Grasso M, Blanco S, Fortuna F, Crippa S, Di Bella C
Department of Urology, Desio Hospital, Milan, Italy.
Arch Esp Urol. 2004 Oct;57(8):870-2.
Leiomyosarcoma is a rare histological subtype of renal sarcomas, accounting for approximately 50-60% of the reported cases. Spontaneous rupture of renal tumor is an uncommon event and the most frequent cause is angiomyolipoma. We report a case of spontaneous rupture of leiomyosarcoma in a 45-year-old woman, presenting with severe left flank pain and perirenal hemorrhage.
A 45-year-old caucasian white woman was transferred to our department from emergency room of a different Hospital for acute left flank pain interpreted as a renal colic not responsive to medical therapy. On clinical examination patient was haemodynamically stable but with rapid decrease in hemoglobin, pale, without haematuria with a persistent left flank and hypochondrium pain as in acute abdomen. CT scan of abdomen showed a retroperitoneal haematoma around the left kidney, and a large heterogeneous mass.
Laparotomy was urgently performed. There was large retroperitoneal hematoma extending from left kidney to pelvic space. At the upper pole of the kidney a bleeding tumor was found. Radical nephrectomy was performed. The histological diagnosis was of low-grade leiomyosarcoma from renal angiomyolipoma.
We attract attention both on kidney cancer (at our knowledge only 3 cases described in literature) and on the need of imaging in the clinical approach of renal colic. We strongly believe that the patients presenting at emergency for renal colic must be scanned by ultrasounds or TC.
平滑肌肉瘤是肾肉瘤中一种罕见的组织学亚型，约占已报道病例的50 - 60%。肾肿瘤自发性破裂是一种罕见事件，最常见的原因是肾血管平滑肌脂肪瘤。我们报告一例45岁女性平滑肌肉瘤自发性破裂病例，表现为严重的左侧腰痛和肾周出血。
一名45岁的白种女性从另一家医院的急诊室转入我科，因急性左侧腰痛被诊断为肾绞痛，对药物治疗无反应。临床检查时患者血流动力学稳定，但血红蛋白迅速下降，面色苍白，无血尿，左侧腰部和季肋部持续疼痛，类似急腹症。腹部CT扫描显示左肾周围有腹膜后血肿，以及一个大的不均匀肿块。
紧急进行了剖腹手术。有巨大的腹膜后血肿，从左肾延伸至盆腔。在肾的上极发现一个出血性肿瘤。进行了根治性肾切除术。组织学诊断为来自肾血管平滑肌脂肪瘤的低级别平滑肌肉瘤。
我们提请注意肾癌（据我们所知，文献中仅描述了3例）以及肾绞痛临床诊治中影像学检查的必要性。我们坚信，因肾绞痛到急诊科就诊的患者必须接受超声或CT扫描。
