LEIOMYOSARCOMA OF THE KIDNEY WITH RENAL VEIN THROMBOSIS

Abstract

A case of renal leiomyosarcoma with extension into the renal vein is presented. We believe this is the first report of renal leiomyosarcoma associated with a main renal vein tumor thrombus.
A 51-year-old male was admitted because of a left flank mass and pain on July, 18, 1983. Excretory urogram did not visualize the left kidney. A left retrograde pyelogram showed a shift and displacement of pelvis and calyx due to a large mass. CT scan showed a large mass with cystic pattern and irregular wall. Aortogram showed left renal artery occlusion. The mass was fed by parasitic arterial vessels from the splenic and lumbar arteries. There was poor vascularity in the central portion of the mass. Selective celiac arteriogram in the late phase showed “thread and streak pattern” around the left renal vein, which suggested renal vein thrombosis.
Transperitoneal radical left nephrectomy was performed on Aug., 16, 1983. During the operation about 500ml of yellowish serous fluid was aspirated and the tumor thrombus in the left renal vein was excised. The tumor measured 17 by 12 by 8cm and weighed 1300gm. The tumor was continuous with the left renal capsule and the left kidney was enveloped by the tumor. Histological diagnosis was renal leiomyosarcoma originating from renal capsule and renal vein thrombosis by leiomyosarcoma. After operation irradiation of 30Gy Linac was done at the tumor bed. The patient was well without recurrence 4 months after operation.
Diagnostic problems and clinical features of renal leiomyosarcoma are discussed.