Spontaneous rupture of the kidney in the patients with synchronous renal hemangioma and nephrogenic hypertension

Radiologic and pathologic correlation of a renal venous hemangioma

Renal hemangiomas, including the rare subtype of venous hemangioma, are typically non-cancerous, often asymptomatic, and usually discovered incidentally during imaging studies. Here, we report a unique case of a 59-year-old African-American female with a renal venous hemangioma that initially mimicked papillary-type renal cell carcinoma (RCC-pt) on imaging studies. The patient's presentation included a long history of rectal bleeding and an incidental discovery of a hypoattenuating mass in the left kidney during a contrast-enhanced CT scan. Renal MRI revealed a 3.5 cm left renal lower pole mass, presenting as heterogeneously hyperintense on T1-weighted images and hypointense on T2-weighted images, with gradual mild enhancement post-contrast. Subsequent total nephrectomy confirmed the histopathological diagnosis of a venous hemangioma. This case underlines the need for recognizing unique imaging features of renal venous hemangiomas, contributing to the differential diagnosis of T2 dark hypoenhancing renal masses. Correct interpretation may prevent unnecessary invasive procedures and operations, thereby improving patient management and outcomes.

Case report: Capillary hemangioma in the renal hilum mimicking paraganglioma

Background

Capillary hemangioma is a common benign tumor in children. Its presence in the kidney is rare, and there have been only case reports in the English literature. Herein, we report a special case of capillary hemangioma located in the renal hilum, which was suspected to be a paraganglioma.

Case presentation

A 44-year-old woman had an irregular mass in the right hilar region. She had a history of hypertension for 3 years, and her 24-hour urinary norepinephrine was slightly high (41.53 µg, normal range: 16.69-40.65 µg). Abdominal MRI revealed a mass in the renal hilum measuring approximately 4.8×4.0×3.2 cm, slightly low signal intensity on T1WI, and very high signal intensity on both T2WI and DWI. The multiphase enhanced scan showed that the tumor had obvious enhancement with a central hypointense area. Therefore, paraganglioma was initially diagnosed. Phenoxybenzamine was administered over the next 2 weeks. She performed laparoscopic right hilar area tumor resection, and the kidney was preserved. Unexpectedly, the final pathology report was capillary hemangioma.

Conclusions

Capillary hemangioma in the renal hilum is extremely rare. Surgery is the first choice to reduce the risk of compression symptoms and to rule out malignancy with respect to an undefined growing retroperitoneal mass. In addition, renal-sparing surgery should be preferred.

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.

Spontaneous Kidney Rupture: Two Case Reports With Unusual Presentations

Two patients came to the emergency department with sudden-onset abdominal pain. The first case was a 20-year-old male; a contrast-enhanced computed tomography (CT) scan revealed a 17 cm x 7 cm hematoma in the abdomen and left retroperitoneal space. Furthermore, the left kidney was not visualized by CT. With an emergent diagnostic laparotomy, the etiology of the bleeding was determined to be left atrophic-hydronephrotic kidney rupture. Thus, a left nephrectomy was performed. The second case was a 38-year-old male with a history of chronic hypertension; a CT scan revealed a 7 cm x 6 cm left perirenal hematoma. A left nephrectomy was performed due to hemodynamic instability on the second day of follow-up. A pathology specimen revealed a 1-cm renal cell carcinoma (RCC) in the kidney. In case of hemodynamic instability, spontaneous kidney rupture requires immediate surgical intervention; its causes include atrophic-hydronephrotic kidney and RCC.

Renal Capillary Hemangioma Mimicking Urothelial Carcinoma, A Case Report and Review of the Literature

Renal hemangioma is a rare tumor which can be capillary or cavernous. There have been less than 30 renal capillary hemangioma cases reported in the English literature.

Herein we will report a case of renal hemangioma which was detected in a 74-year-old man operated with the impression of urothelial carcinoma of hilum.

Sinonasal Hemangioma: Diagnosis, Treatment, and Follow-Up of 37 Patients at a Single Center

PURPOSE

Hemangioma is a common benign vascular lesion of the head and neck region. It rarely involves the mucous membranes of the nasal cavity and paranasal sinuses. It should be added to the differential diagnosis of nasal cavity masses when the presenting symptoms are epistaxis or nasal obstruction.

MATERIALS AND METHODS

A retrospective chart review was conducted of a histologic diagnosis of lobular capillary hemangioma or cavernous hemangioma of the sinonasal mucous membranes treated at the Chonbuk National University Hospital from January 1995 through December 2015. There were 1,479 patients diagnosed with hemangiomas in the total body area. Medical records were reviewed to gather data on clinical symptoms, demographic characteristics, site of tumor, imaging and histologic features, and treatment. A review of the literature on previously diagnosed cases of sinonasal hemangioma was performed.

RESULTS

Three hundred patients had hemangiomas in the head and neck region and only 37 patients (12.5%) had hemangiomas of the sinonasal mucous membranes. The most common complaint was nasal obstruction (59.5%), followed by epistaxis (51.4%). There were 18 male (48.6%) and 19 female (51.4%) patients. The predominant subsites were the nasal septum (40.5%), followed by the inferior turbinate (29.7%), the maxillary sinus (8.1%), and the uncinate process (8.1%). Lobular capillary hemangioma (24 of 37) was more common than cavernous hemangioma (13 of 37). There was a meaningful correlation between the histologic type and tumor site of the hemangioma.

CONCLUSION

Sinonasal hemangiomas are relatively uncommon. Clinicians should be aware of the clinical, radiologic, and histologic features of sinonasal hemangiomas to avoid a misdiagnosis of a malignant tumor, angiofibroma, or other benign mass.