Abboudi Hamid, Tschobotko Benjamin, Carr Christopher, DasGupta Ranan
Department of Urology, Charing Cross Hospital, Fulham Palace Road, London, United Kingdom.
Department of Radiology, Charing Cross Hospital, Fulham Palace Road, London, United Kingdom.
J Endourol Case Rep. 2017 Dec 1;3(1):176-178. doi: 10.1089/cren.2017.0018. eCollection 2017.
Renal anastomosing hemangioma (RAH) is an extremely rare benign vascular tumor first described in 2009. Making this diagnosis is fraught with challenges. Radiologically they share features consistent with renal cell carcinomas (RCCs). Their vascular nature poses risks if considering preoperative biopsy and histologically they share characteristics akin to angiosarcomas. The few reports published in the literature suggest presentation with hematuria, flank pain, and polycythemia although the majority are diagnosed at postnephrectomy histologic examination. This case represents the first metachronous RAH in the literature, and is the first RAH presenting with severe hemorrhage. A 62-year-old woman of Albanian heritage presented to urology with visible hematuria and positive urine cytology. Three years before this presentation, she had undergone an elective radical right-sided nephrectomy for a suspected RCC detected on magnetic resonance imaging, which proved to be an RAH after postoperative histologic examination of the specimen. The patient was investigated with cystoscopy and ureteroscopy for this new hematuria presentation, both of which were unremarkable. Fourteen hours post ureteroscopy, the patient became severely hypotensive and developed acute kidney injury. A CT scan indicated a large left-sided renal subcapsular and retroperitoneal hematoma that was actively bleeding. The patient was hemodynamically unstable and, therefore, required an emergency open left-sided nephrectomy, rendering her anephric and dialysis dependent. Postoperative histologic examination proved that the left kidney also contained an RAH. The anastomosing hemangioma is an important subtype to differentiate from angiosarcoma before and after a nephrectomy. Urologists should carefully consider invasive tests in patients with previously diagnosed vascular lesions as there may be an increased risk of bleeding. Patients with a previously diagnosed anastomosing hemangioma may require surveillance of the contralateral kidney.
肾吻合性血管瘤（RAH）是一种极其罕见的良性血管肿瘤，于2009年首次被描述。做出这一诊断充满挑战。在放射学上，它们具有与肾细胞癌（RCC）一致的特征。考虑术前活检时，其血管性质带来风险，并且在组织学上它们具有与血管肉瘤相似的特征。文献中发表的少数报告表明，患者表现为血尿、侧腹痛和红细胞增多症，不过大多数是在肾切除术后的组织学检查中被诊断出来的。本病例是文献中首例异时性RAH，也是首例表现为严重出血的RAH。一名62岁的阿尔巴尼亚裔女性因肉眼血尿和尿细胞学检查阳性就诊于泌尿外科。在此次就诊前三年，她因磁共振成像检测出疑似RCC而接受了择期右侧根治性肾切除术，术后标本的组织学检查证明是RAH。针对此次新出现的血尿表现，对该患者进行了膀胱镜检查和输尿管镜检查，结果均无异常。输尿管镜检查后14小时，患者出现严重低血压并发生急性肾损伤。CT扫描显示左侧肾包膜下和腹膜后有一个大血肿，且正在出血。患者血流动力学不稳定，因此需要紧急进行左侧开放性肾切除术，导致她无肾并依赖透析。术后组织学检查证明左肾也含有RAH。在肾切除术前和术后，吻合性血管瘤都是需要与血管肉瘤相鉴别的重要亚型。泌尿外科医生对于先前诊断为血管病变的患者应谨慎考虑侵入性检查，因为出血风险可能会增加。先前诊断为吻合性血管瘤的患者可能需要对侧肾的监测。
