METASTATIC RENAL HEMANGIOPERICYTOMA TEN YEARS AFTER PRIMARY INTRACRANIAL
LEE N. HAMMONTREE, KRISTOPHER WHITEHEAD, JAMES M. MARKERT
Department of Surgery, Divisions of Urology and Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
We report a case of bilateral metastatic renal hemangiopericytoma. A 37-year-old Caucasian male presented in 1993 with intracranial hemangiopericytoma. Subsequent metastatic disease noted years later include bilateral renal hemangiopericytoma 10 years after initial presentation. To our knowledge, this is only the second reported case of bilateral metastatic renal hemangiopericytoma.
words: intracranial neoplasms; hemangiopericytoma; kidney; metastases;
Since Black & Heinemann are credited as first described a renal hemangiopericytoma in 1955, 34 other cases have been reported. Only one report described bilateral renal involvement. This rarity occurred in 1991 when Heppe et al. described a male patient with bilateral metastases 12 years after an initial intracranial lesion (1). To our knowledge, this is only the second reported case of bilateral metastatic renal hemangiopericytoma.
37-year-old white male presented in 1993 with headaches and dizziness,
vomiting, and personality changes. A large dural-based middle fossa intracranial
mass was discovered and excised after a subdural hematoma developed following
embolization. Cellular morphology was consistent with hemangiopericytoma.
Subsequently, 2 episodes of recurrence within the middle fossa were noted
on follow-up imaging. The patient’s intracranial lesions responded
favorably to gamma knife irradiation and further imaging studies were
done to detect metastatic lesions. Abdominal imaging demonstrated 2 large
enhancing lesions in the right hepatic lobe. After resection, examination
of the specimen revealed 2 large foci (13.5 cm and 10.5 cm) of metastatic
disease. Immunoperoxidase staining for cytokeratin, EMA, actin, and CD-34
markers showed only CD-34 stain uptake in the prominent vascularity of
these tumors do not share a characteristic appearance but do tend to grow
rapidly within the confinements of a capsule or pseudocapsule, but calcifications
are seldom evident unless tumors have been present for long durations.
Histological confirmation also is difficult because of microscopic similarities
that exist between these lesions and other soft tissue tumors, namely
synovial sarcomas, fibrous histiocytomas, and solitary fibrous tumors.
It should be noted that while most hemangiopericytomas express CD-34 as
illustrated by our case, the sensitivity of this marker is suboptimal
in some cases, often limited to endothelial cells (2).
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