腎臟去分化型脂肉瘤-案例報告
李蕎青1,2、丁慧恭1、邵郁鏵1,3、高泓偉4、查岱龍1、孫光煥1、于大雄1、吳勝堂1、曹智惟1
1三軍總醫院外科部泌尿外科；2國軍高雄總醫院外科部；
3國軍桃園總醫院外科部；4三軍總醫院病理部
Dedifferentiated liposarcoma of left kidney: A rare case report
Chiao-Ching, Li1,2、Huang-Gung, Ting1、Yu-Hua, Shao1,3、Hong-Wei, Gao4、
Tai-Lung, Cha1、Guang-Huan, Sun1、Dah-Shyong, Yu1、Sheng-Tang, Wu1、Chih-Wei, Tsao1
1Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan；2Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan；3Department of Surgery, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan；4Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Case presentation:
Liposarcoma is one of the common soft tissue sarcoma in adults and is a malignancy of mesenchymal origin from fat-containing region of the body. In addition, it is the second most common renal sarcoma. In our case, the lesion originated from the left kidney in a 67-year-old man. The renal tumor was found incidentally. It was detected by ultrasonography due to unkown fever. Subsequently, further examinations including computed tomography scan of abdomen and magnetic resonance imaging of left kidney were arranged.
The renal tumor was huge (Size: 10.3cm x 9.3cm x 8cm) and had ambiguous border at upper pole of left kidney. Therefore, transarterial embolization of renal tumor was arranged to prophylactically decrease operative bleeding. The incision by the way of subcostal method was made. Radical nephrectomy was performed. The pathology finding is dedifferentiated liposarcoma.
The pathology
interpretation is as follows: Hypercellular spindle tumor cells with nuclear hyperchromatism and pleomorphism as well as focal aggregated lipoblasts (H&E stain, original magnification 200X); Tumor cells with rhabdomyoblastic differentiation characterized by abundant eosinophilic cytoplasm with eccentric nuclei and somewhat cytoplasmic striation in focal areas (H&E stain, original magnification 400X); Nuclear immunohistochemical staining of MDM2 for tumor cells (original magnification 400X); Nuclear and cytoplasmic immunohistochemical staining of P16 for tumor cells (original magnification 400X).