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(A) Pre-enhanced CT image shows a 4.3x3.8cm, well circumscribed mass on the peri-hilar portion of the right kidney (yellow arrow) and small calcifications on pancreatic head portion (red arrow). (B) Contrast-enhanced CT shows a well-defined mass with obviously annular and nodular enhancement which is suggestive of renal cell carcinoma (yellow arrow). (C) Delayed CT image shows a right renal mass with homogeneously persistent enhancement and a well-circumscribed boundary (yellow arrow).
Contexts in source publication
Context 1
... blood chemistries were unremarkable except for an elevated serum creatinine (1.81mg/dl), and decreased estimated glomerular filtration rate (eGFR) (44.8ml/min/1.7m 2 ). Pre-en- hanced CT image showed a 4.3x3.8cm, well circumscribed mass on the peri-hilar portion of the right kidney and small cal- cifications on pancreatic head portion (Fig. 1A). Contrast-en- hanced CT showed a well demarcated mass with obviously in- (x200) and (B) factor VIII-related antigen (x200), but negative for (C) cytokeratin (x200), and (D) D2-40, a mesothelial biomarker (x200). tense annular and nodular enhancement (Fig. 1B). On delayed CT image, the mass showed homogeneously persistent enhance- ment ...
Context 2
... portion of the right kidney and small cal- cifications on pancreatic head portion (Fig. 1A). Contrast-en- hanced CT showed a well demarcated mass with obviously in- (x200) and (B) factor VIII-related antigen (x200), but negative for (C) cytokeratin (x200), and (D) D2-40, a mesothelial biomarker (x200). tense annular and nodular enhancement (Fig. 1B). On delayed CT image, the mass showed homogeneously persistent enhance- ment and a well-circumscribed boundary (Fig. 1C). The CT findings were suggestive of renal cell carcinoma. We performed laparoscopic radical nephrectomy after detailed discussion be- cause the tumor was too close to the main renal vein to do partial nephrectomy. ...
Context 3
... showed a well demarcated mass with obviously in- (x200) and (B) factor VIII-related antigen (x200), but negative for (C) cytokeratin (x200), and (D) D2-40, a mesothelial biomarker (x200). tense annular and nodular enhancement (Fig. 1B). On delayed CT image, the mass showed homogeneously persistent enhance- ment and a well-circumscribed boundary (Fig. 1C). The CT findings were suggestive of renal cell carcinoma. We performed laparoscopic radical nephrectomy after detailed discussion be- cause the tumor was too close to the main renal vein to do partial nephrectomy. Grossly, cut section of the kidney showed 4.3x2.7cm tumor with well-demarcated margins and a spongy consistency in the ...
Citations
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.
Anastomosing haemangioma of the kidney is a benign vascular neoplasm composed of thin-walled anastomosing blood vessels. Anastomosing haemangiomas are exceptionally rare. Approximately 75 cases have been described in the literature. The mean age of patients at diagnosis is 49 years (range, 10–83 years). There is a slight male predominance with a male-to-female ratio of 2:1. Patients present with non-specific symptoms including abdominal pain, haematuria, and abdominal mass. Anastomosing haemangiomas are spongy and well circumscribed mahogany brown masses without necrosis. These tumours are usually unilateral and solitary. Microscopically, the tumours are composed of anastomosing capillary-sized blood vessels lined by a single layer of bland endothelial cells. Anastomosing haemangiomas are positive for ERG, CD31, CD34, factor VIII-related antigen and FLI1. These tumours harbour recurrent somatic mutations in the GNAQ gene and its paralogue, GNA14. The considerable overlap of clinical features and imaging characteristics between anastomosing haemangioma and other vascular tumours of the kidney, particularly primary renal angiosarcoma, makes diagnosis quite challenging. Unlike primary renal angiosarcoma, anastomosing haemangioma has an excellent prognosis with no risk of recurrence or metastasis. For this reason, anastomosing haemangioma must be distinguished from primary renal angiosarcoma. Awareness of anastomosing haemangioma of the kidney is essential to avoiding misdiagnosis of primary renal angiosarcoma and preventing unnecessary aggressive treatment.
Background: Vascular tumors of the kidney are rare tumors that are usually diagnosed and confirmed by histopathological examination due to the difficulty in definitive diagnosis by clinical and radiological examination. Anastomosing hemangioma is a rare variant of capillary hemangioma that mimics angiosarcoma.
Case Report: Here, we present a case of a 55-year-old female with a history of partial nephrectomy due to clear cell renal cell carcinoma three years earlier, who presented with a contralateral anastomosing capillary hemangioma. The diagnosis was confirmed by histopathology and immunohistochemistry studies.
Conclusions: Anastomosing hemangioma is a rare variant of capillary hemangioma. It has a sinusoidal growth pattern which resembles splenic parenchyma. It mimics malignant neoplasms, thus, clinical and radiological examination are not enough for accurate diagnosis. In this paper, we discuss the most crucial differential diagnoses and the pitfalls in diagnosing this rare variant of hemangioma. Furthermore, we present a literature review of all cases reported in the English-language literature.
