Renal Hemangioblastoma with Mixed Mullerian tumor of endometrium: A tale of two rare primary tumors

Abstract

Introduction Renal hemangioblastoma (RH) is a very rare benign tumor. Hemangioblastoma most commonly occur in the central nervous system (CNS) and only few cases of RH have been reported in literature. They occur most commonly as asymptomatic masses found incidentally. Mixed Mullerian Tumor (MMT) of the uterus is a rarer and aggressive form of uterine malignancy. The detection of two primary rare tumors incidentally is a rare entity. Case presentation A 50 years female patient presented with abnormal uterine bleeding which on endometrial sampling was diagnosed as a rare variety of endometrial cancer i.e., MMT or uterine carcinosarcoma. On preoperative Magnetic resonance imaging (MRI), a renal mass was also detected which was highly vascular and was mimicking Renal Cell Carcinoma (RCC). Fine needle aspiration cytology (FNAC) was done from the renal mass to differentiate between RCC and metastasis but it showed only blood cells. Patient underwent staging laparotomy for endometrial cancer and frozen section examination of the renal mass. Frozen section report was inconclusive with few atypical cells and thus patient underwent radical nephrectomy too. Histopathological examination revealed it to be a RH which is a very rare benign tumor. Discussion Only 14 cases of RH outside the CNS have been reported till date. Occurrence of renal mass as an incidental finding in the preoperative work up of uterine malignancy directed us to the differentials of metastasis or another histologically distinct primary tumor. RH may mimic RCC radiologically. To correctly diagnose RH is important because sporadic RH does not require further treatment and the prognosis is much better than that of RCC. MMT which compromise 1-2% of all uterine neoplasms have higher chance of metastasis than endometroid variety. Conclusion Renal hemangioblastoma is a rare benign tumor which doesn’t require any treatment in majority of the patients. Mixed Mullerian tumor is a rare aggressive uterine tumor which metastasizes early, henceforth early identification and treatment is the key. RH needs to be differentiated from RCC to avoid over treatment. Morphological findings are similar in both, preoperative FNAC, PET scan and intraoperative frozen section can be utilized to differentiate in between two in well circumcised tumors and in high suspicion. The presence of two rare primary tumors i.e., RH and MMT in the same patient which are unrelated is a rare entity.