435

CASE REPORTS

Malignant Fibrous Histiocytoma of the Renal Capsule J.A. SCHNEIDER, H. KONlG and E. HERTEL, Departments of Urology and Pathology, General Hospital, lngolstadt, Germany

Case Report A 49-year-old female discovered a tumour in her abdomen shortly before being admitted to hospital. Her previous history was uneventful. Examination revealed a mobile, large, hard tumour in the right hypogastric region. Haematological and biochemical tests, chest X-ray and bone scan showed no abnormalities. Intravenous urography showed normal structures on the left side but on the right only the upper calices appeared normal. The rest of the renal pelvis was obscured by a 12-cm turnour. Sonography identified a 9 x 12 cm tumour, partly filled with liquid, originating from the lower pole of the right kidney, and a 1.5 cm lesion in the left hepatic lobe. Computed tomography confirmed the haemangioma of the liver and a solid tumour with central necrosis and cranial displacement of the kidney. Angiography showed the lesion in the kidney to have a pathological vessel pattern and non-hornoge-

neous filling during the parenchymal phase (Fig. 1). Suspecting a renal carcinoma, we performed a transperitoneal nephrectomy. The patient made an uneventful recovery. Macroscopic inspection showed the right kidney to be small. The tumour appeared to originate from the capsule of the lower pole. It was surrounded by smooth connective tissue, displayed a greyish-white cut surface and contained central necrosis or haernatoma (Fig. 2). Histological examination showed spindle-shaped nuclei of fibroblastoidcells embedded in collagenous stroma. Interspersed were groups of histiocytes and pleomorphic giant cells with large nuclei and moderate mitotic activity. In several sections the tumour cells lay only a few tissue layers from the capsule. Stain for alpha-l-antichymotrypsin was moderately positive in the tumour cells but stains for desmin and actin as a pure muscle marker proved negative.

Comment Approximately 12 to 14% of malignant fibrous histiocytomas occur in the retroperitoneum or kidneys. Only 6 cases originating in the renal capsule have been described (Takashi et al., 1987). The most common symptoms are a palpable abdominal tumour, fever, fatigue, weight loss and gastrointestinal problems (Kearney el al., 1980). The diagnosis can only be made histologically.

Fig. 1 Selective digital substraction angiogram of right kidney shows (A) a large mass with pathological neovascularity in the arterial phase and (B) non-homogeneousfilling in the parenchymal phase.

436

BRITISH JOURNAL OF UROLOGY

Primary Hepatorenal Hydatid Disease K. RADHAKRISHNA, P. L. N. G. RAO and V. SHENOY, Departments of Paediatric Surgery and Paediatrics, Kasturba Medical College and Hospital, Manipal, India

Case Report

Fig. 2 Gross appearance and cut surface of the tumour, which appears as a greyish-white mass with central necrosis; it is partially detached from the renal parenchyma.

A 9-year-old boy was admitted with a 4-week history of abdominal pain and fever. He had had similar attacks previously and had been in close contact with a pet dog. Examination revealed 2 abdominal masses, one in the left epigastric region and the other in the left lumbar region. Both were cystic, with doubtful cross-fluctuation. A dumb-bell mesenteric cyst was diagnosed. Sonography revealed 2 separate cystic masses, one in the left lobe of the liver and the other in close relation to the left kidney. Intravenous urography showed medial displacement and distortion of the left pelvicaliceal system (Fig. I). Casoni’s test was negative. A laparotomy was performed and hydatidosis was diagnosed. The first hydatid cyst was in the left lobe of the liver and was about to rupture, and the second was in the cortex of the left kidney (Fig. 2). There were no daughter cysts and the peritoneal cavity was free. The ectocysts were removed and the cavities obliterated. The patient made an uneventful recovery and intravenous

The best treatment is radical removal of the tumour. If there is local infiltration or distant metastases, treatment with cyclophosphamide, vincristine, doxorubicin, actinomycin D or cisplatin may be indicated, although the response rate is only 33% compared with other sarcomas (Leite et al., 1977). Radiotherapy offers little, if any, benefit. The overall prognosis is poor and the 5-year survival rate is less than 14%(Kearney et al., 1980).

References Kearney, M. M., Soule, E. H. and Ivins, J. C. (1980). Malignant fibrous histiocytoma. A retrospective study of 167 cases. Cancer, 45, 167-178. Leite, C., Goodwin, J. W., Sikovics, J. G. et al. (1977). Chemotherapy of malignant fibrous histiocytoma. A Southwest Oncology Group report. Cancer, 40,2010-2014. Takahashi, M., Murase, T., Kato, K. et al. (1987). Malignant fibrous histiocytoma arising from the renal capsule: report of a case. Urol. Int., 42,227-230.

Requests for reprints to: J. A. Schneider, Department of Urology, General Hospital of Ingolstadt, Krumenauerstrasse 25, 8070 Ingolstadt, Germany.

Fig. 1 Intravenous urogram (lateral view) showing anteriorly displaced and distorted left pelvicaliceal system.

Malignant fibrous histiocytoma of the renal capsule.

435 CASE REPORTS Malignant Fibrous Histiocytoma of the Renal Capsule J.A. SCHNEIDER, H. KONlG and E. HERTEL, Departments of Urology and Pathology, G...
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