Primary Pleomorphic Undifferentiated Sarcoma—a Rare Renal Localization: A Case Report

A 58-year-old gentleman presented with history of fever and left loin pain for three months. On physical examination, he was found to have a renal mass. On laboratory evaluation he was found to be anaemic (PCV 23.8) with thrombocytosis (7,25,000/mm 3 ) and had an elevated ESR (77). His CT abdomen revealed an 11 x 13 cm heterogenously enhancing mass arising from the upper pole of left kidney [Table/ Fig-1]. There was no involvement of the contiguous structures but superiorly, it was adherent to the spleen. aBstRaCtMalignant Fibrous Histiocytoma (MFH) usually arises from the extremities with the retroperitoneum being the second most common site. We present the case report of a 58-year-old man presenting with fever and was detected to have a renal mass on evaluation. He underwent a radical nephrectomy with a preoperative diagnosis of renal cell carcinoma. But the final histopathological report was MFH. Primary renal MFH is extremely rare and is usually diagnosed on histopathology with the aid of immunohistochemistry.keywords: CD 68, Kidney, Radical nephrectomy microscopy: The renal parenchyma was infiltrated by a fairly circumscribed tumour [Table /Fig-2]; with clustered and scattered polygonal cells to spindle cells with markedly pleomorphic, vesicular nuclei and moderate amount of eosinophilic, cytoplasm. There were multinucleate giant cells, foamy macrophages and bizarre tumor cells. The intervening stroma showed many thick collagen bundle and dense infiltrates of lymphocytes, plasma cells, histiocytes, many neutrophils and eosinophils [Table/ Fig-3]. There was focal hyalinization. There was no lymphovascular invasion or nodal involvement. The tumour cells were negative for desmin and myogenin but showed positive staining with CD68 [Table/ Fig-4] on immunohistochemistry. These features were consistent with the diagnosis of inflammatory subtype of malignant fibrous histiocytoma. The tumour infiltrated the sinus fat with rest of the parenchyma being normal. Spleen showed features of congestive splenomegaly but was otherwise free of tumour [Table/ Fig-5].

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“…Mellas S et al, [10] 2012 Pleomorphic undifferentiated sarcoma Post nephroureterectomy, refused adjuvant therapy. Died after 10 months.…”

Section: Resultsmentioning

confidence: 99%

A Rare Case of Malignant Fibrous Histiocytoma/ Pleomorphic Undifferentiated Sarcoma of the Kidney

Pathrose

John

Manojkumar

2015

JCDR

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“…La radiografía abdominal presenta aumento de densidad con efecto de masa al nivel del flanco comprometido, y la ecografía permite identificar la localización, el tamaño y la estructura renal interna 15 . Aunque el SIP es indistinguible tanto clínica como radiográficamente del carcinoma renal, usando imágenes de mayor resolución, como la tomografía computarizada y la resonancia magné-tica se puede orientar el diagnóstico 14,15,20 . Se han descrito…”

Section: Discussionunclassified

“…El diagnóstico diferencial incluye lesiones benignas como la pielonefritis xantogranulomatosa y malignas como el carcinoma renal sarcomatoide y otros tipos de sarcoma 6,13,14 .…”

Section: Figura 3 Microscopia (H-e)unclassified

“…Se han identificado como factores asociados a pobre pronóstico: edad añosa, tamaño tumoral, profundidad de infiltración, necrosis tumoral, alto índice mitótico y metástasis a distancia 14,17 . El componente inflamatorio y el grado histológico también han sido incluidos 1,19 .…”

Section: Figura 3 Microscopia (H-e)unclassified

“…El SIP es un tumor agresivo, de pobre pronóstico, que tiene la cirugía radical como primera línea de tratamiento con intención curativa 14,16,17,20 . La recurrencia local es alta, entre el 50% y el 82%, en un rango temporal de 3 a 24 meses después de la cirugía 7,15,18 .…”

Section: Figura 3 Microscopia (H-e)unclassified

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