Transcript Diapositiva 1

Università di VERONA
SCHWANNOMA DEL RENE
M. Vergine, S. Gobbo, M. Brunelli, A. Eccher, D.
Segala, M. Chiosi, F. Bonetti, F. Menestrina, L. Cheng,
G. Martignoni
Introduzione:
Solo pochi casi di
schwannoma del rene
sono stati riportati.
Autori, anno di pubblicazione
Numero casi
descritti
Phillips & Baumrucker, 1955
1
Kuzmina, 1962
1
Fein, 1965
1
Bair, 1978
1
Steers, 1985
1
Somers, 1988
1
Kitagawa, 1990
1
Ma, 1990
1
Naslund, 1991
1
Romics, 1992
1
Ikeda, 1996
1
Singer, 1996
1
Alvarado-Cabrero, 2000
4
Tsurusaki, 2001
1
Singh, 2005
2
Tot:
19 casi
Materiali e Metodi:
Abbiamo riportato tre ulteriori casi di
schwannoma renale
con analisi immunoistochimica.
Abbiamo inoltre eseguito una
revisione sistematica della letteratura
Analisi Immunoistochimica:
S100
S100A1
NSE
Neurofilamenti
HMB45
Caso1
+
Neg.
10%
Neg
Neg
Caso2
+
+
90%
Neg
Caso3
+
Neg.
90%
Neg
MiTF
AML
CK AE1/3
CK 7
CD34
CD10
Neg Neg
Neg
Neg
Neg
Neg
Neg
Neg Neg
Neg
Neg
Neg
Neg
Neg
Neg Neg
Neg
Neg
Neg
Neg
Dati Clinici:
Caso #
Età
Sesso
Segni e Sintomi
Lato
Intervento
chirurgico
Follow-up
1
59
F
Asintomatico
S
Nefrectomia
Non Disponibili
Nefrectomia
Libero da malattia
a 8 mesi di followup
Nefrectomia
Libero da malattia
a 4 mesi di followup
2
3
27
35
F
Reperto occasionale
F
Dolore addominale,
nausea
D
S
Dati patologici:
Diametro
Caso #
1
4,8 cm
8,5 cm
2
7 cm
3
Aspetto
Macroscopico
Sede
Diagnosi
Massa lobulata
Ilo
Schwannoma
Massa fibrosomixomatosa
Intraparenchimale, polo
inferiore
“Ancient”
schwannoma
Massa
microcistica
Ilo
Schwannoma
CASO 1
CASO 1
S100
CASO 2
CASO 2
S100
CASO 3
CASO 3
S100
REVISIONE DELLA LETTERATURA
Author, Year of
Publication
Age
Sex
Symptoms and
Signs
Side
Operation
Gross
Location
Diagnosis
Follow-up
L
Left nephrectomy
12-cm Encapsulated tumor
Pelvis
Schwannoma
NA
Phillips &
Baumrucker, 1955
56
M
Generalized malaise,
weight loss, fever,
flank pain, mild
anemia
Kuzmina, 1962
33
F
Generalized malaise,
weight loss, mild
temperature, flank
mass
R
Right nephrectomy
Encapsulated, rubbery, pale gray;
tumor
Capsule
Schwannoma
NA
F
Congenital
malforamtion,
hydronephrosis,
fever, flank pain,
pyuria,palpable mass
R
Right nephrectomy
6-cm well encapsulated mass
Pelvis
Schwannoma a
NED
(~24-mo follow-up)
R
Right nephrectomy
7-cm mass
Hilum
Schwannoma
NED
(5-mo follow-up)
Fein, 1965
51
Bair, 1978
56
M
Hypertension,
microhematuria,
hypertensive renal
disease
Steers, 1985
50
F
Microhematuria,
palpable mass
R
Tumorectomy
9-cm multicystic mass
Hilum
Schwannoma
NA
Somers, 1988
55
F
Incidental finding
L
Left nephrectomy
5.1-cm Well-defined solid
lobular mass
Intraparenchy
mal
upper pole
Schwannoma
NED
(18-mo follow-up)
L
Left nephrectomy
2.8-cm Well-demarcated
yellowish tumor,
Hilum
Schwannoma
NA
Kitagawa, 1990
51
M
Upper abdominal
pain and high
fever;painful
swelling of the
scrotum
Ma, 1990
67
M
Epigastric pain
R
Right nephrectomy
8-cm Well-encapsulated, firm,
yellowish
Intraparenchy
mal and pelvis
Cellular schwannoma
NED
(1-y follow-up)
Naslund, 1991
50
F
Mild abdominal
disconfort, weight
loss, anemia
L
Left nephrectomy
14-cm mass
Intraparenchy
mal
upper pole
Malignant schwannoma
DOD after 15-mo
…CONTINUA
Romics et al, 1992
52
M
Back and flank
pain, recurrent
fever, anemia,
leukocytosis
Ikeda, 1996
89
M
Abdominal pain
R
Right nephrectomy
NA
Pelvis
Schwannoma
NA
Singer, 1996
70
F
Asymptomatic,
elevated CEA
L
Left nephrectomy,
6-cm well demarcated
lobulated mass
Hilum
Schwannoma
NED
(18-mo follow-up)
Alvarado-Cabrero
et al, 2000
45
M
Flank and
abdominal pain
L
Left nephrectomy
16-cm mass
Intraparench
ymal
“Ancient”
schwannoma
NED
(5-y follow-up)
40
F
Flank pain
L
Left nephrectomy
12.5-cm mass
Intraparench
ymal
Cellular schwannoma
NED
(1-y follow-up)
84
M
Found during
work-up of
cystitis
R
Right nephrectomy
4-cm mass
Intraparench
ymal
Cellular schwannoma
NED
(4.5-y follow-up)
18
F
Flank pain
R
Right nephrectomy
6.2-cm mass
Intraparench
ymal
Cellular schwannoma
NED
(3.5-y follow-up)
Tsurusaki, 2001
69
F
Incidental finding
L
Tumorectomy
Elastic white mass with
necrosis
Capsule
Schwannoma
NA
Singh, 2005
40
M
Renal colicky
pain, vomiting
L
Left nephrectomy
3-cm firm mass
Hilum
Schwannoma
NED
(3-y follow-up)
35
M
Flank pain, gross
hematuria
R
Right nephrectomy
NA
Intraparench
ymal and
pelvis
Schwannoma
NED
(2-y follow-up)
Gobbo et al, 2008:
case 1
35
F
Abdominal pain,
nausea
L
Left nephrectomy
7-cm encapsulated
microcystic mass
Hilum
Schwannoma
NED
(4-mo follow-up)
Gobbo et al, 2008:
case 2
27
F
Incidental finding
during study for
polycythemia
R
Right nephrectomy
8.5-cm myxomatous fibrous
mass
Intraparench
ymal mid
lower pole
“Ancient”
schwannoma
NED
(8-mo follow-up)
Gobbo et al, 2008:
case 3
59
F
Asymptomatic
L
Left nephrectomy
4.8-cm lobulated mass
Hilum
Schwannoma
NA
R
Right nephrectomy;
mesenteric
metastasectomy
Large infiltrating mass with
cystic necrotic degeneration
Capsule
Malignant
schwannoma
DOD after 3-mo
Conclusioni:
Lo schwannoma renale è raro, usualmente si
localizza nella regione centrale del rene
improntando l’ilo o la pelvi ed è curato
chirurgicamente. Nella diagnosi differenziale
devono essere presi in considerazione il
carcinoma sarcomatoide e altri tumori a
cellule fusate.