res Pract 2009; 205:347-51. [PMID: 19147300 DOI: 10.1016/j.prp.2008.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 10/23/2008] [Accepted: 11/17/2008] [Indexed: 12/25/2022]
Abstract
A case of renal angiosarcoma with minute clear cell carcinomas in a 61-year-old male is described. The tumor was clinically considered a renal cell carcinoma. The lesion, removed by nephrectomy, was an unencapsulated hemorrhagic mass measuring 8.0cm in diameter. The tumor was histologically characterized by anastomosing vascular channels lined by cytologically atypical endothelial cells. The tumor cells reacted positively with CD31, factor-VIII related antigen, and CD34. A few minute clear cell carcinomas measuring less than 1mm were observed in the periphery of the angiosarcoma. There was no transition between angiosarcoma and renal cell carcinoma. The patient died of a widespread disease 13 months after surgery. This tumor is considered a primary renal angiosarcoma with clear cell carcinomas and not a sarcomatoid carcinoma.
Collapse
Affiliation(s)
- Masaharu Fukunaga
- Department of Pathology, The Jikei University School of Medicine, The Jikei Daisan Hospital, 4-11-1, Izumihoncho, Komaeshi, Tokyo 201-8601, Japan.
| |
Collapse
|
6
|
Akkad T, Tsankov A, Pelzer A, Peschel R, Bartsch G, Steiner H. Early diagnosis and straight forward surgery of an asymptomatic primary angiosarcoma of the kidney led to long-term survival. Int J Urol 2006; 13:1112-4. [PMID: 16903939 DOI: 10.1111/j.1442-2042.2006.01490.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report the first case of a diagnosis of an asymptomatic primary renal angiosarcoma. The patient underwent laparoscopic nephrectomy and is alive after long-term follow up. We provide the preoperative imaging studies and the histologic features of this exceedingly rare tumor.
Collapse
Affiliation(s)
- Thomas Akkad
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
| | | | | | | | | | | |
Collapse
|
7
|
Leggio L, Addolorato G, Abenavoli L, Ferrulli A, D'Angelo C, Mirijello A, Vonghia L, Schinzari G, Arena V, Perrone L, Citterio F, Bonomo L, Rapaccini GL, Capelli A, Barone C, Gasbarrini G. Primary renal angiosarcoma: A rare malignancy. A case report and review of the literature☆. Urol Oncol 2006; 24:307-12. [PMID: 16818182 DOI: 10.1016/j.urolonc.2005.10.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Revised: 09/25/2005] [Accepted: 10/04/2005] [Indexed: 02/07/2023]
Abstract
Angiosarcoma is a rare malignant tumor occurring in less than 2% of soft tissue sarcomas. Angiosarcoma involving the kidney usually represents metastasis from skin or visceral primary lesions, while angiosarcoma primarily occurring in the kidney is a very rare neoplasm. In the English literature, from 1942 to the present, only 19 cases of primary kidney angiosarcoma have been reported. A case of primary renal angiosarcoma presenting as a large kidney mass and flank pain occurring after traumatism is reported. The present case represents further evidence of a rare malignancy.
Collapse
Affiliation(s)
- Lorenzo Leggio
- Institute of Internal Medicine, Catholic University of Rome, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Tsuda N, Chowdhury PR, Hayashi T, Anami M, Iseki M, Koga S, Matsuya F, Kanetake H, Saito Y, Horita Y. Primary renal angiosarcoma: a case report and review of the literature. Pathol Int 1997; 47:778-83. [PMID: 9413038 DOI: 10.1111/j.1440-1827.1997.tb04457.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Primary renal angiosarcoma is very rare. To our knowledge, only 15 cases have been reported to date. A 77-year-old Japanese man with a unilateral kidney presented with massive hematuria followed by renal failure. A renal tumor was suspected and a left nephrectomy was performed. The histopathological diagnosis was angiosarcoma of the kidney. A hemorrhagic tumor measuring 10 x 5 cm and clotted blood was found in the medullary area. The atypical tumor cells had a sinusoidal and solid appearance, and showed immunohistochemically positive reactions for some of the endothelial markers. The patient died about 21 months after the nephrectomy and the autopsy revealed massive metastases to the liver and retroperitoneum. One of the differential diagnoses of the case was angiomyolipoma, because the tumor cells were relatively bland in their histological appearance with entrapped fat cells in the pelvic area. Fifteen case reports with titles that included the term 'hemangiosarcoma/angiosarcoma', 'hemangioendothelioma/endothelioma' or 'vascular sarcoma' of the kidney were reviewed and compared to the present case.
Collapse
Affiliation(s)
- N Tsuda
- Department of Pathology, Nagasaki University Hospital, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
We report the first case of angiosarcoma in the kidney occurring in a woman; the tumor was initially believed to be renal cell carcinoma. This malignant tumor was discovered in a patient with macrohematuria. The final diagnosis was confirmed by histologic and immunohistochemical findings. A review of the literature on this tumor is also included in the discussion.
Collapse
Affiliation(s)
- Y Hiratsuka
- Department of Urology, School of Medicine, Fukuoka University, Japan
| | | | | | | | | |
Collapse
|
10
|
Martínez-Piñeiro L, López-Ferrer P, Picazo ML, Martínez-Piñeiro JA. Primary renal angiosarcoma. Case report and review of the literature. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1995; 29:103-8. [PMID: 7618041 DOI: 10.3109/00365599509180547] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Primary angiosarcoma is one of the rarest kidney tumors. Only six satisfactorily documented cases have been reported in the literature. A new case is described. The tumour is usually in an advanced clinical stage when detected, and generally first presents with local pain and no urinary symptoms.
