The first recurrent intravascular papillary endothelial hyperplasia (Masson’s tumor) of the kidney

Abstract

Intravascular papillary endothelial hyperplasia (IPEH, Masson's Tumor) of the kidney is an unusual, benign vascular lesion. A rare case of recurrent IPEH in the kidney was presented in this article. A 50-year-old male with a diagnosis of a suspicious mass in the left kidney was referred to our center for robotic partial nephrectomy. Robotic zero ischemia partial nephrectomy was performed due to the suspicion of a renal malignancy. On the basis of the histopathological results, the patient was diagnosed as IPEH. A urinary ultrasound was performed on the 3 rd postoperative month and a hyper echoic solid lesion, which was in the same localization, was detected. Due to the previous atypical pathological result, computed tomography (CT) guided fine-needle aspiration biopsy from the left renal mass was performed but malignant cytology was not confirmed with this biopsy. On follow-up CT done 6 months later, a persistent suspicious left renal mass, measuring 40 x 30 cm in size was detected with no change in its dimensions and appearance. Additionally, magnetic resonance imaging (MRI) scan revealed a bone lesion of 15 x 10 mm in the left hip, which was not present on previous MRI/CT scans. In view of the solid masses in the left kidney, and left hip on CT and MRI scan suspicious for a probably metastatic renal neoplasm, left radical nephrectomy via a left subcostal transperitoneal incision was performed. The ultimate pathological report of the patient was also supported the diagnosis of Masson's tumor and any renal malignancy was not encountered The patient was discharged on the 4 th postoperative day and has been followed up for 4 months without any problems. In this case, we discuss the clinical features, histopathological characteristics, and the management of Masson's tumor of the kidney in the light of the current literature.

Masson’s tumor of the kidney: a case report

“…Preoperative diagnosis of renal IPEH was hard to carry out and this led to nephrectomy in all cases. It was managed by a partial nephrectomy as mentioned in three cases [1, 3, 10]. In other cases, radical nephrectomy was realized since tumors were located in the renal hilum.…”

“…Finally, neither metastases nor malignant degeneration has been reported with renal IPEH. There is only one case of recurrence, which occurred after a nephron-sparing surgery [10].…”

“…[8]30MIncidentallyL12HilarCT: renal massRenal neoplasmNephrectomyNA102012Mehta et al . [1]48MNANA22NANARenal neoplasmNSS132/NED112016Alkan et al [10]50MNAL40HilarCT: renal mass with calcifications and internal homogeneous enhancement in the delayed phaseMRI: T1 hypointense T2 hyperintenseRenal neoplasmNSSNephrectomy3/LR4/NED122017Moreillo-Vicente et al . [5]61MFlank painR40HilarCT: heterogeneous mass with necrotic coreMRI: T1 hypointense T2 hyperintenseAdrenal neoplasmNephrectomy6/NED132018Our Case61MIncidentallyL38MidportionUS: hypoechoic massCT: peripheral enhancementMRI: peripheral enhancementRenal neoplasmNephrectomy108/NED CT computed tomography, F female, G graft, L left, LR local recurrence, M male, MRI magnetic resonance imaging, NA not assigned, NED no evidence of disease, NSS nephron-sparing surgery, R right, US ultrasonography…”

Vascular Neoplasms and Related Lesions of Kidney

“…Ultrasound examination of IPEH shows variable echogenicity, and CT demonstrates a heterogeneous mass isodense to the renal parenchyma, frequently with intense peripheral enhancement [69,70]. On MRI, the lesion is hypointense or isointense on T1weighted imaging and hyperintense on T2-weighted imaging [70,71]. Overall, the radiographic features of IPEH in the kidney are nonspecific and often mimic a malignancy with degenerative changes such as necrosis and thrombosis [70].…”

“…On MRI, the lesion is hypointense or isointense on T1weighted imaging and hyperintense on T2-weighted imaging [70,71]. Overall, the radiographic features of IPEH in the kidney are nonspecific and often mimic a malignancy with degenerative changes such as necrosis and thrombosis [70]. On gross examination, a well-demarcated hemorrhagic mass with a dark-red to dark-tan cut surface is seen [69,72].…”