Skip to main content
Top
Published in: Diagnostic Pathology 1/2018

Open Access 01-12-2018 | Case Report

Primary angiosarcoma arising in an angiomyolipoma of the kidney: case report and literature review

Authors: Hongwei Guan, Lizhi Zhang, Qiuping Zhang, Wenjing Qi, Suling Xie, Jinping Hou, Huali Wang

Published in: Diagnostic Pathology | Issue 1/2018

Login to get access

Abstract

Background

Primary angiosarcoma of the kidney is a rare and aggressive malignant tumor presenting with a recognizable vascular differentiation. Its prognosis is fatal and the pathogenesis remains unclear. Renal angiomyolipoma is a relatively infrequent renal cortical neoplasm and is composed of variable proportions of adipose tissue, spindle cells, epithelioid smooth muscle cells and abnormal thick-walled blood vessels.

Case presentation

Here, we reported a case in which a 64-year-old woman presenting with the chief complaint of a progressively enlarged mass in the left abdomen. Abdominal computed tomography confirmed presence of a tumor measuring 18 cm × 11 cm in the left posterior renal fascia. Microscopic examination and immunohistochemical staining confirmed co-existence of angiomyolipoma and angiosarcoma. Furthermore, the two components interspersed with each other and there were transitional zones between them.

