Article

Renal hilar mass in an 85-year-old woman. Solitary fibrous tumor.

Department of Pathology and Microbiology, The Nebraska Medical Center, Omaha, NE 68198-3135, USA.
Archives of pathology & laboratory medicine (Impact Factor: 2.88). 02/2006; 130(1):117-9. DOI: 10.1043/1543-2165(2006)130[117:RHMIAY]2.0.CO;2
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    ABSTRACT: Solitary fibrous tumors are rare mesenchymal spindle cell neoplasms that are usually found in the pleura. The kidneys are an uncommon site and only few cases of renal solitary fibrous tumor exhibit malignant behavior metastasizing to the liver, lung, and bone through the hematogenous pathway.PurposeTo describe the first case of lymph node metastasis from renal solitary fibrous tumor in order to increase the knowledge about the malignant behavior of these tumors.Patients and methodsA 19-year-old female patient had intermittent hematuria for several months without flank pain or other symptoms. A chest and abdomen CT scan was performed and showed a multi-lobed bulky solid mass of 170 × 98 × 120 mm in the left kidney. One day before the surgery, the left renal artery was catheterized and the kidney embolization was performed using a Haemostatic Absorbable Gelatin Sponge and polyvinyl alcohol. We then performed a radical nephrectomy with hilar, para-aortic, and inter-aortocaval lymphadenectomy.ResultsEstimated intraoperative blood loss was 200 mL and the operative time was 100 minutes. No postoperative complications occurred. The hospital stay was 7 days long. The histological examination was malignant solitary fibrous tumor of the kidney. Cancerous tissue showed cellular atypia, with an increased mitotic index (up to 7 × 10 hpf). Immunohistochemical analysis showed positive results for CD34, BCL2, partial expression of HBME1, and occasionally of synaptophysin. Histological evaluation confirmed the presence of metastasis in one hilar node. The patient did not receive any other therapy. At 30-month follow-up, the patient was in good health and no local recurrence or metastases had occurred.ConclusionThis is the first case of lymph node metastasis from a renal solitary fibrous tumor showing unusual malignant behavior; this finding adds new information about the biology and progression of these tumors, which remain unclear.
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    ABSTRACT: Renal solitary fibrous tumor (SFT) is a rare, and a large scale study on this topic is lacking to date. In this article, we summarize the previously reported cases. The symptoms and signs resemble those of renal cell carcinoma, including hematuria, flank/abdominal/lumbar pain and palpable abdominal mass. Grossly, the tumor demonstrates a well-circumscribed solid mass. Microscopically, the tumor consists of fusiform or ovoid spindle cells and a various amounts of collagen bundles with patternless, storiform, or fascicular arrangements with an occasional hemangiopericytomatous pattern. Immunohistochemically, CD34, CD99 and bcl-2 are often detected. Ultrastructurally, tumor cells contain irregular nuclei, prominent Golgi apparatus, branching rough endoplasmic reticulum, variable numbers of mitochondria. Surgical resection is considered to be the gold standard therapy. Most of renal SFT are benign, but cases of approximately 10 to 15% behave in an aggressive fashion. All patients need to be on long-term follow-up because clinical behavior is rather unpredictable. As the molecular genetic study of renal SFTs is lacking, a large scale study will be desirable in the future.
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    ABSTRACT: A 49-year-old woman admitted to our hospital with a 3-month history of right flank pain without gross hematuria. Computed tomography scan of the abdomen showed that a 6x6x5 cm, contrast-enhanced mass was localized on the right renal pelvis. Histologically, a tumor composed of small ovoid to spindle shaped nuclei with indistinct cytoplasm was seen. Neoplastic cells showed diffuse immunoreactivity with CD34. It was diagnosed as solitary fibrous tumor. Solitary fibrous tumor of kidney is a very rare spindle cell neoplasm. It can mimic renal malignancy radiographically but almost all of renal solitary fibrous tumors are benign lesions. ÖZET Böbreğin soliter fibröz tümörü: bir olgu sunumu ve literatürün detaylı gözden geçirilmesi Kırk dokuz yaşındaki kadın hasta, gros hematüri olmaksızın 3 aydır süren sağ yan ağrısı şikayeti ile hastanemize başvurdu. Bilgisayarlı tomografide batında, sağ renal pelvis yerleşimli, kontrast tutan 6x6x5 cm boyutlarında kitle görüldü. Histolojik kesitlerde, küçük, iğsi-oval çekirdekli, sitoplazmik sı-nırları net olarak seçilemeyen hücrelerden oluşan tümör görüldü. Neoplastik hücreler CD34 ile kuvvetli immünreaktivite gösterdi. Lezyona soliter fibröz tümör tanısı konuldu. Böbreğin soliter fibröz tümörü, nadir görülen iğsi hüc-reli bir neoplazmdır. Radyolojik olarak renal maligniteleri taklit edebilir, ancak hemen tüm renal soliter fibröz tümörler benign lezyonlardır.