Primary Vascular Tumors and Tumor-like Lesions of the Kidney: A Clinicopathologic Analysis of 25 Cases
- 1 July 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in The American Journal of Surgical Pathology
- Vol. 34 (7), 942-949
- https://doi.org/10.1097/pas.0b013e3181e4f32a
Abstract
Vascular tumors of the kidney are distinctly rare, and to date no large series have been reported. We analyzed a series of primary vascular tumors of the kidney to further delineate their clinicopathologic features and identify organ-specific morphologic features, if present. Twenty-five renal cases previously coded as "arteriovenous malformation," "hemangioma," and "angiosarcoma" were retrieved from the archives of 4 collaborating institutions and were reevaluated histologically. Tumors were classified according to the 2002 World Health Organization classification of tumors of soft tissue and bone. There were 18 males and 7 females (M:F=2.6:1) ranging from 21 to 95 years (mean 56.7 y). Lesions ranged from "microscopic" to 30 cm (mean 6.0 cm) and were tan-brown, cystic, and hemorrhagic. On re-review, cases were classified as arteriovenous malformation (n=3), capillary hemangioma (n=14), and angiosarcoma (n=8). Arteriovenous malformations were identical to their somatic soft tissue counterparts. Renal capillary hemangiomas often lacked a well-formed lobular pattern and 5 cases showed a "sieve-like" arrangement reminiscent of splenic sinusoids, a pattern previously noted by others (anastomosing hemangioma). All hemangiomas were noninfiltrative and lacked cytologic atypia and mitotic activity. GLUT-1, D2-40, and CD8 were performed in 3 anastomosing hemangiomas and were all negative. Angiosarcomas were diffusely infiltrative with extensive parenchymal destruction; all showed at least small areas of conventional vasoformative growth, but were frequently dominated by spindled and epithelioid histology. All cases were positive for some combination of vascular tumor-associated markers (CD31, CD34, and FLI-1). Cytokeratin expression was absent in all angiosarcomas. Follow-up was available for 15 cases: all patients with arteriovenous malformation and hemangioma with follow-up were disease free after complete excision; 4 cases of angiosarcoma died of the disease at 1, 1, 6, and 11 months. Our review shows that many capillary hemangiomas of the kidney are morphologically distinctive tumors, which often show "spleen-like" or "anastomosing" features. Angiosarcomas of the kidney are highly aggressive tumors with poor outcome and may have morphologic features (spindling and epithelioid change), which could result in confusion with sarcomatoid carcinomas and other renal mesenchymal tumors.Keywords
This publication has 23 references indexed in Scilit:
- Sporadic Cutaneous Angiosarcomas: A Proposal for Risk Stratification Based on 69 CasesThe American Journal of Surgical Pathology, 2008
- Renal primary angiosarcomaClinical and Translational Oncology, 2007
- Early diagnosis and straight forward surgery of an asymptomatic primary angiosarcoma of the kidney led to long-term survivalInternational Journal of Urology, 2006
- Renal hemangiomaInternational braz j urol, 2004
- ENDOSCOPIC MANAGEMENT OF RENAL HEMANGIOMAJournal of Urology, 2002
- Spontaneous Rupture of a Renal AngiosarcomaUrologia Internationalis, 2002
- Letter to the Editor: “Arteriovenous fistula: A complication following renal biopsy of suspected bilateral Wilms tumor”Medical and Pediatric Oncology, 1998
- Arteriovenous fistula: A complication following renal biopsy of suspected bilateral Wilms' tumorMedical and Pediatric Oncology, 1997
- Recent Advances in the Diagnosis and Treatment of Renal Arteriovenous Malformations and FistulasJournal of Urology, 1993
- Haemangioma of the Urinary Tract: Review of the LiteratureBritish Journal of Urology, 1991