SCHWANNOMA DEL RENE
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SCHWANNOMA DEL RENE
M. Vergine, S. Gobbo, M. Brunelli, A. Eccher, D. Segala, M. Chiosi, F. Bonetti, F. Menestrina, L. Cheng,
G. Martignoni
Università di VERONA
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Solo pochi casi di schwannoma del rene sono stati riportati.
Introduzione: 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
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Abbiamo riportato tre ulteriori casi di schwannoma renale con analisi immunoistochimica.
Abbiamo inoltre eseguito una revisione sistematica della letteratura
Materiali e Metodi:
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S100 S100A1 NSE Neurofilamenti HMB45 MiTF AML CK AE1/3 CK 7 CD34 CD10
Caso1 + Neg. 10% Neg Neg Neg Neg Neg Neg Neg Neg
Caso2 + + 90% Neg Neg Neg Neg Neg Neg Neg Neg
Caso3 + Neg. 90% Neg Neg Neg Neg Neg Neg Neg Neg
Analisi Immunoistochimica:
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Caso # Età Sesso Segni e Sintomi Lato Intervento chirurgico Follow-up
1 59 F Asintomatico S Nefrectomia Non Disponibili
2 27 F Reperto occasionale D NefrectomiaLibero da malattia a 8 mesi di follow-up
3 35 F Dolore addominale, nausea S Nefrectomia
Libero da malattia a 4 mesi di follow-up
Caso #Diametro Aspetto
Macroscopico Sede Diagnosi
1 4,8 cm Massa lobulata Ilo Schwannoma
28,5 cm Massa fibroso-
mixomatosaIntraparenchimale, polo inferiore
“Ancient” schwannoma
37 cm Massa
microcistica Ilo Schwannoma
Dati Clinici:
Dati patologici:
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CASO 1
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CASO 1
S100
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CASO 2
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CASO 2
S100
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CASO 3
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CASO 3
S100
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Author, Year of Publication Age Sex Symptoms and
Signs Side Operation Gross Location Diagnosis Follow-up
Phillips & Baumrucker, 1955 56 M
Generalized malaise, weight loss, fever, flank pain, mild anemia
L Left nephrectomy 12-cm Encapsulated tumor Pelvis Schwannoma NA
Kuzmina, 1962 33 F
Generalized malaise, weight loss, mild temperature, flank mass
R Right nephrectomy Encapsulated, rubbery, pale gray; tumor Capsule Schwannoma NA
Fein, 1965 51 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)
Bair, 1978 56 M
Hypertension, microhematuria, hypertensive renal disease
R Right nephrectomy 7-cm mass Hilum Schwannoma NED (5-mo follow-up)
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
Intraparenchymalupper pole
Schwannoma NED(18-mo follow-up)
Kitagawa, 1990 51 M
Upper abdominal pain and high fever;painful swelling of the scrotum
L Left nephrectomy 2.8-cm Well-demarcated yellowish tumor, Hilum Schwannoma NA
Ma, 1990 67 M Epigastric pain R Right nephrectomy 8-cm Well-encapsulated, firm, yellowish
Intraparenchymal and pelvis Cellular schwannoma NED
(1-y follow-up)
Naslund, 1991 50 FMild abdominal disconfort, weight loss, anemia
L Left nephrectomy 14-cm massIntraparenchymalupper pole
Malignant schwannoma DOD after 15-mo
REVISIONE DELLA LETTERATURA
…CONTINUA
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Romics et al, 1992 52 M
Back and flank pain, recurrent fever, anemia, leukocytosis
RRight nephrectomy; mesenteric metastasectomy
Large infiltrating mass with cystic necrotic degeneration Capsule Malignant
schwannoma DOD after 3-mo
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 Intraparenchymal
“Ancient” schwannoma
NED(5-y follow-up)
40 F Flank pain L Left nephrectomy 12.5-cm mass Intraparenchymal Cellular schwannoma NED
(1-y follow-up)
84 MFound during work-up of cystitis
R Right nephrectomy 4-cm mass Intraparenchymal Cellular schwannoma NED
(4.5-y follow-up)
18 F Flank pain R Right nephrectomy 6.2-cm mass Intraparenchymal 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
Intraparenchymal 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
Intraparenchymal 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
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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.
Conclusioni: