International Journal of Surgical Pathology http://ijs.sagepub.com/
Glomus Tumor of the Kidney: Case Report and Literature Review Kotaro Sasaki, Sheldon I. Bastacky, Ronald L. Hrebinko, Anil V. Parwani and Debra L. Zynger INT J SURG PATHOL 2011 19: 393 originally published online 22 January 2009 DOI: 10.1177/1066896908331233 The online version of this article can be found at: http://ijs.sagepub.com/content/19/3/393
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Glomus Tumor of the Kidney: Case Report and Literature Review
International Journal of Surgical Pathology 19(3) 393–397 © The Author(s) 2011 Reprints and permission: http://www. sagepub.com/journalsPermissions.nav DOI: 10.1177/1066896908331233 http://ijs.sagepub.com
Kotaro Sasaki, MD1, Sheldon I. Bastacky, MD1, Ronald L. Hrebinko, MD2, Anil V. Parwani, MD, PhD1, and Debra L. Zynger, MD1
Abstract Glomus tumor is a benign mesenchymal neoplasm of the subcutaneous tissue of the distal extremities and head and neck region. Glomus tumor rarely occurs in the visceral organs. This study reports the sixth case of a glomus tumor arising in the kidney in a 62-year-old man who presented with weight loss and an incidental kidney lesion detected by computed tomographic scan. Radiologically, the tumor was difficult to differentiate from a malignant lesion and was therefore excised by partial nephrectomy. The tumor was challenging to diagnose by routine hematoxylin and eosin microscopic examination, necessitating immunohistochemical analysis. Immunoreactivity was demonstrated for smooth muscle actin, vimentin, collagen IV, and CD57, with little to no expression of neuroendocrine, endothelial, or epithelial markers. To date, the tumor has followed a benign course without evidence of local recurrence or metastasis. Keywords glomus tumor, kidney, immunohistochemistry
Glomus tumors are mesenchymal neoplasms that resemble glomus cells, which are modified smooth muscle cells that have a role in temperature regulation. Glomus tumors most often occur in the extremities, typically in the subungual region of the fingers.1 Glomus tumor rarely arises in internal locations such as mediastinum, lung, and stomach.2,3 We report here a case of primary renal glomus tumor with a literature review to raise awareness of this exceedingly rare renal tumor.4-6 As familiarity with this lesion increases, perhaps less aggressive diagnostic procedures may be performed and surgical treatment can be avoided.
Case Report A 62-year-old man presented to his primary care physician with an unexplained 60-lb weight loss, slight nausea, and anorexia over the course of a year. A dynamic, contrastenhanced abdominal computed tomography scan revealed an incidental 1.8 cm enhancing mass at the lower pole of the left kidney with no other abnormalities identified. Laparoscopic partial nephrectomy of the tumor was performed and the patient made an uneventful recovery. The gross specimen consisted of 2 focally cauterized fragments of kidney containing a well-circumscribed, partially cystic tan lesion measuring 1.8 cm in maximum diameter. Microscopic examination showed a cellular tumor with a solid growth pattern and focal myxoid change. Numerous vessels of varying
size, some with hemangiopericytoma-like configuration, were dispersed throughout the tumor (Figure 1A). The tumor cells were small, round to oval, with smooth nuclear contours, vesicular chromatin, occasional single visible nucleoli, and a moderate amount of pale eosinophilic cytoplasm (Figure 1B). Atypia was minimal to absent, and no mitotic figures or necrosis were seen. Surgical margins were free of tumor. An extensive immunohistochemical panel was performed to evaluate the tumor (Table 1). Tumor cells were strongly positive for vimentin (Figure 1C), smooth muscle actin (Figure 1D), and CD57 (Figure 1E). Collagen IV showed strong and diffuse pericellular immunoreactivity (Figure 1F). Weak focal positivity was seen in the tumor cells for synaptophysin and desmin with no expression of CD56, chromogranin, S100, calretinin, HMB-45 (Figure 1G), pankeratin (Figure 1H), or CK7. The endothelial markers, CD31, CD34 (Figure 1I), and von Willebrand factor, were exclusively expressed in the 1
Departments of Pathology Urology, University of Pittsburgh Medical Center, Pittsburgh, Philadelphia 2
Corresponding Author: Debra L. Zynger, MD, Department of Pathology, University of Pittsburgh Medical Center, Shadyside Hospital, Room WG 02.10, 5230 Center Avenue, Pittsburgh, PA 15232 E-mail:
[email protected].
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International Journal of Surgical Pathology 19(3) Table 1. Renal Glomus Tumor Immunohistochemical Expression Antibody Calretinin CD31 CD34 CD56 CD57 Chromogranin CK7 Collagen IV Desmin HMB-45 Ki-67 Pankeratin Smooth muscle actin Synaptophysin S100 Vimentin von Willebrand factor WT1
Result Rare weakly positive cells Negative (highlights vessels) Negative (highlights vessels) Negative Positive Negative Negative Positive Occasional weakly positive cells Negative
