Case studyUnclassified hemangioma-like renal cell carcinoma: a potential diagnostic pitfall☆
Introduction
Clear cell renal cell carcinoma with hemangioma-like degenerative changes can present a diagnostic dilemma [1]. Despite the kidney being a highly vascular organ, primary vascular tumors of this organ are actually rare [2], although recently the novel hemangioma subtype anastomosing hemangioma has been recognized to have more frequent occurrence in the kidney and genitourinary tract, among other sites [3], [4]. In general, predominant sinusoidal-like vascularity in a renal mass would have a differential diagnosis that includes hemangioma (especially anastomosing hemangioma), hemangioma-like degenerative changes in renal cell carcinoma (usually clear cell type), or spontaneous regression of renal cell carcinoma. There are a few reports of clear cell renal cell carcinoma mimicking a hemangioma [1], [5]; however, to our knowledge, non–clear cell hemangioma-like renal cell carcinoma has not been previously reported. In this article, we report a case of unclassified hemangioma-like renal cell carcinoma presenting in a 62-year-old woman.
Section snippets
Case report
A 62-year-old woman presented to the urology clinic with an incidentally detected asymptomatic left renal mass. The renal mass was under active monitoring for a 2-cm renal cyst, which progressed over 8 years into a solid mass. Computed tomography revealed a thick, enhancing capsule with a solid, enhancing central region suggestive of renal cell carcinoma. An elective partial nephrectomy was performed.
Methods
This study was approved by the Henry Ford Health System Institutional Review Board.
Results
At gross examination, the partial nephrectomy specimen contained a 2.6 × 2.5 × 2.5–cm well-circumscribed, encapsulated tan-brown hemorrhagic mass (Fig. 1). Microscopically, the morphological appearance was unusual with hemangioma-like features, extensive vascular component, fibrin accumulation, and hemorrhage. The areas with morphology suggestive of a renal epithelial component exhibited a tubulocystic appearance with flattened eosinophilic cells showing International Society of Urological
Discussion
Rich vascularity and an extensive capillary network separating nests of neoplastic cells are commonly used as diagnostic clues for a diagnosis of clear cell renal cell carcinoma, and it has been noted recently that some cases may mimic hemangioma when the epithelial component is inconspicuous and the residual vascular network predominates [1], [5], possibly resulting from degenerative changes. Conversely, hemangiomas can also occur in the kidney less frequently, potentially mimicking clear cell
Summary
In this report, we describe an unusual neoplasm, which we term unclassified hemangioma-like renal cell carcinoma, occurring in a 62-year-old woman, in which renal cell carcinoma harbored extensive arborizing vessels mimicking hemangioma. Immunohistochemical staining highlighted the epithelial component of tumor but with an abnormal combination of positive markers, including cytokeratin 7, high-molecular-weight cytokeratin, and carbonic anhydrase IX, with minimal labeling for AMACR and negative
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Disclosures: none.