Epithelioid angiosarcoma arising in schwannoma of the kidney: report of the first case and review of the literature

A meta-analysis of pregnancy outcomes in the diagnosis of isolated foetal renal parenchyma by prenatal ultrasonography

BACKGROUND

To effectively circumvent foetal structural abnormalities and serious newborn sequelae, antenatal ultrasound evaluation can support making an early diagnosis for potential prenatal management or the termination of pregnancy.

OBJECTIVE

This study systematically evaluated a meta-analysis of different pregnancy outcomes in the diagnosis of isolated foetal renal parenchymal echogenicity (IHEK) by prenatal ultrasonography.

METHODS

Two researchers conducted a literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following databases were included in the search: China National Knowledge Infrastructure, Wanfang Medical Network, China Academic Journals Full-text Database, PubMed, Web Of Science and Springer Link; additional library websites were also included, and the search reviewed different pregnancies among patients with IHEK. The outcome indicators were the live birth rate, the incidence of polycystic renal dysplasia and the incidence of pregnancy termination/neonatal death. The meta-analysis was performed using the Stata/SE 12.0 software.

RESULTS

A total of 14 studies were included in the meta-analysis (total sample content, 1,115 cases). The combined effect size of prenatal ultrasound diagnosis of pregnancy termination/neonatal mortality in patients with IHEK was 0.289 (confidence interval (CI) 95%; range, 0.102-0.397). The combined effect size of the live birth rate of pregnancy outcomes was 0.742 (CI 95%; range, 0.634-0.850. The combined effect size of the polycystic kidney dysplasia rate was 0.066 (CI 95%; range, 0.030-0.102). The heterogeneity of all three results was > 50%; accordingly, a random-effects model was used.

CONCLUSION

The indications for eugenic labour should not be included in a prenatal ultrasound diagnosis of patients with IHEK. In the results of this meta-analysis, the live birth and polycystic dysplasia rates were optimistic in terms of pregnancy outcomes. Therefore, under the condition of excluding other unfavourable factors, it is necessary to A thorough technical inspection is required to make an accurate judgment.

Angiosarcoma arising in a schwannoma of the peripheral nervous system: illustrative case

BACKGROUND

Schwannomas of the peripheral nerves are benign tumors that can very rarely undergo malignant transformation. These lesions are particularly challenging to diagnose via noninvasive techniques but can have significant implications for treatment.

OBSERVATIONS

This is a case of a 70-year-old female with a prior history of a right sciatic notch tumor that was diagnosed as a conventional schwannoma via histology from an initial biopsy and subsequent surgical debulking. Unfortunately, she experienced significant worsening of her motor deficit, whereby her postoperative foot weakness progressed to complete foot drop in less than 2 years. In addition, she demonstrated significant radiological progression, with more than 1 to 2 cm of growth in each dimension at her subsequent evaluation, along with intractable right leg pain. An additional operation was performed to completely remove the 7 × 8 cm tumor, and histology demonstrated angiosarcoma within a schwannoma. There was no evidence of recurrence at 15 months, and the patient had significant improvement in her pain.

LESSONS

Rapidly worsening function and radiological progression are not typically seen with conventional benign nerve sheath tumors and should prompt consideration of other lesions. Angiosarcoma within schwannoma is a rare pathology and optimal therapies for these tumors in terms of surgical timing and adjuvant therapy are still unknown.

Renal Schwannoma: A Rare Case Report and Literature Review

Schwannomas originating in the kidney are extremely rare with very few cases documented in the literature. It is difficult to distinguish them from other common renal masses based on clinical symptoms and imaging characteristics alone, as both are non-specific for this pathology. Thus, the final diagnosis of schwannoma is typically made only after surgical resection and histologic examination. We present the case of a 66-year-old female who was initially evaluated for flank pain and referred to us after a renal mass was found on CT imaging. A partial nephrectomy was performed, and subsequent pathological examination confirmed the diagnosis of renal schwannoma.

Giant renal schwannoma with obvious hemorrhage and cystic degeneration: a case report and literature review

BACKGROUND

Renal schwannomas are very rare and are usually benign. Its clinical symptoms and imaging features are nonspecific, and the diagnosis is usually confirmed by pathology after surgical resection.