Conclusions

In this case, we described for the first time a primary renal angiosarcoma possibly arising in a pre-existing angiomyolipoma of the kidney.
Literature
1.
go back to reference Deyrup AT, Miettinen M, North PE, Khoury JD, Tighiouart M, Spunt SL, Parham D, Weiss SW, Shehata BM. Angiosarcomas arising in the viscera and soft tissue of children and young adults: a clinicopathologic study of 15 cases. Am J Surg Pathol. 2009;33:264–9.CrossRefPubMed Deyrup AT, Miettinen M, North PE, Khoury JD, Tighiouart M, Spunt SL, Parham D, Weiss SW, Shehata BM. Angiosarcomas arising in the viscera and soft tissue of children and young adults: a clinicopathologic study of 15 cases. Am J Surg Pathol. 2009;33:264–9.CrossRefPubMed
2.
go back to reference Omiyale AO. Clinicopathological features of primary angiosarcoma of the kidney: a review of 62 cases. Transl Androl Urol. 2015;4:464–73.PubMedPubMedCentral Omiyale AO. Clinicopathological features of primary angiosarcoma of the kidney: a review of 62 cases. Transl Androl Urol. 2015;4:464–73.PubMedPubMedCentral
3.
go back to reference Zenico T, Saccomanni M, Salomone U, Bercovich E. Primary renal angiosarcoma: case report and review of world literature. Tumori. 2011;97:e6–9.CrossRefPubMed Zenico T, Saccomanni M, Salomone U, Bercovich E. Primary renal angiosarcoma: case report and review of world literature. Tumori. 2011;97:e6–9.CrossRefPubMed
4.
go back to reference Martignoni G, Pea M, Reghellin D, Zamboni G, Bonetti F. PEComas: the past, the present and the future. Virchows Arch. 2008;452:119–32.CrossRefPubMed Martignoni G, Pea M, Reghellin D, Zamboni G, Bonetti F. PEComas: the past, the present and the future. Virchows Arch. 2008;452:119–32.CrossRefPubMed
5.
go back to reference Moch H, Humphrey PA, Ulbright TM, Reuter VE. WHO Classification of Tumours of the Urinary System and Male Genital Organs. LARC, Lyon. 2016; p. 62–64. Moch H, Humphrey PA, Ulbright TM, Reuter VE. WHO Classification of Tumours of the Urinary System and Male Genital Organs. LARC, Lyon. 2016; p. 62–64.
6.
go back to reference Zapardiel I, Delafuente-Valero J, Bajo-Arenas JM. Renal angiomyolipoma during pregnancy: review of the literature. Gynecol Obstet Investig. 2011;72:217–9.CrossRef Zapardiel I, Delafuente-Valero J, Bajo-Arenas JM. Renal angiomyolipoma during pregnancy: review of the literature. Gynecol Obstet Investig. 2011;72:217–9.CrossRef
7.
8.
go back to reference Cohen SM, Storer RD, Criswell KA, Doerrer NG, Dellarco VL, Pegg DG, Wojcinski ZW, Malarkey DE, Jacobs AC, Klaunig JE, et al. Hemangiosarcoma in rodents: mode-of-action evaluation and human relevance. Toxicol Sci. 2009;111:4–18.CrossRefPubMed Cohen SM, Storer RD, Criswell KA, Doerrer NG, Dellarco VL, Pegg DG, Wojcinski ZW, Malarkey DE, Jacobs AC, Klaunig JE, et al. Hemangiosarcoma in rodents: mode-of-action evaluation and human relevance. Toxicol Sci. 2009;111:4–18.CrossRefPubMed
9.
go back to reference Yang J, Kantrow S, Sai J, Hawkins OE, Boothby M, Ayers GD, Young ED, Demicco EG, Lazar AJ, Lev D, Richmond A. INK4a/ARF [corrected] inactivation with activation of the NF-kappaB/IL-6 pathway is sufficient to drive the development and growth of angiosarcoma. Cancer Res. 2012;72:4682–95.CrossRefPubMedPubMedCentral Yang J, Kantrow S, Sai J, Hawkins OE, Boothby M, Ayers GD, Young ED, Demicco EG, Lazar AJ, Lev D, Richmond A. INK4a/ARF [corrected] inactivation with activation of the NF-kappaB/IL-6 pathway is sufficient to drive the development and growth of angiosarcoma. Cancer Res. 2012;72:4682–95.CrossRefPubMedPubMedCentral
10.
go back to reference Penel N, Marreaud S, Robin YM, Hohenberger P. Angiosarcoma: state of the art and perspectives. Crit Rev Oncol Hematol. 2011;80:257–63.CrossRefPubMed Penel N, Marreaud S, Robin YM, Hohenberger P. Angiosarcoma: state of the art and perspectives. Crit Rev Oncol Hematol. 2011;80:257–63.CrossRefPubMed
11.
