Indian Journal of Urology
CASE REPORT
Year
: 2002  |  Volume : 18  |  Issue : 2  |  Page : 153--154

Cystic renal leiomyosarcoma : An aggressive tumour


M Raghavendran, Anant Kumar, Raj Shekhar Gupta, Aneesh Srivastava 
 Department of Urology, SGPGIMS, Lucknow, India

Correspondence Address:
Anant Kumar
Department of Urology, SGPGIMS, Raebareli Road, Lucknow - 226 014
India




How to cite this article:
Raghavendran M, Kumar A, Gupta RS, Srivastava A. Cystic renal leiomyosarcoma : An aggressive tumour.Indian J Urol 2002;18:153-154


How to cite this URL:
Raghavendran M, Kumar A, Gupta RS, Srivastava A. Cystic renal leiomyosarcoma : An aggressive tumour. Indian J Urol [serial online] 2002 [cited 2022 May 28 ];18:153-154
Available from: https://www.indianjurol.com/text.asp?2002/18/2/153/37621


Full Text

Primary renal sarcomas are very rare tumours, consti­tuting 1-3% of all malignant renal tumours and of these 40-60% are accounted by leiomyosarcoma (LMS). [1] Here we describe an unusual case of cystic form of a renal leiomyosarcoma.

 Case Report



A 28-year-old female presented with pain in the left flank. Her clinical examination was insignificant and re­nal function was normal. The IVP revealed a drooping lily pattern and USG (ultrasonography) suggested upper polar hydronephrosis [Figure 1]. The contrast enhanced CT scan revealed an irregular cystic mass arising from upper pole of left kidney and the margin of the mass was en­hancing [Figure 2]. Patient was subjected to a radical nephrec­tomy with excision of tail of pancreas, spleen and lymph nodes as they were adherent to the tumour. Histopatho­logy revealed mesenchymal tumour with clear margins. Immunohistochemistry established the diagnosis of LMS. Patient presented 6 months later with paraparesis and MRI examination revealed lytic bone lesions at T 10 L 2 and a paravertebral mass adjacent to L 2 area. Patient did not ac­cept chemotherapy and went home.

 Discussion



The peak frequency of LMS is in the 5 th -6 th decade, and women outnumber men in 2:1 ratio. A flank mass with pain is the characteristic presentation. Radiographic find­ings are nonspecifc and diagnosis is usually made by his­topathological examination postoperatively. [2]

Only in 1/3 of cases tumour intrarenal, as in our case. On gross inspection tumour is firm, fibrous, multi-nodu­lar with a bosselated surface. [1] In our patient gross exami­nation revealed a cystic mass, which is an unusual finding. Cystic areas are reported only in large leiomyosarcomas.

However entire tumour as a cystic mass is very rare.

Leiomyosarcomas have poor prognosis and the 5-year survival has been reported to be 29.36%. [3] The favourable prognostic markers are size [4] In our case, except for the size all other favourable prognostic factors were present.

We conclude that in renal LMS, size is probably the most important prognostic factor and cystic component of the tumour may also have a say in predicting the be­haviour. A cystic mass with thick walls in CT should raise the suspicion of sarcoma.

References

1Farrow GM. Diseases of the kidney. In: Murphy WM (ed.). Urological pathology. Philadelphia, Saunders 1997; 474-475.
2Dominici A et al. Cystic leiomyosarcomas of the kidney. An unu­sual clinical presentation. Urol Int 65; 229-231.
3Vogelzang NV. Guinan PD, Sener SF et al. Primary renal sarcoma in adults : A natural history and management study by the Ameri­can Cancer Society, Illinois Division. Cancer 1993; 71: 804-810.
4Karantzas N. Agapitos E et al. Renal LMS : Report of 3 cases and review of the literature. Arch Ital Urol Androl 71: 307-311.