長得跟腎血管肌肉脂肪瘤很像的良性腫瘤

潘綱凡、李淑文、蕭毅君、賴昱維、黃建榮、薛又仁

台北市聯合醫院仁愛院區 外科部 泌尿外科

Mixed Epithelial and Stromal Tumor of Kideny Mimic Angiomyolipoma

Gary K. Pan, Shu-Wen Li, Yi-Chun Hsiao, Yu-Wei Lai, Andy C. Huang, Thomas Y. Hsueh

Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei

Purpose:

Mixed Epithelial and Stromal Tumor of Kideny is rare. First documented case of its kind was published by Michal and Syrucek in 1998.

Case presentation:

This was a 58-year-old female with past history of 1. Sigmoid cancer, stage III, s/p operation in 2016, s/p oral chemotherapy during 105-106, currently under regular follow-up in Kaohsiung Chang Gung Memorial Hospital 2. Right renal tumor accidentally found in 2016.

According to patient's statement and medical record, she had noted right renal tumor simultaneously during ER visit for severe constipation in zhongxiao Branch, Taipei City Hospital, which later diagnosed sigmoid cancer in 2016. After finishing treatment including operation and oral chemotherapy as aforementioned, she irregularly follow the renal tumor condition. During recent 1 year, she found more frequent presence of bubble and tea-color in urine and systolic blood pressure raising from 11x mmhg to 14x mmhg. Concerning the progression of right renal tumor, she agreed to undergo laparoscopic right radical nephrectomy. Upon admission, no fever or flank pain was noted. Under the impression of 1. Right renal tumor, she was admitted for further evaluation and management.

After surgery,two tumors were sent for pathology.The small one was angiomyolipoma (AML),but other bigger one showed smooth muscle and lipid component with ,cystic component.IHC showed negative result of HMB-45 and Mart,which were positive on AML.The final pathological result was mixed epithelial and stromal tumor.(MEST)

Conclusion:

Mixed Epithelial and Stromal Tumor of Kidney IS Uncommon neoplasm composed of variable cystic and solid components with morphologically diverse epithelial and stromal elements. Most of it is benign with rare local recurrence reported.It is Rarely aggressive.Till now.only 17 cases had malignant transformation of either epithelial or stromal component.14 out of 17 reported tumors showed stromal malignancy with features of undifferentiated sarcoma.