- Email: [email protected]
Fibroma of the kidney in the newborn
Fibroma of the Kidney in the Newborn By YUJI HAMANAKA, EIZO
OKAMOTO,
AND TAKASHI
UEDA
s
MALL ASYMPTOMATIC RENAL FIBROMAS have frequently been found in routine autopsy specimens, but few have grown to sufficient size to be of clinical importance. We could find no report of renal fibroma reviewed from an infant, and submit the following case to be placed on record. CASE
REPORT
A 25-day-old female was admitted August 28, 1965 for investigation of a left-sided abdominal tumor. The mass had been felt by the mother soon after birth. There were no urinary symptoms. The patient was well nourished and weighed 3750 Gm. The liver was palpable at the Costa1 margin, but the right kidney was not palpable. Rectal examination was normal. A goose egg-sized mass occupied the left’ half of the abdomen and extended from the left costal margin down to the left ingumal ligament and medially to the umbilicus. It was slightly mobile and moved with respiration. Bimanual examination was indefinite in determining whether the tumor was renal in origin. On x-ray examination there were no calculi or calcifications in the region of the kidney, ureters, or bladder, and the intestinal gas was pushed to the right side by the tumor. Excretory pyelogram demonstrated a normal pattern in the right kidney pelvis, but the left showed a filling defect compatible with renal tumor. On September 21, 1965, surgical exploration through a left transverse abdominal incision revealed a round tumor in the lower portion of the left kidney, which was easily separated from the peritoneum and the surrounding structures. Nephrectomy was performed. The patient was discharged on the eighth postoperative day. The tumor and the kidney weighed 110 Gm. Normal renal tissue was recognizable only in about one fifth of the upper portion of the total mass. The cut surface was solid, firm, and gray-white with a “watered silk” appearance. The renal substance parenchyma lA,B ). The histologic appearance was that of a was compressed by the tumor (Fig. medullary fibroma. There were interlacing strands of fibroblasts and connective tissue running in all directions (Fig. 2A). There were no areas of degeneration, mitosis, or and tubule-like structures anaplasia. In several parts of the tumor, some glomerulus-like were present
(Fig.
2B,C).
DISCUSSION Thirty-three cases of renal fibroma have been recorded in the literature prior to 1~68 including 4 cases in children (Table 1). The patient in this report is the youngest. Renal fibroma is usually associated with the finding of an abdominal mass, sometimes with hematuria, and in older patients a dull pain in the region of the kidney. The patient has often been aware of its presence for a long time. Diagnosis is made by excretory pyelography. In the recorded From
the First
Department
of Surgery,
Osaka -University
School
of Medicine,
Osaka,
Japan. YUJI HAMANAKA, M.D.: Clinical Assistant, Osaka University Hospital, First Department of Surgery. TAKASHI UEDA, M.D.: Surgeon-in-Chief, Pediatric Surgery, Osaka Children’s Medical Center, EIZO OKAMOTO, M.D.: Lecturer, Osaka University Hospital, First Depatiment of Surgery. 250
JOURNAL OF PEDIATRICSURGERY,VOL. 4, No. 2
(APRIL), 1969
FIRROMA
OF THE KIDNEY
Fig. L-A, Gross appearance of the extirpated mass, showing the kidney on the upper part of the tumor. B, Cut surface of the specimen, showing the replacement of a large part of the kidney by the fibroma.
Fig. 2.-A, Photomicrograph showing the interlacing strands of fibroblasts connective tissue running in all directions; H and E stain, X 100.
and
33Y 21 Y 46~ 1lY 2Y
28 Y 36 Y 2-3Y 28~ 20Y 38Y 41 Y 21 Y
41Y 73Y
45 Y
26~
32 Y
1882 1882 1885 1885 1886
1923 1928 1929 1929 1930 1931 1932 1933
1937 1938
1944 1945
1951
Bruntzel Thomas Claus Wahl Park
2 3 4 5 6
17 18 19
16
Clark Kukudshanoff Boross Steinle Gordon-Taylor Kretschmer Colombino Rush and Rush Nightingale and Lytle Mouat Melicow DOS Santos Immergute and Cottler
53 Y
7 8 9 10 11 12 13 14 15
AZk?
Year
1869
AUthOX
wilks
1
Female
Male Female pain
Tumor Tumor Tumor, pain Tumor
Male Female
Hematuria,
Tumor, pain Tumor Hematuria Hematuria, pain Tumor Hematuria Tumor Tumor
Female Female Male Male Female Male Male Female
18 mos.
1 yr. 10 yrs. 5 yrs. 2 yrs.
