Renal leiomyoma: Case report and literature review

Abstract

Renal leiomyomas are rare benign tumours of the kidney originating from muscle cells. They are usually found by an autopsy, whether the patient is asymptomatic or has symptoms (i.e., abdominal/flank pain, hematuria, palpable mass). Today the widespread use of ultrasonography and computed tomography has increased the detection of clinically asymptomatic renal leiomyomas. The differential diagnosis between leiomyomas and other malignant lesions (above all renal cell carcinoma or leiomyosarcoma) is still possible by histological examination. Radiological examinations are not sufficient for the differential diagnosis. Renal leiomyomas have no aggressive behaviour and they usually do not metastasize. The prognosis, after surgery, is excellent without recurrence. We report a case of leiomyoma in a 31-year-old man who presented hematuria and flank pain. We also review the literature and provide a summary of clinical, radiological and histological features of renal leiomyomas. IntroductionRenal leiomyomas are rare benign tumours of the kidney originating from muscle cells. Differential diagnosis between leyomiomas and other malignant lesions is not possible with imaging, but only with histopathological exam. We report a case of leiomyoma in a 31-year-old man who presented hematuria and flank pain. We also review the literature and provide a summary of clinical, radiological and histological features of renal leiomyomas. Clinical historyA 31-year-old male presented in the emergency department with hematemesis and abdominal pain on the left flank. An esophagogastroscopy was performed which revealed linear erosions as "grade B erosive esophagitis" that was treated with injection of adrenaline. The next day the patient presented a second time with left flank pain and hematuria. MethodsThe ultrasonography detected an enlargement of the left kidney with a mass occupying the caudal half of the organ, hypoechoic with irregular central fluid collection and destructuration of the normal renal echostructure. Using a power Doppler, we found that the lesion was hypovascular with no visualization of the renal vein.A computed tomography (CT) scan the lesion was described as a voluminous heterogeneous mass of 8.6 × 11 cm in the lower pole of the left kidney. Without contrast medium, the lesion appeared hyperdense compared the surrounding renal parenchyma and with signs of bleeding. After contrast medium injection, the tumour was hypodense in relation to the renal cortex. A CT scan also revealed a renal pelvis and ureter dilatation with non-flow of contrast medium into bladder (Fig. 1, Fig. 2). Since a definitive diagnosis was impossible, the patient underwent nephrectomy with adrenal gland-sparing and para-aortic and retroaortic lymphadenectomy. ResultsOn gross examination, the mass was circumscribed and encapsulated with a well-defined limit between the thin rim of renal tissue and the lesion. The outer surface was lobular, and the cut surface showed a solid whorled white appearance. The tumour was very hard in consistency. No...

Renal Leiomyoma: An Uncommon Differential Diagnosis of Renal Masses with a Clinical Relevance

“…The average age at presentation ranges from 40-45 years [6]. Both the findings, not being in concordance with this particular case, make it an unusual presentation of renal leiomyoma.…”

“…More than 50% cases reported in the literature presented with pain and a palpable mass, 20% presented with hematuria with a fair number of cases being incidental with no clinical signs or symptoms [6]. In this case as well the patient presented with a non specific complaint of flank pain.…”

“…The autopsy evidence has a much higher frequency than the clinical incidence [5]. The literature reviewed showed an autopsy evidence of 4.2% to 5.2% [6]. They are often detected incidentally.…”

“…With the new advents in radiology and imaging this third group encompasses a majority of leiomyoma cases [6].…”

Leiomyoma of the tunica albuginea, a case report of a rare tumour of the testis and review of the literature

“…But there are also been seen cases of leiomyomas of the renal pelvis, bladder, spermatic cord, epididymis, prostate, scrotum and the glans penis [1,3-6]. Rare cases of a primary ovarian leiomyoma [7] , leiomyoma of the testis [8] or leiomyoma of the kidney have been also reported [9]. Leiomyomas of the tunica albuginea are extremely rare, and to our knowledge only five cases have been reported so far [10-15].…”