Primary Benign Vascular Tumors and Tumor-Like Lesions of the Kidney: A Clinicopathologic Analysis of 16 Cases
Vikas Mehta, Vijayalakshmi Ananthanarayanan, Tatjana Antic, Thomas Krausz, Girish Venkataraman, Maria M Picken. Loyola University Medical Center, Maywood; University of Chicago, Chicago
Background: Primary benign vascular lesions of the kidney are uncommonly encountered in routine surgical pathology practice. They can, however, mimic malignancy or be an incidental finding adjacent to a malignancy.
Design: 16 specimens harboring 17 primary benign renal lymphatic/vascular lesions were identified from our files from 1999-2011 and subjected to a detailed pathologic evaluation and clinico-pathologic correlation.
Results: There were 9 males and 7 female patients (M:F =1.2:1) with age range of 33-75 years (mean 55 years). The radiologic finding in most cases was the presence of either a cystic (6 cases) or a solid (10 cases) mass suspicious for neoplasia. Lesions ranged from 0.5cm to 9.5cm (mean 2.8cm) and were all solitary except 2. There were 6 arteriovenous malformations (AVM), 4 capillary hemangiomas, 5 lymphangiomas and 1 solid intravascular papillary endothelial hyperplasia (i.e. Masson's hemangioma, fig. B) and 1 anastomosing hemangioma (fig.A). Five AVMs were located in the kidney parenchyma and 1 in the pelvi-ureteric system. Additional associated lesions ranged from renal stones to renal cell carcinoma in 2 cases (1 lymphangioma and 1 AVM). One AVM was associated with a capillary hemangioma in the vicinity, another with a history of renal cell carcinoma in the contralateral kidney. The Masson's hemangioma was arising in an intra-renal hematoma. AVMs were identical to their somatic soft tissue counterparts. Capillary hemangiomas and lymphangiomas were noninfiltrative and lacked cytologic atypia and mitotic activity. Except for a renal pelvic AVM, all other lesions radiologically mimicked malignancy. The patients had undergone partial or radical nephrectomies except for the renal pelvic AVM which was laparoscopically excised. None of the cases had any syndromal/systemic associations to our knowledge.
Conclusions: Benign vascular lesions of the kidney are rarely seen in routine surgical pathology practice, partly because a vast majority of them are medically treated by embolization. However lesions mimicking renal malignancy are subjected to surgery. They may exist as isolated lesions or coexist with, malignant lesions, either in the ipsilateral or the contralateral kidney.
Category: Genitourinary (including renal tumors)
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 144, Monday Morning