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Year : 2013  |  Volume : 56  |  Issue : 3  |  Page : 318-319
Angioleiomyoma of the kidney parenchyma


Department of Pathology, 251th Hospital of PLA, Zhangjiakou - 075 000, Hebei Province, P.R. China

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Date of Web Publication24-Oct-2013
 

How to cite this article:
Huang Y, Xiong Z. Angioleiomyoma of the kidney parenchyma . Indian J Pathol Microbiol 2013;56:318-9

How to cite this URL:
Huang Y, Xiong Z. Angioleiomyoma of the kidney parenchyma . Indian J Pathol Microbiol [serial online] 2013 [cited 2020 Feb 19];56:318-9. Available from: http://www.ijpmonline.org/text.asp?2013/56/3/318/120412


Sir,

Angioleiomyomas are benign tumors that usually occur in skin as subcutaneous nodules; angioleiomyomas developing in organs other than skin are very rare. [1] To the best of our knowledge, only two cases of renal angioleiomyoma have been reported previously. We here report an unusual case of renal angioleiomyoma and review the literature.

A 45-year-old man presented a mass in his right kidney after routine examination and admitted to 251 th Hospital of PLA for further examination and operation. Ultrasonic examination revealed a 3.4 × 3.5 × 3.1 cm slightly low echo-level mass in parenchyma. Color Doppler flow imaging displayed blood flow in and around the mass. Under the capsule on axial unenhanced computed tomography image shows a homogeneous circumscribed mass under the capsule of the right kidney. Systemic examination was performed and no other lesion was observed in the abdomen. The patient was treated with nephrectomy and four months after the surgery, there was no evidence of recurrence.

On gross examination, the circumscribed mass located under the capsule of the right kidney, measured 4.0 × 3.5 × 3.0 cm. The tumor had a firm, vaguely nodular, pale cut surface with no evidence of calcification or necrosis [Figure 1]a and did not invade the renal capsule. Microscopically, the tumor was located in the parenchyma under the capsule, it was well-demarcated from the adjacent non-neoplastic renal parenchyma and demonstrated smooth pushing borders [Figure 1]b. The tumor was characterized by prominent blood vessels and cellular short spindle cells. The elongated neoplastic cells were distributed in sweeping fascicles in the intervascular area. A concentric growth pattern of neoplastic cells surrounding the blood vessels was frequently seen [Figure 1]c. The neoplastic cells were cytologically bland and exhibited spindle nuclei, evenly distributed chromatin, distinct nucleoli and abundant lightly eosinophilic cytoplasm. No necrosis or mitosis was identified. No cellular pleomorphism or vascular invasion was observed. There were numerous evenly distributed, arteriole-like vessels with thick muscular walls throughout the whole lesion. Some fibrin deposits were found within the blood vessels. Immunohistochemcially, the neoplastic cells exhibited strong and diffuse immunoreactivity for vimentin, muscle-specific action, smooth muscle actin (SMA) [Figure 1]d, but negative for CD34, pan-cytokeratin, epithelial membrane antigen (EMA), HMB45, Melan A, S-100 and CD10. The Ki-67 label was lower (<1%).
Figure 1: (a) The tumor had a firm, vaguely nodular, pale cut surface with no evidence of calcification or necrosis. (b) The tumor was well demarcated from the adjacent non-neoplastic renal parenchyma and demonstrated smooth pushing borders. (c) A concentric growth pattern of neoplastic cells surrounding the blood vessels was frequently seen. (d) The neoplastic cells exhibited strong and diff use immunoreacti vity for smooth muscle acti n

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Mesenchymal tumors of almost every type have been reported as arising in the kidney, with angioleiomyoma being most frequent. Angioleiomyomas are the most common mesenchymal tumors of the adult kidney, but angioleiomyoma is a rare benign tumor arising in the kidney, which often exists as subcutaneous nodules of the lower extremities. The tumors appear as sharply demarcated nodules of well-differentiated smooth muscles and thick-walled vessels of various sizes, which belong to the smooth muscle tumor group according to the 2002 World Health Organization classification of soft-tissue tumors. The differential diagnosis of angioleiomyoma is broad, included myopericytoma, glomus tumor, angiomyolipoma, hemangiopericytoma, leiomyosarcoma, spindle cell renal cell carcinoma. Myopericytoma shares many histologic features with angioleiomyoma. However, it is typically more cellular than angioleiomyoma and unlike the latter tumor, is usually negative or only focally positive for desmin by immunohistochemistry, [2] and angioleiomyoma usually lacked the characteristic perivascular concentric growth of myoid tumor cells, which is a salient feature of myopericytoma. [3] Glomus tumors are typically subungal, which is a well-circumscribed lesion consisting of tight convolutes of capillary-sized vessels surrounded by collars of glomus cells set in a hyalinized or myxoid stroma, proliferation of glomus cells in small and thin vessels at the periphery of glomus tumor is its characteristics. Immunohistochemically, glomus tumor is positive for SMA and type IV collagen. However, angioleiomyoma is composed of smooth muscle bundles that appear to originate from medium-sized vessels. The vessels in the tumor are difficult to characterize, which lack elastic lamina and are thicker than veins. Hemangiopericytomas usually lack the dilated and thick vessels; the cells in hemangiopericytoma lie exterior to the endothelial cells. The cells in hemangiopericytoma have a short spindled morphology, but the cells of angioleiomyoma are cigar-like or sausage-like. Leiomyosarcoma has many mitoses and necrosis was also found, what's more, celluar plemorphism was obvious. Spindle cell renal cell carcinoma appears spindle and fascicle pattern, but the cells are plump and don't grow around the vessels. What's more, immunohistochemically, the cells of spindle cell renal cell carcinoma were positive for cytokeratin and EMA; it was easily different from angioleiomyoma. Angiomyolipoma is the most common mesenchymal tumor of the kidney. Classic angiomyolipoma is characterized by the presence of a variable mixture of adipose tissue, spindle and epithelioid smooth muscle cells and abnormal thick-walled blood vessels and also the smooth muscle appears to take origin from the peripheral muscle of the blood vessel walls. If the adipose is not obvious, it could be confused with angioleiomyoma, but immunohistochemical staining indicates HMB45 and Melan A positive more or less in angiomyolipoma. Leiomyoma is a benign neoplasm with smooth muscle differentiation, which is not found thick-wall vessels appearing in angioleiomyoma. The prognosis of angioleiomyoma is favorable; however, more cases are needed to enhance our knowledge of the diagnosis, treatment and prognosis of this rare renal lesion.

 
   References Top

1.Lavis R, Igbokwe U, Freeman S, Smith M. Intratesticular angioleiomyoma. Arch Pathol Lab Med 2004;128:1165-6.  Back to cited text no. 1
    
2.Lau SK, Klein R, Jiang Z, Weiss LM, Chu PG. Myopericytoma of the kidney. Hum Pathol 2010;41:1500-4.  Back to cited text no. 2
    
3.Mentzel T, Dei Tos AP, Sapi Z, Kutzner H. Myopericytoma of skin and soft tissues: Clinicopathologic and immunohistochemical study of 54 cases. Am J Surg Pathol 2006;30:104-13.  Back to cited text no. 3
    

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Correspondence Address:
Yong Huang
Department of Pathology, 251th Hospital of PLA, Zhangjiakou - 075 000, Hebei Province, P.R. China.

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.120412

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