CASE PRESENTATION

A 46-year-old Chinese female was admitted to the hospital with right flank pain that had persisted for the six months prior to admission. This pain had worsened for 10 days before admission, and dyspnea occurred when she was supine and agitated. A right abdominal mass could be palpated on physical examination. Computed tomography and magnetic resonance imaging examinations revealed a large, nonenhanced, cystic and solid mass in the right kidney. The patient received radical nephrectomy for the right kidney. The diagnosis of schwannoma was confirmed by pathological examination.

CONCLUSIONS

We report a case of a large renal schwannoma with obvious hemorrhage and cystic degeneration, which can be used as a reference for further study.

Primary vascular tumours of the kidney

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.

Surgical Excision of a Giant Schwannoma of the Hand: A Case Report

CASE

We report a 78-year-old man who underwent excision of a 13-year-old benign schwannoma originating from the terminal motor branch of the ulnar nerve. The mass measured 13 cm in diameter on presentation and was successfully excised, preserving a functional hand. At 4-year follow-up, the patient was asymptomatic with intact motor and sensory function and no signs of recurrence. To the best of our knowledge, this is the largest schwannoma of the hand to be reported in the literature.

CONCLUSIONS

Large schwannomas of the hand can successfully be excised with no postoperative complications.

Ovarian epithelioid angiosarcoma complicating pregnancy: a case report and review of the literature

Epithelioid angiosarcoma is a rare and highly aggressive soft tissue angiosarcoma most commonly arising in the deep soft tissues. Given that abundant vascular cavities anastomose with each other, most angiosarcomas prone to metastasis recur quickly, and the overall prognosis is poor. We report a 25-year-old woman at 24 weeks’ gestation who presented with a 1-month history of abdominal distension. Ultrasonography suggested a mass in the right adnexa, and she underwent two operations owing to uncontrolled intraperitoneal bleeding with progressive anemia. The right ovarian tumor and right adnexa were removed successively. Biopsy yielded a diagnosis of primary epithelioid angiosarcoma with mature cystic teratoma. The patient died from uncontrolled progressive bleeding 1 week after the second operation. This case revealed that epithelial angiosarcoma is a highly malignant endothelial cell tumor. The results of surgery and chemoradiotherapy tend to be poor, and the recurrence rate is high. The purpose of this study is to raise clinical awareness of epithelial angiosarcoma and its adverse events and to provide new ideas for the treatment of these adverse events. Immunohistochemical staining of pathological specimens can facilitate diagnosis. Pregnancy with malignant tumors may lead to rapid disease progression, extensive lesions, and a poor prognosis.

Posterior Mediastinal Epithelioid Angiosarcoma Arising in Schwannoma: A Case Report and Review of the Literature

Epithelioid angiosarcoma arising in schwannoma is an extremely rare mesenchymal tumor that accounts for only 1 to 2% of all sarcomas. This type of tumor occurs in all parts of the body, most often in the skin and soft tissues and rarely in the mediastinum. The present study describes the case of an asymptomatic, 58-year-old male who presented with epithelioid angiosarcoma in the posterior mediastinum during a physical examination. Enhanced computed tomography of the chest revealed a 3.5 × 3.1-cm mass in the posterior mediastinum. Thoracoscopic mediastinal mass resection was performed under general anesthesia due to the possibility that the tumor was malignant. Pathological examination revealed the presence of angiosarcoma and schwannoma components. Immunohistochemical staining for cluster of differentiation (CD) 31, CD34, early growth response (EGR), vimentin, Sry-related HMG box (SOX)-10 and S-100 was strongly positive. The patient recovered and was discharged on postoperative day 5. Two months postsurgery, the patient returned for evaluation, and no evidence of tumor recurrence was observed.