Right
Left
Right Right Left
Left Left Right Right Left
6 4 8 4 4
wks. yrs. days mos. yrs.
Right Left -
Few mos. after birth 1 yr. 5 yrs. -
6 yrs.
Left Right Right Right
Left
5 yrs.
Location
Tumor Tumor Tumor Tumor Tumor
Duration
Female Female Female -
Male
Right
SYmPtoms
Cases, Clinical Data
10 yrs.
Chief
of the Kidney: Reported Tumor, hematuria
Sex
Table l.-Fibroma
Recovery Recovery Recovery Recovery Recovery Recovery Recovery Recovery
Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy
Nephrectomy
Recovery
Recovery Recovery Recovery Recovery
Recovery Recovery Recovery
-
Nephrectomy Extirpation Nephrectomy Nephrectomy
Outcome Death with uremia Recovery Recovery
Treatment
25 26 27 28 29 30 31 32 33 34
Chauvin Le Brun Foster Weaver and Carlquist Early Lygonis Shucksmith Sat0 Lahbabi Haastert Tsuchida Takei Pezzoli Hamanaka
21 22 23 24
Author
Devos
GS‘?
20
1957 1958 1961 1963 1963 1963 1964 1964 1965 1965 1968
1954 1955 1956
1952
3Y 27 Y 60Y 35 Y 30 Y 31 Y 51 Y 2oy 49 Y 25 days
31 Y
8Y
Male Male Female Male Male Male Female Female Female Male Female
Male
Male Female
61 y 23 y
Sex Female
AW
32 y
Symptoms
Tumor, p:rin Hematuria Pain Hematuria Hematuria, pain Tumor Tumor Tumor Tumor Tumor Tumor
Right Left Right Right Left Left Left Left Left Left Left
18 mos. 1 yr. 4 mos. 3 days 4 mos. 2 mos. 16 yrs. 2 wks. 12 yrs. 1 yr. soon after birth
Right
Location
Right Right Left
Duration
6 wks. 4 mos. 18 mos.
L-Continued _.
Tumor, hematuria pain Tumor Hematuria Tumor
Chief
Table
Nephrectomy Ncphrectomy Nephrectomy Extirpation Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy
Recovery Recovery Death after the operation started Recovery Recovery Recovery Recovery Recovery Recovery Recovery Recovery Recovery Recovery Recovery Nephrectomy Nephrectomy
Outcome
Recovery
Treatment _
Nephrectomy
HAMANAKA
ET
AL.
Fig. 2.-B, Photomicrograph showing some glomerulus-like structures; H and E stain, X 100. C, Photomicrograph showing tubule-like structures in the tumor. The majority of glomerulus-like and tube-like structures is found in the area nearest the kidney; none found in the far end of the tumor; H and E stain, X 100. cases, nephrectomy was done, but were it possible to determine that the tumor is benign during operation the growth alone might be removed without total nephrectomy. However, since most of the renal tumors occurring in the infant age group are malignant, it is quite difficult to avoid nephrectomy when one encounters this type of rare benign tumor. Large nephrofibroma warranting surgery in the newborn period has not been found in the literature. SUMMARY
A large fibroma of the kidney, successfully removed by surgery, in a newborn is reported with a bibliography pertinent to 33 previously recorded cases of which 4 were children. SUMMABIO IN INTEBLINGUA Con le successose remotion de un grande fibroma renal in un neonato, cases reportate in juveniles attinge un total de 5.
le numero
de tal
ACKNOWLEDGMENT The authors
wish to thank Professor
Hisao Manabe
for his courtesy.
REFERENCES 1. Gordon-Taylor, G.: Gigantic benign tumor of kidney weighing 22 pounds. Nephrectomy: Cure. Brit. J. Surg., 17:551, 1930.
2. Kretschmer, H. L.: Fibroblastoma (fibroma) of the kidney. A report of a case with review of the literature. Surg. Gynec. Obstet. 54:534, 1932.
