World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access
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Case Report

Volume 4, Number 2, June 2015, pages 213-217

Renal Leiomyosarcoma: Case Report and Review of the Literature

Figures

Figure 1.
Figure 1. Computed tomography of abdomen and pelvis without contrast prior to surgery showed an enhancing, heterogeneous, 9.5 cm endophytic right renal mass with mild retroperitoneal lymphadenopathy (a) axial view (b) coronal view.
Figure 2.
Figure 2. Sharply demarcated, spindle tumor cells are seen adjacent to uninvolved kidney parenchyma (HE, × 40).
Figure 3.
Figure 3. Fascicular arrangement of spindled cells are seen (HE, × 100).
Figure 4.
Figure 4. Staining for caldesmon, a smooth muscle marker, shows strong cytoplasmic positivity (× 100).
Figure 5.
Figure 5. At × 200, numerous mitoses are evident. The nuclei are cigar-shaped with granular eosinophilic cytoplasm. Focal giant cells are present.

Table

Table 1. A Selected Review of Literature on Renal Leiomyosarcoma
 
YearPatientCC and locationImagingClinical and final DxTreatmentSx after TxMicroscopic viewIHC positiveSignificance
CC: chief complaint; Dx: diagnosis; Sx: symptoms; Tx: treatment; R: right; L: left; M: male; F: female; HTN: hypertension; IHC: immunohistochemistry; LMS: leiomyosarcoma; CT: computed tomography; MRI: magnetic resonance imaging; US: ultrasonography; RCC: renal cell carcinoma; TCC: transitional cell carcinoma; Asymp: asymptomatic; Lap: laparoscopic; Ab: abdominal; FU: follow-up.
Kwon et al201546 M; WhiteR flank pain; R kidneyCT: enhancing heterogeneous 9.5 cm endophytic right massRCC; high grade LMSR robotic total nephrectomyAsympFascicular arrangement of spindled cellsSmooth muscle actin, caldesmon, vimentin; negative for desminYoung male patient
Demir et al [4]200755 F; WhiteAb pain, fever; R kidneyMRI: R sided renal mass (3.8 × 2 × 2 cm)RCC; high grade LMSNephron-sparing surgeryAsymp and disease free at 2 - 3 yearsMyofibrils in cross formation, pleomorphism, mitotic activity, hyalinization and vascular proliferationVimentinPatient refused surgery initially; FU for 3 years; nephron-sparing surgery still feasible
Tanaka et al [5]201450 F; JapaneseAb pain; R kidneyCT: calcification of upper pole of R kidneyRCC cT3N0M0; LMS pT2aN0M0R heminephrectomy and division of isthmusAsymp and disease-free at 6 monthsSmooth muscle cell with alternating fascicles of spindle shaped cellsAlpha smooth muscle, desmin, and Ki-67Horseshoe kidney in Turner syndrome patient
Venkatesh et al [6]201055 F; IndianL flank pain, palpable mass; L kidneyCT: large L renal mass without any vascular or hepatic metastasisRCC; LMSL radical nephrectomy and L hemicolectomyUnknownSpindle shaped with abundant eosinophilic cytoplasm. Area of necrosis, cystic change, and lymphoplasmacytic infiltrateActin and desminColonic adhesion requiring hemicolectomy in addition to nephrectomy
Pong et al [7]201274 F; AsianAb pain; L kidneyUS of abdomen: 8.3 × 5.9 cm massRCC cT2N0M0; LMSR radical nephrectomyAsymp; MRI 1 month after surgery shows no metastasisSpindle cells; tumor cells blunt-ended nuclei and eosinophilic cytoplasm; nuclear atypiaSmooth muscle actin and desminNA
Valery et al [8]201370 M; WhiteR flank pain; R kidneyCT: stable renal massRCC or TCC; grade II LMSR lap nephrectomyUnknownAtypia with scattered mitotic figures and no areas of necrosisActin and desminSeveral preoperative biopsies were negative for malignancy
Ellouze et al [9]201165 F; unknown raceR flank pain; R kidneyCT: 13 × 11 × 10 cm solid renal massUnknown; grade III LMSR radical nephrectomyAsymp at 15 months still has arterial hypertensionSpindle shaped cells; pleomorphic and hyperchromatic cigar-shaped nuclei and eosinophilic cytoplasm w mitotic figuresVimentin, desmin, h-caldesmon, and smooth muscle actinLarge-sized tumor and persistent arterial HTN after surgery