NDT Advance Access originally published online on October 4, 2005
Nephrology Dialysis Transplantation 2006 21(1):228-229; doi:10.1093/ndt/gfi156
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Images in Nephrology
(Section Editor: G. H. Neild)
Renal capsular leiomyoma—imaging features on computed tomography and angiography
1 Department of Nephrology and 2 Departmant of Radiology, Chang-Gung Memorial Hospital, Taipei, Taiwan
Correspondence and offprint requests to: Li-Jen Wang, MD, Department of Radiology, Chang-Gung Memorial Hospital, 199, Tung Hwa North Road, Taipei 105, Taiwan. Email: ljw33db{at}adm.cgmh.org.tw
Keywords: angiography; capsule; computed tomography; kidney; leiomyoma
Case
A 60-year-old woman presented with a sense of fullness in the flank for 1 month. Urinalysis revealed microscopic haematuria. Serum creatinine was normal. Initial survey with excretory urography was unremarkable. Physical examination on admission revealed no palpable masses. Computerized tomography (CT) of the abdomen showed a well-circumscribed mass of homogenous density abutting on the upper pole of the right kidney (Figure 1). Right renal angiography disclosed a hypervascular tumour, primarily supplied by right renal capsular artery (Figure 2). She underwent right radical nephrectomy. On gross examination of the specimen, a 5.0 x 3.1 x 2.6 cm exophytic tumour was found on the upper pole, invested by renal capsule and completely separated from renal parenchyma. Microscopically, it was composed of interlacing fascicles of spindle cells without mitotic figures and pleomorphism. Immunohistochemical study showed positive stain with smooth muscle specific actin. The pathological diagnosis was a renal capsular leiomyoma. Convalescence was uneventful with no evidence of recurrence 5 years post-operatively.
|
|
Discussion
Symptomatic renal capsular leiomyomas are rare, although they are usually discovered accidentally at autopsy [1–3]. The most frequent presenting features are abdominal mass, pain and microscopic haematuria [1]. Renal leiomyomas are well-circumscribed tumours without arteriovenous shunting, vascular encasement, extrarenal invasion and metastasis on angiography and CT [1,2]. In our patient, the lenticular shape on CT and arterial supply from capsular artery on angiography imply its capsular origin. The absence of significant parenchymal distortion also provides a clue that it is not an exophytic renal cell carcinoma.
Unfortunately, renal leiomyoma is almost impossible to distinguish clinically from its malignant counterpart, although the presence of weight loss and gross haematuria are more consistent with renal leiomyosarcoma than with leiomyoma [1]. In fact, it is believed that leiomyosarcoma results from malignant degeneration in the pre-existing leiomyoma [1]. Sarcomatous change of a leiomyoma is also difficult to identify on imaging [4]. The only definite method of diagnosis relies on microscopic evaluation [1–3]. The presence of frequent mitosis, pleomorphism or adjacent tissue invasion is consistent with malignant change [1]. Total nephrectomy is indicated for large leiomyomas to avoid the risk of malignancy, necrosis and infection [4].
References
- Steiner MS, Quinlan D, Goldman SM et al. Leiomyoma of the kidney: presentation of 4 new cases and the role of computerized tomography. J Urol 1990; 143: 994–998[Medline]
- Zollikofer C, Castaneda-Zuniga W, Nath HP et al. The angiographic appearance of intrarenal leiomyoma. Radiology 1980; 136: 47–49
[Abstract/Free Full Text] - Mohler JL, Casale AJ. Renal capsular leiomyoma. J Urol 1987; 138: 853–854[Medline]
- Nagar AM, Raut AA, Narlawar RS et al. Giant renal capsular leiomyoma: study of two cases. B J Radiol 2004; 77: 957–958
[Abstract/Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  V. R. Surabhi, C. Menias, S. R. Prasad, A. H. Patel, A. Nagar, and N. C. Dalrymple Neoplastic and Non-neoplastic Proliferative Disorders of the Perirenal Space: Cross-sectional Imaging Findings1 RadioGraphics, July 1, 2008; 28(4): 1005 - 1017. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. R. Prasad, V. R. Surabhi, C. O. Menias, A. A. Raut, and K. N. Chintapalli Benign Renal Neoplasms in Adults: Cross-Sectional Imaging Findings Am. J. Roentgenol., January 1, 2008; 190(1): 158 - 164. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||