FIBROMA
OF THE
3. Colombino,
S.:
255
KIDNEY
Fibrome
multipli,
in-
vadenti de1 rene. Cancro 3:63, 1932. 4. Rush, L. V., and Rush, H. L.: Fibroma of the kidney. Amer. J. Surg. 19:531, 1933. 5. Nightingale, H. J., and Lytle, S. N.: Fibroma of the kidney with cyst. Brit. J. Surg. 25:57, 1937. 6. Mouat, T. B.: Large pedunculated fibroma of the kidney. Brit. J. Urol. 10:158, 1938. 7. Melicow, M. M.: Classification of renal neoplasms: A clinical and pathological study based on 199 cases. J. Urol. 51:333, 1944. 8. DOS Santos, R., and Wohlwill, F.: Uma observacao ram de fibroma calcificado do rim. Amatus Lustanus; Revista de Midicina Chirurgia 4:61, 1945. 9. Immergute, S., and Cottler, Z.: Intrapelvic fibroma. J. Urol. 66:673, 1951. 10. Devos, R.: Tumeur conjonctiva benigne du rein. J. Belge D’Urol. 21:53, 1952. 11. Chauvin, E., Chauvin, H. F., and Bonneau: Enorme fibrome pm febrile du rein J. D’Urol. 60:541, 1954. 12. Le Brun, H. I., Kellet, H. S., and Wacalister, C. L. 0.: Renal hamartoma. Brit. J. Ural. 27:394, 1955. 13. Foster, D. G.: Large benign renal tumors: A review of the literature and report of a case in childhood. J. Urol. 76:231, 1956.
14. Weaver,
R. G., and Carlquist,
J. H.:
Two rare tumors of the renal parenchyma. J. Urol. 77:351, 1957. 15. Early, R., Brown, B., and Terplan, K.: Fibroblastoma of renal parenchyma. J. Urol. 80:417, 1958. 16. Lygonis, C. S.: Cortical fibroma of the kidney. Brit. J. Urol. 33:275, 1961. 17. Shucksmith, H. S.: Fibroma of the renal pelvis. Brit. J. Urol. 35:261, 1963. 18. Sate, S., Takano, M., and Chiba, E.: Fibroma of the kidney with cyst. Acta hfedica et Biologica 11:99, 1963. 19. Lahbabi, M. M., and Be&ran: Un cas de fibrome kystique du rein. Maroc Medical 42:696, 1963. 20. Tsuchida, S., Kimura, Y., Someno, T., and Sugawara, H.: Coincidental occurrence of renal fibroma and cancer of the rectum: Report of a case. Rinsho Hifu Hinyokika 18: 1289, 1964. 21. Haastert, S.: Verkalktes Nierenkapselfibrom. Fortsch. Roentgenstr. 100:267, 1964. 22. Takei, H.: A case of giant fibroma of the kidney. Shinshu Igaku Zzashi 14: 91, 1965. 23. Pezzoli, G., and Bertolotti, A.: I Fibromi de1 rene, Rivista della letteratura e presentazione di un case. Annali Italiani di Chirurgia 42: 129, 1965.
OKAMOTO,
AND TAKASHI
UEDA
s
MALL ASYMPTOMATIC RENAL FIBROMAS have frequently been found in routine autopsy specimens, but few have grown to sufficient size to be of clinical importance. We could find no report of renal fibroma reviewed from an infant, and submit the following case to be placed on record. CASE
REPORT
A 25-day-old female was admitted August 28, 1965 for investigation of a left-sided abdominal tumor. The mass had been felt by the mother soon after birth. There were no urinary symptoms. The patient was well nourished and weighed 3750 Gm. The liver was palpable at the Costa1 margin, but the right kidney was not palpable. Rectal examination was normal. A goose egg-sized mass occupied the left’ half of the abdomen and extended from the left costal margin down to the left ingumal ligament and medially to the umbilicus. It was slightly mobile and moved with respiration. Bimanual examination was indefinite in determining whether the tumor was renal in origin. On x-ray examination there were no calculi or calcifications in the region of the kidney, ureters, or bladder, and the intestinal gas was pushed to the right side by the tumor. Excretory pyelogram demonstrated a normal pattern in the right kidney pelvis, but the left showed a filling defect compatible with renal tumor. On September 21, 1965, surgical exploration through a left transverse abdominal incision revealed a round tumor in the lower portion of the left kidney, which was easily separated from the peritoneum and the surrounding structures. Nephrectomy was performed. The patient was discharged on the eighth postoperative day. The tumor and the kidney weighed 110 Gm. Normal renal tissue was recognizable only in about one fifth of the upper portion of the total mass. The cut surface was solid, firm, and gray-white with a “watered silk” appearance. The renal substance parenchyma lA,B ). The histologic appearance was that of a was compressed by the tumor (Fig. medullary fibroma. There were interlacing strands of fibroblasts and connective tissue running in all directions (Fig. 2A). There were no areas of degeneration, mitosis, or and tubule-like structures anaplasia. In several parts of the tumor, some glomerulus-like were present
(Fig.
2B,C).
