Vol. 116, November Printed in U.S .A .
THE JOURNAL OF UR OLOGY
Copyright © 1976 by The Williams & Wilkins Co.
HEMANGIOMA OF THE KIDNEY W. SAMELLAS, L. G. MORPHIS
C. V. BAKOPOULOS
AND
From the Depart ment of Pediatrics, A thens University, St. Sophia Children's Hospital, A thens, Greece
ABSTRACT
An unusual case of a large renal hemangioma in an infant is reported. These tumors are usually benign and are the cause of obscure origin of hematuria.
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Renal hemangiomas are rare tumors of congenital origin, occurring from young adulthood to old age with equal sex ·distribution . About 80 cases have been reported. 1 CASE REPORT
I 11
I
A 4-month-old male infant was admitted to our hospital because of gross hematuria 3 days in duration. The baby was the product of a normal pregnancy and delivery . Physical examination revealed a well nourished and moderately pale baby in good health. Blood pressure was 90/70 mm. Hg. A mass, the size of an orange, was palpable on the right side of the abdomen. It was firm, smooth and did not extend across the midline. The rest of the physical examination was unremarkable. Chest x-ray was within normal limits. The hemoglobin was 9 gm. per cent and the white blood count 11,000 per cu.mm. with normal differential. The blood urea nitrogen was 15 mg. per 100 cc. Urinalysis showed many red cells and the urine culture was negative. The excretory urogram (IVP) showed an enlarged right renal shadow. A mass was seen in the upper pole of the kidney displacing the calices downward, which appeared distended (fig. 1). The micturition cystogram was within normal limits. During hospitalization the child suffered another episode of gross hematuria with clots requiring transfusion of 150 gm. whole blood. Exploration was performed through a right paramedian incision. The kidney appeared enlarged and the upper pole was the size of a lemon. A nephrectomy was performed. Convalescence was uneventful. The pathology report disclosed a 10 by 6 by 4 cm. kidney. On section the upper half of the kidney showed brownish areas, the largest of which was 3 cm. in diameter. Microscopically, the cavernous vascular channels were dilated and filled with blood. The wall of the channels consisted of connective tissue lined, in areas, by enlarged endothelial cells. The interstitial tissue was hemorrhagic infiltrated (fig. 2). The rest of the renal parenchyma was atrophic. The tumor was a cavernous hemangioma.
FIG. 1. Upper pole mass of right kidney displacing calices
COMMENT
Hematuria caused by bleeding from a hemangioma of the kidney is rare and, although it is often mentioned as a possible cause of hematuria, few reports have been found in the literature. T~ions are usually small, producing at most deformity of a calix. No similar case could be found in the lrterature ora rerutl hemangioma as large as that which was seen in our infant. Hemangiomas of the kidney, which are similar to vascular tumors of the liver and skin, are usually benign but other organs may show malignant changes. Nephroblastoma is the most common cause of a renal mass capable of producing hematuria in infants. The IVP indicated the presence of an intrarenal mass of the upper pole of the kidney distorting and Accepted for publication March 12, 1976.
653
FIG. 2. Dilated vascular channels filled with blood
displacing the calices. Our provisional diagnosis was nephroblastoma. A partial nephrectomy should be considered if the lesion is small and the condition can be recognized with any degree of certainty. In our case the evidence indicated a tumor and the size of the hemangioma precluded any such procedure. REFERENCE
1. Campbell, M. F. and Harrison, J. H.: Urology, 3rd ed. Philadelphia: W. B. Saunders Co., p. 949, 1970.
THE JOURNAL OF UR OLOGY
Copyright © 1976 by The Williams & Wilkins Co.
HEMANGIOMA OF THE KIDNEY W. SAMELLAS, L. G. MORPHIS
C. V. BAKOPOULOS
AND
From the Depart ment of Pediatrics, A thens University, St. Sophia Children's Hospital, A thens, Greece
ABSTRACT
An unusual case of a large renal hemangioma in an infant is reported. These tumors are usually benign and are the cause of obscure origin of hematuria.
-·-a
----
Renal hemangiomas are rare tumors of congenital origin, occurring from young adulthood to old age with equal sex ·distribution . About 80 cases have been reported. 1 CASE REPORT
I 11
I
A 4-month-old male infant was admitted to our hospital because of gross hematuria 3 days in duration. The baby was the product of a normal pregnancy and delivery . Physical examination revealed a well nourished and moderately pale baby in good health. Blood pressure was 90/70 mm. Hg. A mass, the size of an orange, was palpable on the right side of the abdomen. It was firm, smooth and did not extend across the midline. The rest of the physical examination was unremarkable. Chest x-ray was within normal limits. The hemoglobin was 9 gm. per cent and the white blood count 11,000 per cu.mm. with normal differential. The blood urea nitrogen was 15 mg. per 100 cc. Urinalysis showed many red cells and the urine culture was negative. The excretory urogram (IVP) showed an enlarged right renal shadow. A mass was seen in the upper pole of the kidney displacing the calices downward, which appeared distended (fig. 1). The micturition cystogram was within normal limits. During hospitalization the child suffered another episode of gross hematuria with clots requiring transfusion of 150 gm. whole blood. Exploration was performed through a right paramedian incision. The kidney appeared enlarged and the upper pole was the size of a lemon. A nephrectomy was performed. Convalescence was uneventful. The pathology report disclosed a 10 by 6 by 4 cm. kidney. On section the upper half of the kidney showed brownish areas, the largest of which was 3 cm. in diameter. Microscopically, the cavernous vascular channels were dilated and filled with blood. The wall of the channels consisted of connective tissue lined, in areas, by enlarged endothelial cells. The interstitial tissue was hemorrhagic infiltrated (fig. 2). The rest of the renal parenchyma was atrophic. The tumor was a cavernous hemangioma.
FIG. 1. Upper pole mass of right kidney displacing calices
COMMENT
Hematuria caused by bleeding from a hemangioma of the kidney is rare and, although it is often mentioned as a possible cause of hematuria, few reports have been found in the literature. T~ions are usually small, producing at most deformity of a calix. No similar case could be found in the lrterature ora rerutl hemangioma as large as that which was seen in our infant. Hemangiomas of the kidney, which are similar to vascular tumors of the liver and skin, are usually benign but other organs may show malignant changes. Nephroblastoma is the most common cause of a renal mass capable of producing hematuria in infants. The IVP indicated the presence of an intrarenal mass of the upper pole of the kidney distorting and Accepted for publication March 12, 1976.
653
FIG. 2. Dilated vascular channels filled with blood
displacing the calices. Our provisional diagnosis was nephroblastoma. A partial nephrectomy should be considered if the lesion is small and the condition can be recognized with any degree of certainty. In our case the evidence indicated a tumor and the size of the hemangioma precluded any such procedure. REFERENCE
1. Campbell, M. F. and Harrison, J. H.: Urology, 3rd ed. Philadelphia: W. B. Saunders Co., p. 949, 1970.