Primary and secondary cutaneous angiosarcoma: Distinctive clinical, pathological and molecular features

Angiosarcomas are ubiquitous neoplasms involving both cutaneous and soft tissue and visceral locations. Accumulating biomolecular evidences suggest that cutaneous angiosarcomas are distinctive entities with molecular, clinical and pathological peculiarities. Despite several ongoing clinical trials with promising therapeutic agents, the prognosis of cutaneous angiosarcomas is dismal and survival still rely on early diagnosis and surgery. An accurate diagnosis and the knowledge of the underlying molecular landscape are therefore essential to improve the prognosis. We detail the molecular, clinical, dermoscopic, morphological and prognostic features of cutaneous angiosarcoma. Although the molecular landscape of cutaneous angiosarcoma is not completely understood, accumulating evidences suggest that there are characteristic molecular alterations including dysregulation of angiogenesis and several complex molecular pathways. Secondary cutaneous angiosarcomas, arising in correlation with chronic lymphedema and ionizing radiation, have different molecular hallmarks, which are also leading to the first diagnostic applications. The diagnosis of cutaneous angiosarcoma may be challenging, as well-differentiated forms can be hard to distinguish from benign and low-grade vascular neoplasms, while poorly differentiated forms can be easily confounded with other non-vascular high-grade neoplasms. An accurate and early diagnosis, which is mandatory to ensure the best survival for the patients, is mainly based on morphological hallmarks.

Primary Angiosarcoma of the Kidney: Case Report and Comprehensive Literature Review

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.

Giant posterior pararenal schwannoma: A case report and review of literature

Schwannomas, arising from Schwann cells of peripheral nerve sheaths, are primarily benign tumors. They are rarely found in the retroperitoneal space. To date, ~30 cases on giant retroperitoneal schwannomas have been reported. Those with a location of pararenal space are even rarer. Clinically, they are often misdiagnosed as malignancies. In the present study, a case of a 35-year-old woman with a giant schwannoma measuring 13 × 8.5 × 6.5 cm in the posterior pararenal space of left retroperitoneum was presented, which was thought to be a malignant tumor from the result of computed tomography scan. Later postoperative pathology and immunohistochemistry were consistent with benign schwannoma. To the best of our knowledge, this was the largest posterior pararenal schwannoma reported in literature. It is significant to report this case, and summarize the characteristics, diagnosis, treatment and prognosis of the similar cases. Furthermore, a brief review of the previously published cases in literature is provided.

Equine renal hemangiosarcoma: clinical presentation, pathologic features, and pSTAT3 expression

Hemangiosarcoma is an uncommon tumor in horses. We characterized 3 cases of equine renal hemangiosarcoma, focusing on clinical and pathologic features, and describe occurrence of the epithelioid variant of hemangiosarcoma in one of these cases. Nuclear expression of phosphorylated STAT3 (pSTAT3) was assessed to analyze potential inappropriate STAT3 activation as a component of tumor pathogenesis. Clinical signs in the 3 horses included insidious weight loss, followed in one case by serosanguineous nasal discharge and terminal epistaxis, and nonspecific signs of abdominal pain. Two of the hemangiosarcomas had a classical histopathologic appearance; in the other, neoplastic cells were polygonal and were arranged in densely packed sheets, resembling the epithelioid variant. Cross-reactivity of a pSTAT3 antibody was established by demonstration of pSTAT3 expression in the epithelium of glabrous skin by immunoblotting and immunohistochemistry. In the epithelioid hemangiosarcoma, ~40% of neoplastic cells exhibited nuclear pSTAT3 expression, but in the other 2 cases, expression was weak and variable in the neoplastic population, although stromal cell pSTAT3 activity was evident in pulmonary metastases in one case.

Robot-Assisted Laparoscopic Renal Schwannoma Excision

Background: To report the first case of a renal schwannoma excised with robot-assisted laparoscopy. Case Presentation: A 43-year-old Caucasian female patient with vague abdominal symptoms was noted to have incidental right renal mass. Physical examination and laboratory tests were within normal limits. CT revealed a 4.6 cm heterogeneous enhancing right renal mass arising near the hilum. RENAL nephrometry score was 11a. She was treated by right robot-assisted laparoscopic nephrectomy. She recovered well without complications. Pathology analysis revealed a benign renal schwannoma. Conclusion: Renal schwannoma is a rare kidney tumor. We report the first known case of this tumor excised by robot-assisted laparoscopic nephrectomy.