Giant Renal Hemangioma in an Adolescent Girl - Beyond the Abstract
This case report is an important example of diagnostic challenges in adolescents with renal masses. The patient was a 15-year-old female who was admitted to our department for intermittent abdominal pain ongoing for 10 days. Her physical examination revealed a tender, easily palpable mass on the right upper quadrant. Her urinalysis was normal, hemoglobin level was 9.8 mg/dl and C-reactive protein level was high (136 mg/dl). Abdominal ultrasonography showed multicystic lesion located in the renal pelvis of the kidney with hyperechogenic solid components, 15.0 x 11.3 x 11.2 cm in size, showing vascularity on Doppler ultrasound imaging. Contrast enhanced abdominal computed tomography (CT) revealed 14.9 x 11.0 x 11.3 cm mass lesion located in the right renal hilum. The mass lesion has growth over parapelvic region compressing the renal parenchyma and the collecting system, exhibiting an enhancing capsule while having multicystic components with intralesional arteries larger than segmental renal arteries in size. Pre-operative differential diagnoses were cystic renal cell carcinoma, cystic Wilms’ tumor and multilocular cystic nephroma. Also no signs of metastases were present in thorax CT. Tumor markers were negative. Meanwhile, she developed fever (38 – 39oC) despite negative cultures.
She underwent right radical nephrectomy with lymph node dissection via right Chevron incision that was extended to the left side. In the pathology, gross examination of the nephrectomy specimen revealed 15x13x7.5 cm multicystic mass with hemorrhagic, edematous and gelatinous areas. Microscopically, the cysts were lined by bland endothelial cells. Endothelial cells showed positive immune reactivity for CD34 and CD31. No mitosis, necrosis or nuclear atypia were detected. The final diagnosis was renal hemangioma with mixed capillary and cavernous type. She recovered very well with normalized body temperature and was discharged 6 days after surgery.
To conclude, renal hemangiomas are rare benign tumors. The differential diagnoses include cystic renal cell carcinoma, cystic Wilms’ tumor and multilocular cystic nephroma. However, most cases can be diagnosed after surgical removal. Careful preoperative planning is crucial in order to reduce surgical complications and morbidity.
Written by: M. İrfan Dönmez, MD., FEBU, Urologist, Pediatric Urologist, Istanbul University, Istanbul Faculty of Medicine, Dept of Urology, Division of Pediatric Urology
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