Letter to the Editor
Giant solitary fibrous tumor of the kidney
Tumor fibroso solitario renal gigante
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Luis-Cardo, F.J. González-García, C. Agra-Pujol, J. Hernández-Cavieres, C. Hernández-Fernández" "autores" => array:5 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Luis-Cardo" "email" => array:1 [ 0 => "adrianluiscardo@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F.J." "apellidos" => "González-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Agra-Pujol" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Hernández-Cavieres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "C." "apellidos" => "Hernández-Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumor fibroso solitario renal gigante" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 994 "Ancho" => 1255 "Tamanyo" => 303626 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Macroscopic view of radical nephrectomy specimen and macroscopic section appearance. (B) Microscopic image (hematoxylin and eosin staining, 20×). Densely cellular spindle cell tumor with extensive tumor necrosis (arrow). (C) Detail of spindle-shaped cells with poorly demarcated cytoplasm, weakly eosinophilic and ovoid nuclei with fine chromatin (hematoxylin and eosin staining, 40×). Branching ‘hemangiopericytoma-like’ vessels (“staghorn” branching) are observed (arrow). (D) Immunohistochemical staining of STAT6 (40×) showing positivity. Nuclear expression of tumor cells is observed with immunohistochemical staining of STAT6.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Solitary fibrous tumor (SFT) is a very rare tumor of mesenchymal origin, initially described in the pleura. Cases of extrapleural origin have also been reported in several anatomic sites.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Fewer than 150 cases of SFT of renal origin have been reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 66-year-old man with a 3-month history of increased abdominal circumference and edema in the lower limbs and genitals. Computed tomography showed a 9<span class="elsevierStyleHsp" style=""></span>cm bilobulated tumor in the renal sinus of the right kidney, which continued as a dumbbell tumor with another lower-pole dependent mass of approximately 20<span class="elsevierStyleHsp" style=""></span>cm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There was no evidence of adenopathy, venous thrombosis, or distant dissemination. Open radical nephrectomy with preservation of the ipsilateral adrenal gland was performed through a t-shaped extended mid-line laparotomy incision on the right flank, using the surgical maneuvers derived from transplant surgery described earlier.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The mass presented important collateral venous circulation which compressed adjacent anatomical structures, without apparent infiltration (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Its macroscopic cross-section appearance revealed a whitish, well-demarcated bilobulated tumor measuring 35<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>21<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>14<span class="elsevierStyleHsp" style=""></span>cm (5600<span class="elsevierStyleHsp" style=""></span>g) in total, which did not affect the urinary tract and blood vessels. Resection margins were free (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The pathological evaluation revealed a renal SFT. Histologically, these tumors are characterized by haphazardly arranged mesenchymal spindle cell proliferation, weak eosinophilic cytoplasm, poorly demarcated, growing on a collagen stroma with staghorn type vessels (hemangiopericytoma pattern). There is a wide spectrum of lesions: from more cellular to paucicellular tumors with myxoid or keloid-type stroma. The evaluation with immunohistochemical techniques shows positivity for CD34, more specifically for STAT6 (diffuse nuclear staining), but the expression of these markers can be lost in dedifferentiated SFTs. In our case, there was tumor necrosis in approximately 40% and 2<span class="elsevierStyleHsp" style=""></span>mitoses/10 HPF in the evaluated material. The Ki67 proliferation marker was less than 5% (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Extra-pleural SFTs are usually presented in middle-aged patients, with a peak incidence in the 6th decade of life, and their onset is slightly predominant in men. Given their slow growth, the diagnosis is usually incidental, and potential symptoms are caused by the pressure effects on adjacent anatomical structures. On rare occasions they cause hypoglycemia, attributable to the secretion of insulin-like growth factor (Doege-Potter syndrome).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The preferred treatment option is radical surgery, aiming to provide free resection margins. Even in the presence of free surgical margins, a minority of patients may develop metastasis; lung, bone and liver are the most common locations.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> The World Health Organization proposes a risk stratification model for metastasis based on 4 variables: age, tumor size, number of mitoses/10 high-power fields and presence of necrosis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> The appearance of metastases is associated with worse prognosis, as mortality rates of up to 75% have been described after their development, with median survival times ranging from 22 to 46 months.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Luis-Cardo A, González-García FJ, Agra-Pujol C, Hernández-Cavieres J, Hernández-Fernández C. Tumor fibroso solitario renal gigante. Actas Urol Esp. 2021;45:656–658.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2084 "Ancho" => 1305 "Tamanyo" => 418064 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A–D) CT images showing a large bilobulated mass occupying the renal sinus and lower pole of the right kidney. (E) Intraoperative image showing the renal mass occupying almost the entire right side of the abdomen.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 994 "Ancho" => 1255 "Tamanyo" => 303626 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Macroscopic view of radical nephrectomy specimen and macroscopic section appearance. (B) Microscopic image (hematoxylin and eosin staining, 20×). Densely cellular spindle cell tumor with extensive tumor necrosis (arrow). (C) Detail of spindle-shaped cells with poorly demarcated cytoplasm, weakly eosinophilic and ovoid nuclei with fine chromatin (hematoxylin and eosin staining, 40×). Branching ‘hemangiopericytoma-like’ vessels (“staghorn” branching) are observed (arrow). (D) Immunohistochemical staining of STAT6 (40×) showing positivity. Nuclear expression of tumor cells is observed with immunohistochemical staining of STAT6.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extrapleural solitary fibrous tumor: a distinct entity from pleural solitary fibrous tumor. An update on clinical, molecular and diagnostic features" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Ronchi" 1 => "I. Cozzolino" 2 => "F. Zito Marino" 3 => "M. Accardo" 4 => "M. Montella" 5 => "I. 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Pollock" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/modpathol.2012.83" "Revista" => array:7 [ "tituloSerie" => "Mod Pathol" "fecha" => "2012" "volumen" => "25" "paginaInicial" => "1298" "paginaFinal" => "1306" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22575866" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673617314678" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000004500000010/v1_202112020948/S2173578621001190/v1_202112020948/en/main.assets" "Apartado" => array:4 [ "identificador" => "6296" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000004500000010/v1_202112020948/S2173578621001190/v1_202112020948/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578621001190?idApp=UINPBA00004N" ]
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