顧明軒¹、吳宏豪^{1, 2, 3}、林登龍^{1, 2, 3}、陳光國^{1, 2, 3}

臺北榮民總醫院 泌尿部¹；國立陽明大學醫學院泌尿學科²；書田泌尿科學研究中心³

 

 

Ming-Hsuan Ku¹, Howard H.H. Wu ^1,2,3, Alex T.L. Lin ^1,2,3, Kuang-Kuo Chen ^1,2,3

¹ Department of Urology, Taipei Veterans General Hospital;

² School of Medicine and ³Shu-Tien Urological Institute, National Yang-Ming University, Taiwan

 

Renal anastomosing hemangioma is an extremely rare vascular neoplasm, with good prognosis after surgical resection. Anastomosing hemangioma most commonly occurred in middle-aged people, with an average age of 52.6 years old. The incidence showed no difference in both sex, and most patients are asymptomatic. It is difficult to diagnose the disease via simple biopsy, because the pathological features sometimes mimick malignant diseases such as angiosarcoma. To differentiate the disease from other malignancies is important because the choices of treatments and outcomes are totally different. In anastomosing hemangioma, physicians aim to preserve the maximal renal function during the surgery, while other malignancies such as angiosarcoma should be considered achieving the best oncologic outcome in priority.

 

A 58-year-old man with history of focal segmental glomerulosclerosis. He was under regular followed up at our Nephrology OPD. Incidental finding of protruding mass over cortex of left kidney was noted by sonogram. He was then referred to our GU OPD for further management. CT was performed and an heterogenous enhancing mass about 3.5x3.3cm at upper pole of right kidney was noted. Renal cell carcinoma or oncocytoma were considered first. We suggested robotic-assisted partial nephrectomy (RaPN) to the patient and he agreed. The surgery was performed on 6^th, January, 2016. However, during the surgery, the tumor wasn’t excised completely due to difficult approach. Some portion of the tumor was collected, and sent to to our pathologist for frozen section biopsy during the operation, and the report came out probable renal cell carcinoma. To avoid disease recurrence, we performed robotic-assisted radical nephrectomy insetad after well-explained and discussed with the family. The surgery was done smoothly, and the patient tolerated and recovered well. The final pathology turned out anastomosing hemangioma.We explained the good prognosis to him and he is now under our OPD follow-up. No evidence of disease was noted for 3 months.