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Case Report
Controlateral and mesenteric metastasis of kidney leiomyosarcoma sixteen years after the surgery: A case report
1 Sahloul Hospital, Department of Urology, Route de la ceinture, Hammam Sousse, Sousse, Tunisia
2 Sahloul Hospital, Department of Radiology, Route de la ceinture, Hammam Sousse, Sousse, Tunisia
3 Farhat Hached Hospital, Department of Histopathology, Ibn El Jazzar Road, Sousse Ezzouhour, Sousse, Tunisia
Address correspondence to:
Skander Zouari
Route de la ceinture, Hammam Sousse,
Pin- 4011, Tunisia
Message to Corresponding Author
Article ID: 100958Z01SZ2018
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Zouari S, Othmen MB, Cheikh YB, Yacoub S, Hmissa SBHS, Mokni M, Jaidane M, Hmida W, Mosbah AF. Controlateral and mesenteric metastasis of kidney leiomyosarcoma sixteen years after the surgery: A case report. Int J Case Rep Images 2018;9:100958Z01SZ2018.ABSTRACT
Introduction: Primary renal leiomyosarcoma is an extremely rare malignant tumour. It is more common in females than in males and in the right kidney. The diagnosis is difficult. The prognosis is poor because of frequent metastasis and recurrence.
Case Report: A 41-year-old woman who had undergone left radical nephrectomy for a kidney tumour 16 years previously presented to our institution with right flank pain. On examination, the left sided mass was a 20 cm encapsulated firm tumor with necrotic and hemorrhagic foci compressing the residual kidney. Histological examination showed a high cellular proliferation of large spindle cells mixed with necrosis and calcification. Nuclei were irregular, hyperchromatic, 4 mitoses/10hpf were counted. Renal capsule and renal vein were tumor free. Tumors cells were positive for smooth muscle actin (AML), neuron specific enolase (NSE), with negative expression for, anti S100, cytokeratin, Epithelial membrane Antigen (EMA), HMB45 and CD34. Histopathological examination concluded to a low grade leiomyosarcoma without capsular effraction neither lymph node invasion measuring 20x13x10 cm. No postoperative treatment was indicated and the patient was lost to follow up for 16 years. Imaging finding (MRI) revealed a solid heterogenic mass at the lower pole of the right kidney. Besides, three mesenteric masses were noticed. A controlateral and mesenteric metastasis of the left kidney leiomyosarcoma was suspected. In order to confirm the diagnosis, an ultrasound guided biopsy of the right kidney lesion was performed. Histopathological findings concluded to a low grade leiomyosarcoma. The patient did not undergo surgery and was referred to a medical oncology center and chemotherapy is in progress.
Conclusion: Leiomyosarcoma of the kidney is a rare aggressive tumour. Only few cases are reported in literature. Clinical features are non-specific making generally a delayed diagnosis. The treatment is based on surgery. The prognosis is still poor.
Keywords: Metastasis, Renal leiomyosarcoma, Recurrence, Surgery, Sarcoma
SUPPORTING INFORMATION
Author Contributions
Skander Zouari - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mouna Ben Othmen - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Yasser Ben Cheikh - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sarra Yacoub - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Sihem Ben Haj Salah Hmissa - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Moncef Mokni - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Mehdi Jaidane - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Wissem Hmida - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ali Faouzi Mosbah - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this case report.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2018 Skander Zouari et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