DISCUSSION Thirty-three cases of renal fibroma have been recorded in the literature prior to 1~68 including 4 cases in children (Table 1). The patient in this report is the youngest. Renal fibroma is usually associated with the finding of an abdominal mass, sometimes with hematuria, and in older patients a dull pain in the region of the kidney. The patient has often been aware of its presence for a long time. Diagnosis is made by excretory pyelography. In the recorded From
the First
Department
of Surgery,
Osaka -University
School
of Medicine,
Osaka,
Japan. YUJI HAMANAKA, M.D.: Clinical Assistant, Osaka University Hospital, First Department of Surgery. TAKASHI UEDA, M.D.: Surgeon-in-Chief, Pediatric Surgery, Osaka Children’s Medical Center, EIZO OKAMOTO, M.D.: Lecturer, Osaka University Hospital, First Depatiment of Surgery. 250
JOURNAL OF PEDIATRICSURGERY,VOL. 4, No. 2
(APRIL), 1969
FIRROMA
OF THE KIDNEY
Fig. L-A, Gross appearance of the extirpated mass, showing the kidney on the upper part of the tumor. B, Cut surface of the specimen, showing the replacement of a large part of the kidney by the fibroma.
Fig. 2.-A, Photomicrograph showing the interlacing strands of fibroblasts connective tissue running in all directions; H and E stain, X 100.
and
33Y 21 Y 46~ 1lY 2Y
28 Y 36 Y 2-3Y 28~ 20Y 38Y 41 Y 21 Y
41Y 73Y
45 Y
26~
32 Y
1882 1882 1885 1885 1886
1923 1928 1929 1929 1930 1931 1932 1933
1937 1938
1944 1945
1951
Bruntzel Thomas Claus Wahl Park
2 3 4 5 6
17 18 19
16
Clark Kukudshanoff Boross Steinle Gordon-Taylor Kretschmer Colombino Rush and Rush Nightingale and Lytle Mouat Melicow DOS Santos Immergute and Cottler
53 Y
7 8 9 10 11 12 13 14 15
AZk?
Year
1869
AUthOX
wilks
1
Female
Male Female pain
Tumor Tumor Tumor, pain Tumor
Male Female
Hematuria,
Tumor, pain Tumor Hematuria Hematuria, pain Tumor Hematuria Tumor Tumor
Female Female Male Male Female Male Male Female
18 mos.
1 yr. 10 yrs. 5 yrs. 2 yrs.
Right
Left
Right Right Left
Left Left Right Right Left
6 4 8 4 4
wks. yrs. days mos. yrs.
Right Left -
Few mos. after birth 1 yr. 5 yrs. -
6 yrs.
Left Right Right Right
Left
5 yrs.
Location
Tumor Tumor Tumor Tumor Tumor
Duration
Female Female Female -
Male
Right
SYmPtoms
Cases, Clinical Data
10 yrs.
Chief
of the Kidney: Reported Tumor, hematuria
Sex
Table l.-Fibroma
Recovery Recovery Recovery Recovery Recovery Recovery Recovery Recovery
Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy
Nephrectomy
Recovery
Recovery Recovery Recovery Recovery
Recovery Recovery Recovery
-
Nephrectomy Extirpation Nephrectomy Nephrectomy
Outcome Death with uremia Recovery Recovery
Treatment
25 26 27 28 29 30 31 32 33 34
Chauvin Le Brun Foster Weaver and Carlquist Early Lygonis Shucksmith Sat0 Lahbabi Haastert Tsuchida Takei Pezzoli Hamanaka
21 22 23 24
Author
Devos
GS‘?
20
1957 1958 1961 1963 1963 1963 1964 1964 1965 1965 1968
1954 1955 1956
1952
3Y 27 Y 60Y 35 Y 30 Y 31 Y 51 Y 2oy 49 Y 25 days
31 Y
8Y
Male Male Female Male Male Male Female Female Female Male Female
Male
Male Female
61 y 23 y
Sex Female
AW
32 y
Symptoms
Tumor, p:rin Hematuria Pain Hematuria Hematuria, pain Tumor Tumor Tumor Tumor Tumor Tumor
Right Left Right Right Left Left Left Left Left Left Left
18 mos. 1 yr. 4 mos. 3 days 4 mos. 2 mos. 16 yrs. 2 wks. 12 yrs. 1 yr. soon after birth
Right
Location
Right Right Left
Duration
6 wks. 4 mos. 18 mos.
L-Continued _.
Tumor, hematuria pain Tumor Hematuria Tumor
Chief
Table
Nephrectomy Ncphrectomy Nephrectomy Extirpation Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy Nephrectomy
Recovery Recovery Death after the operation started Recovery Recovery Recovery Recovery Recovery Recovery Recovery Recovery Recovery Recovery Recovery Nephrectomy Nephrectomy
Outcome
Recovery
Treatment _
Nephrectomy
HAMANAKA
ET
AL.
