外科ジャーナル

Kidney Preserving Resection of Leiomyosarcoma with Reconstruction of Left Renal Vein: Case Report

Abstract

Murat Urkan, Gökhan Yağci, Ä°smail Hakk Özerhan, Erkan Öztürk, Aytekin Ünlü, Mehmet Gamsizkan and Yusuf Peker

Background: Leiomyosarcoma is a common retroperitoneal sarcomas mostly originating from muscles. Only about 5% of leiomyosarcomas arise directly from large blood vessels and more than 50% of cases originate from inferior vena cava. Primary leiomyosarcomas of renal veins are extremely rare (30 cases). Mostly diagnosed at advanced stages because of nonspecific clinical signs.

Case: A 40-year-old woman was evaluated of a left retroperitoneal mass with severe back pain. CT scan revealed a left retroperitoneal mass 7 cm. in size adjacent to left renal hilum. During the operation; a multilobular, solid tumor in 7 x 6.5 x 3 cm size, surrounding the left renal vein was observed. Further dissection revealed that the tumor was originated from left renal vein wall. Total devascularization and partial left renal vein resection with tumor and end to end anastomosis was performed. Vascular outflow was confirmed with intraoperative and postoperative doppler examination. Pathology was reported as moderately differentiated leiomyosarcoma, originated from renal vein wall with tumor free resection margins and the patient was discharged with adjuvant chemoradiotherapy.

Conclusion: Although the radical nephrectomy is the gold standard approach for malign tumors of the kidney, kidney preserving tumor free resection with vascular reconstruction is a feasible alternative followed by adjuvant chemoradiotherapy and close follow up. Kidney preserving tumor free resection with vascular reconstruction and followed by adjuvant chemoradiotherapy is a feasible alternative instead of radical nephrectomy.