Collapse
Affiliation(s)
- L Martínez-Piñeiro
- Urology Service, La Paz Hospital, Faculty of Medicine, Universidad Autónoma, Madrid, Spain
| | | | | | | |
Collapse
|
11
|
Kragel PJ, Travis WD, Luibel FJ. Sarcomatoid renal carcinoma with angiosarcomatoid component. Light microscopic and immunohistochemical study. Urology 1992; 40:381-4. [PMID: 1413363 DOI: 10.1016/0090-4295(92)90396-e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We describe a case of primary renal pelvic carcinoma which showed an unusual histologic pattern of anastomosing blood-filled channels lined by atypical cells. This angiosarcomatoid pattern merged with solid areas typical of renal carcinoma. Immunoperoxidase stains for cytokeratin and epithelial membrane antigen were positive in both the angiosarcomatoid and typical carcinomatous areas, while stains for factor VIII-related antigen and desmin were negative. Since primary renal angiosarcomas are rare neoplasms, the diagnosis of sarcomatoid renal carcinoma should be considered in primary renal neoplasms which show this angiosarcomatoid pattern.
Collapse
Affiliation(s)
- P J Kragel
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | | |
Collapse
|
12
|
Livaditou A, Alexiou G, Floros D, Filippidis T, Dosios T, Bays D. Epithelioid angiosarcoma of the adrenal gland associated with chronic arsenical intoxication? Pathol Res Pract 1991; 187:284-9. [PMID: 2068012 DOI: 10.1016/s0344-0338(11)80785-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Epithelioid angiosarcoma is a rare tumor quite recently described. There is no accurate epidemiological study of this tumor. Among the internal organs, the liver is the one most frequently affected with angiosarcoma while there is no reference to the adrenal gland as a primary site. It is well known that the direct exposure to arsenicals (especially of vineyard cultivators) may be an important causative factor in the pathogenesis of the disease. A 59-year-old male vineyard cultivator with an epithelioid angiosarcoma of the right adrenal gland is described. The histologic characteristics as well as the immunohistochemical profile of the tumor are presented and the literature is briefly reviewed.
Collapse
Affiliation(s)
- A Livaditou
- Air Force and Veterans Administration General Hospital, Athens, Greece
| | | | | | | | | | | |
Collapse
|
13
|
Garber BB, Prestipino AJ, Pollack HM, Levine SR, Whitmore KE. Masson's tumor of the kidney: a new renal lesion. J Urol 1990; 143:344-6. [PMID: 2299727 DOI: 10.1016/s0022-5347(17)39956-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Intravascular papillary endothelial hyperplasia (Masson's tumor) is a rare benign reactive lesion usually found in thrombosed subcutaneous blood vessels. We report a case of Masson's tumor of the kidney, and discuss the relevant clinical, radiographical and pathological aspects.
Collapse
Affiliation(s)
- B B Garber
- Department of Urology, Graduate Hospital, Philadelphia, Pennsylvania
| | | | | | | | | |
Collapse
|
14
|
Desai MB, Chess Q, Naidich JB, Weiner R. Primary renal angiosarcoma mimicking a renal cell carcinoma. UROLOGIC RADIOLOGY 1989; 11:30-2. [PMID: 2734970 DOI: 10.1007/bf02926469] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Primary renal angiosarcoma is a very rare malignant tumor that closely mimics the more common renal cell adenocarcinoma (hypernephroma) in radiologic appearance. Both tumors are hypervascular masses and the diagnosis must be confirmed histologically. However, in the presence of a tumor with a capsular blood supply, and in the absence of venous invasion, the diagnosis of renal angiosarcoma may be suggested, especially in a patient with a new onset of consumption coagulopathy.
Collapse
Affiliation(s)
- M B Desai
- Department of Medicine, North Shore University Hospital, Cornell University Medical College, Manhasset, New York 11030
| | | | | | | |
Collapse
|
15
|
Abstract
We describe a forty-six-year-old man who died of disseminated angiosarcoma ten months after a radical nephrectomy and postoperative radiation therapy for a renal angiosarcoma. We found 3 other well-documented reports of renal angiosarcoma, all in men. Two of the 3 cases previously reported also had a rapidly fatal course with hematogenous spread of the neoplasm following nephrectomy. Angiosarcoma of the kidney, although rare, is apparently a highly malignant fatal neoplasm, and effective therapy remains unknown.
Collapse
|
16
|
Abstract
Renal angiosarcoma, an uncommon vascular sarcoma, is primarily treated surgically. We present a patient who, at nephrectomy, had tumor adherent to the diaphragm and renal artery. Postoperative radiation was given to the renal fossa. Despite the subsequent development of bone and liver metastases, disease in the renal fossa was apparently controlled. Symptomatic bone lesions were effectively palliated with radiotherapy. This report confirms those of others suggesting that angiosarcoma does respond to radiation.
Collapse
|
17
|
Abstract
We report a retrospective study of 18 patients with renal sarcomas seen between 1950 and 1980. Renal sarcomas are highly malignant neoplasms and the over-all prognosis is poor, with only 2 long-term survivors in this series. Radical nephrectomy seems to be the treatment of choice.
Collapse
|