Fig. 2.-B, Photomicrograph showing some glomerulus-like structures; H and E stain, X 100. C, Photomicrograph showing tubule-like structures in the tumor. The majority of glomerulus-like and tube-like structures is found in the area nearest the kidney; none found in the far end of the tumor; H and E stain, X 100. cases, nephrectomy was done, but were it possible to determine that the tumor is benign during operation the growth alone might be removed without total nephrectomy. However, since most of the renal tumors occurring in the infant age group are malignant, it is quite difficult to avoid nephrectomy when one encounters this type of rare benign tumor. Large nephrofibroma warranting surgery in the newborn period has not been found in the literature. SUMMARY
A large fibroma of the kidney, successfully removed by surgery, in a newborn is reported with a bibliography pertinent to 33 previously recorded cases of which 4 were children. SUMMABIO IN INTEBLINGUA Con le successose remotion de un grande fibroma renal in un neonato, cases reportate in juveniles attinge un total de 5.
le numero
de tal
ACKNOWLEDGMENT The authors
wish to thank Professor
Hisao Manabe
for his courtesy.
REFERENCES 1. Gordon-Taylor, G.: Gigantic benign tumor of kidney weighing 22 pounds. Nephrectomy: Cure. Brit. J. Surg., 17:551, 1930.
2. Kretschmer, H. L.: Fibroblastoma (fibroma) of the kidney. A report of a case with review of the literature. Surg. Gynec. Obstet. 54:534, 1932.
FIBROMA
OF THE
3. Colombino,
S.:
255
KIDNEY
Fibrome
multipli,
in-
vadenti de1 rene. Cancro 3:63, 1932. 4. Rush, L. V., and Rush, H. L.: Fibroma of the kidney. Amer. J. Surg. 19:531, 1933. 5. Nightingale, H. J., and Lytle, S. N.: Fibroma of the kidney with cyst. Brit. J. Surg. 25:57, 1937. 6. Mouat, T. B.: Large pedunculated fibroma of the kidney. Brit. J. Urol. 10:158, 1938. 7. Melicow, M. M.: Classification of renal neoplasms: A clinical and pathological study based on 199 cases. J. Urol. 51:333, 1944. 8. DOS Santos, R., and Wohlwill, F.: Uma observacao ram de fibroma calcificado do rim. Amatus Lustanus; Revista de Midicina Chirurgia 4:61, 1945. 9. Immergute, S., and Cottler, Z.: Intrapelvic fibroma. J. Urol. 66:673, 1951. 10. Devos, R.: Tumeur conjonctiva benigne du rein. J. Belge D’Urol. 21:53, 1952. 11. Chauvin, E., Chauvin, H. F., and Bonneau: Enorme fibrome pm febrile du rein J. D’Urol. 60:541, 1954. 12. Le Brun, H. I., Kellet, H. S., and Wacalister, C. L. 0.: Renal hamartoma. Brit. J. Ural. 27:394, 1955. 13. Foster, D. G.: Large benign renal tumors: A review of the literature and report of a case in childhood. J. Urol. 76:231, 1956.
14. Weaver,
R. G., and Carlquist,
J. H.:
Two rare tumors of the renal parenchyma. J. Urol. 77:351, 1957. 15. Early, R., Brown, B., and Terplan, K.: Fibroblastoma of renal parenchyma. J. Urol. 80:417, 1958. 16. Lygonis, C. S.: Cortical fibroma of the kidney. Brit. J. Urol. 33:275, 1961. 17. Shucksmith, H. S.: Fibroma of the renal pelvis. Brit. J. Urol. 35:261, 1963. 18. Sate, S., Takano, M., and Chiba, E.: Fibroma of the kidney with cyst. Acta hfedica et Biologica 11:99, 1963. 19. Lahbabi, M. M., and Be&ran: Un cas de fibrome kystique du rein. Maroc Medical 42:696, 1963. 20. Tsuchida, S., Kimura, Y., Someno, T., and Sugawara, H.: Coincidental occurrence of renal fibroma and cancer of the rectum: Report of a case. Rinsho Hifu Hinyokika 18: 1289, 1964. 21. Haastert, S.: Verkalktes Nierenkapselfibrom. Fortsch. Roentgenstr. 100:267, 1964. 22. Takei, H.: A case of giant fibroma of the kidney. Shinshu Igaku Zzashi 14: 91, 1965. 23. Pezzoli, G., and Bertolotti, A.: I Fibromi de1 rene, Rivista della letteratura e presentazione di un case. Annali Italiani di Chirurgia 42: 129, 1965.