MEETING No. 40, MARCH 13th, 2002 AT THE G. PINI HOSPITAL, MILAN

Case 1 Case 2 Case 3 Case 4 Case 5
Case 4


"ABDOMINAL MASS IN A KIDNEY TRANSPLANTED PATIENT"
A. RAMPONI - Novara Hospital
(pict. by dr. Ramponi)

Clinical history: a 58y.o.man underwent kidney transplant because of a polycystic kidney.
After 10 months he comes back to his doctor because of respiratory impairment.
During admission he develops acute abdomen and undergoes surgery.
During the surgical operation a large, 15 cm, right, intra-peritoneal abdominal mass is discovered.
The mass infiltrates the liver, the diaphragm, the gall bladder and the adjacent bowel loops. A biopsy of the lesion is performed.
The polycystic kidneys are on site and, likewise the transplanted kidney, they don't appear involved by the lesion.
Microscopical description: the lesion grows in the peritoneal adipose tissue and shows large haemorrhagic areas (pict. 1 - pict. 2); it consists of epithelioid cells with large (melanoma-like) cytoplasm and vesicular nuclei with prominent nucleoli (pict. 3); there are some alveolar-like structures and atypical mitoses (pict. 4).
The neoplastic cells are positive with immunohistochemical staining for Vimentin (pict. 5), pool Cytokeratins (pict. 6) and focally positive for Factor VIII (pict. 7); they are negative for Cytokeratin 20, Cytokeratin 7, CD34, EMA, CD30, LCA, S100, Calretinin, CD68, Bcl2, SM Actin and HMB45.

Diagnosis

pict. 1	pict. 2
pict. 3	pict. 4
pict. 5	pict. 6
pict. 7

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