go back to reference Brown JG, Folpe AL, Rao P, Lazar AJ, Paner GP, Gupta R, Parakh R, Cheville JC, Amin MB. Primary vascular tumors and tumor-like lesions of the kidney: a clinicopathologic analysis of 25 cases. Am J Surg Pathol. 2010;34:942–9.CrossRefPubMed Brown JG, Folpe AL, Rao P, Lazar AJ, Paner GP, Gupta R, Parakh R, Cheville JC, Amin MB. Primary vascular tumors and tumor-like lesions of the kidney: a clinicopathologic analysis of 25 cases. Am J Surg Pathol. 2010;34:942–9.CrossRefPubMed
12.
go back to reference Papadimitriou VD, Stamatiou KN, Takos DM, Adamopoulos VM, Heretis IE, Sofras FA. Angiosarcoma of kidney: a case report and review of literature. Urol J. 2009;6:223–5.PubMed Papadimitriou VD, Stamatiou KN, Takos DM, Adamopoulos VM, Heretis IE, Sofras FA. Angiosarcoma of kidney: a case report and review of literature. Urol J. 2009;6:223–5.PubMed
13.
go back to reference Akkad T, Tsankov A, Pelzer A, Peschel R, Bartsch G, Steiner H. Early diagnosis and straight forward surgery of an asymptomatic primary angiosarcoma of the kidney led to long-term survival. Int J Urol. 2006;13:1112–4.CrossRefPubMed Akkad T, Tsankov A, Pelzer A, Peschel R, Bartsch G, Steiner H. Early diagnosis and straight forward surgery of an asymptomatic primary angiosarcoma of the kidney led to long-term survival. Int J Urol. 2006;13:1112–4.CrossRefPubMed
14.
go back to reference Popper H, Thomas LB, Telles NC, Falk H, Selikoff IJ. Development of hepatic angiosarcoma in man induced by vinyl chloride, thorotrast, and arsenic. Comparison with cases of unknown etiology. Am J Pathol. 1978;92:349–76.PubMedPubMedCentral Popper H, Thomas LB, Telles NC, Falk H, Selikoff IJ. Development of hepatic angiosarcoma in man induced by vinyl chloride, thorotrast, and arsenic. Comparison with cases of unknown etiology. Am J Pathol. 1978;92:349–76.PubMedPubMedCentral
15.
go back to reference Trassard M, Le Doussal V, Bui BN, Coindre JM. Angiosarcoma arising in a solitary schwannoma (neurilemoma) of the sciatic nerve. Am J Surg Pathol. 1996;20:1412–7.CrossRefPubMed Trassard M, Le Doussal V, Bui BN, Coindre JM. Angiosarcoma arising in a solitary schwannoma (neurilemoma) of the sciatic nerve. Am J Surg Pathol. 1996;20:1412–7.CrossRefPubMed
16.
go back to reference Brown RW, Tornos C, Evans HL. Angiosarcoma arising from malignant schwannoma in a patient with neurofibromatosis. Cancer. 1992;70:1141–4.CrossRefPubMed Brown RW, Tornos C, Evans HL. Angiosarcoma arising from malignant schwannoma in a patient with neurofibromatosis. Cancer. 1992;70:1141–4.CrossRefPubMed
17.
go back to reference Meis-Kindblom JM, Kindblom LG. Angiosarcoma of soft tissue: a study of 80 cases. Am J Surg Pathol. 1998;22:683–97.CrossRefPubMed Meis-Kindblom JM, Kindblom LG. Angiosarcoma of soft tissue: a study of 80 cases. Am J Surg Pathol. 1998;22:683–97.CrossRefPubMed
18.
go back to reference Fletcher CD, Beham A, Bekir S, Clarke AM, Marley NJ. Epithelioid angiosarcoma of deep soft tissue: a distinctive tumor readily mistaken for an epithelial neoplasm. Am J Surg Pathol. 1991;15:915–24.CrossRefPubMed Fletcher CD, Beham A, Bekir S, Clarke AM, Marley NJ. Epithelioid angiosarcoma of deep soft tissue: a distinctive tumor readily mistaken for an epithelial neoplasm. Am J Surg Pathol. 1991;15:915–24.CrossRefPubMed
19.
go back to reference Ulbright TM, Clark SA, Einhorn LH. Angiosarcoma associated with germ cell tumors. Hum Pathol. 1985;16:268–72.CrossRefPubMed Ulbright TM, Clark SA, Einhorn LH. Angiosarcoma associated with germ cell tumors. Hum Pathol. 1985;16:268–72.CrossRefPubMed
20.
go back to reference Tallini G, Price FV, Carcangiu ML. Epithelioid angiosarcoma arising in uterine leiomyomas. Am J Clin Pathol. 1993;100:514–8.CrossRefPubMed Tallini G, Price FV, Carcangiu ML. Epithelioid angiosarcoma arising in uterine leiomyomas. Am J Clin Pathol. 1993;100:514–8.CrossRefPubMed
21.
go back to reference Hayashi T, Koike K, Kumasaka T, Saito T, Mitani K, Terao Y, Ogishima D, Yao T, Takeda S, Takahashi K, Seyama K. Uterine angiosarcoma associated with lymphangioleiomyomatosis in a patient with tuberous sclerosis complex: an autopsy case report with immunohistochemical and genetic analysis. Hum Pathol. 2012;43:1777–84.CrossRefPubMed Hayashi T, Koike K, Kumasaka T, Saito T, Mitani K, Terao Y, Ogishima D, Yao T, Takeda S, Takahashi K, Seyama K. Uterine angiosarcoma associated with lymphangioleiomyomatosis in a patient with tuberous sclerosis complex: an autopsy case report with immunohistochemical and genetic analysis. Hum Pathol. 2012;43:1777–84.CrossRefPubMed
22.
go back to reference Pillay K, Lazarus J, Wainwright HC. Association of angiomyolipoma and oncocytoma of the kidney: a case report and review of the literature. J Clin Pathol. 2003;56:544–7.CrossRefPubMedPubMedCentral Pillay K, Lazarus J, Wainwright HC. Association of angiomyolipoma and oncocytoma of the kidney: a case report and review of the literature. J Clin Pathol. 2003;56:544–7.CrossRefPubMedPubMedCentral
23.
go back to reference van Slegtenhorst M, de Hoogt R, Hermans C, Nellist M, Janssen B, Verhoef S, Lindhout D, van den Ouweland A, Halley D, Young J, et al. Identification of the tuberous sclerosis gene TSC1 on chromosome 9q34. Science. 1997;277:805–8.CrossRefPubMed van Slegtenhorst M, de Hoogt R, Hermans C, Nellist M, Janssen B, Verhoef S, Lindhout D, van den Ouweland A, Halley D, Young J, et al. Identification of the tuberous sclerosis gene TSC1 on chromosome 9q34. Science. 1997;277:805–8.CrossRefPubMed
24.
go back to reference European Chromosome 16 Tuberous Sclerosis Consortium. Identification and characterization of the tuberous sclerosis gene on chromosome 16. Cell. 1993;75:1305–15.CrossRef European Chromosome 16 Tuberous Sclerosis Consortium. Identification and characterization of the tuberous sclerosis gene on chromosome 16. Cell. 1993;75:1305–15.CrossRef
25.
26.
go back to reference Kenerson H, Folpe AL, Takayama TK, Yeung RS. Activation of the mTOR pathway in sporadic angiomyolipomas and other perivascular epithelioid cell neoplasms. Hum Pathol. 2007;38:1361–71.CrossRefPubMedPubMedCentral Kenerson H, Folpe AL, Takayama TK, Yeung RS. Activation of the mTOR pathway in sporadic angiomyolipomas and other perivascular epithelioid cell neoplasms. Hum Pathol. 2007;38:1361–71.CrossRefPubMedPubMedCentral
27.
go back to reference Tamboli P, Ro JY, Amin MB, Ligato S, Ayala AG. Benign tumors and tumor-like lesions of the adult kidney. Part II: benign mesenchymal and mixed neoplasms, and tumor-like lesions. Adv Anat Pathol. 2000;7:47–66.CrossRefPubMed Tamboli P, Ro JY, Amin MB, Ligato S, Ayala AG. Benign tumors and tumor-like lesions of the adult kidney. Part II: benign mesenchymal and mixed neoplasms, and tumor-like lesions. Adv Anat Pathol. 2000;7:47–66.CrossRefPubMed
28.
go back to reference Italiano A, Chen CL, Thomas R, Breen M, Bonnet F, Sevenet N, Longy M, Maki RG, Coindre JM, Antonescu CR. Alterations of the p53 and PIK3CA/AKT/mTOR pathways in angiosarcomas: a pattern distinct from other sarcomas with complex genomics. Cancer. 2012;118:5878–87.CrossRefPubMedPubMedCentral Italiano A, Chen CL, Thomas R, Breen M, Bonnet F, Sevenet N, Longy M, Maki RG, Coindre JM, Antonescu CR. Alterations of the p53 and PIK3CA/AKT/mTOR pathways in angiosarcomas: a pattern distinct from other sarcomas with complex genomics. Cancer. 2012;118:5878–87.CrossRefPubMedPubMedCentral
29.
go back to reference Lahat G, Dhuka AR, Hallevi H, Xiao L, Zou C, Smith KD, Phung TL, Pollock RE, Benjamin R, Hunt KK, et al. Angiosarcoma: clinical and molecular insights. Ann Surg. 2010;251:1098–106.CrossRefPubMed Lahat G, Dhuka AR, Hallevi H, Xiao L, Zou C, Smith KD, Phung TL, Pollock RE, Benjamin R, Hunt KK, et al. Angiosarcoma: clinical and molecular insights. Ann Surg. 2010;251:1098–106.CrossRefPubMed
30.
Metadata
Title
Primary angiosarcoma arising in an angiomyolipoma of the kidney: case report and literature review
Authors
Hongwei Guan
Lizhi Zhang
Qiuping Zhang
Wenjing Qi
Suling Xie
Jinping Hou
Huali Wang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Diagnostic Pathology / Issue 1/2018
Electronic ISSN: 1746-1596
DOI
https://doi.org/10.1186/s13000-018-0730-z

Other articles of this Issue 1/2018

Diagnostic Pathology 1/2018 Go to the issue