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A 49-year-old female was incidentally found to have a left renal tumor during a medical check-up. The tumor was too small to be fully diagnosed using computed tomography (CT) or magnetic resonance imaging (MRI). Since it was small and showed a homogenous enhancement pattern on contrast-enhanced CT, which made it difficult for us to distinguish the malignancy of the tumor, we performed regular CT follow-up. On the fifth year of her regular follow-up, the tumor had grown apparently larger and showed a heterogenous enhancement pattern, which suggested a malignant tumor. Since the tumor was exophytic, we decided to perform a laparoscopic partial nephrectomy. The operation was performed without any serious complications, and her renal function remained unchanged. The histopathology of the tumor was leiomyoma. Here, we discuss the characteristics of this tumor and the role of immunohistopathology in the diagnosis.

Background Renal leiomyomas are exceptionally rare, benign, mesenchymal tumours originating from smooth muscle in the kidney. Historically, because of their small size, most renal leiomyoma cases were discovered incidentally based on autopsy findings. However, since the advent and improved access to imaging modalities such as ultrasound and computed tomography (CT), renal leiomyomas are being discovered more frequently. Although usually incidental discoveries, clinical presenting signs and symptoms comprise abdominal or flank pain, a palpable flank mass, and haematuria in 20% of those with symptoms. Case presentation We study the case of an incidentally found, asymptomatic, left kidney mass that presented in a 60-year-old female. Initial suspicions on CT imaging of either renal cell carcinoma or oncocytoma resulted in a radical nephrectomy of the left kidney. Postoperative pathological examination of the mass revealed a renal leiomyoma; a rare, benign tumour that is mostly indistinguishable from malignant tumours on imaging. Conclusions With the current availability of ultrasonography and CT, they are often discovered incidentally, and the radiological differential diagnoses are often inadequate or challenging in such cases. The gold standard management of these suspicious cancer cases is still a radical nephrectomy with postoperative pathological and immunohistochemical analysis. Due to its benign nature, patients enjoy excellent prognoses without recurrence. We discuss and briefly review the relevant literature of the clinical, imaging and pathological features of renal leiomyomas and those of the differential diagnoses.

Renal leiomyoma is a rare benign mesenchymal tumor. It arises from the smooth muscle cells of the kidney and renal capsule is its most common location. Small tumor may be asymptomatic and usually appears as a well circumscribed peripherally located solid mass. Large tumor may manifest with pain, palpable flank mass or hematuria. Intersecting fascicles of spindle cells showing immunoreactivity to actin or desmin are characteristic histologic features. We present a case of giant renal leiomyoma in a 20-year-old female with chief complaints of abdominal discomfort and lump in her left side of abdomen. AP radiograph showed a large abdominopelvic soft tissue opacity. Contrast-enhanced computed tomography scan revealed a massive well circumscribed exophytic complex solid cystic mass of size 17 cm × 15 cm × 13 cm arising from upper pole of left kidney. The role of percutaneous biopsy is limited in such lesions and surgery is the only therapeutic option. Keywords: Mesenchymal tumor, Renal leiomyoma, Computed tomography (CT)

Yakupoglu, Yarkin Kamil/0000-0002-4764-0289; Mercimek, Mehmet Necmettin/0000-0002-0680-4451 WOS: 000494962600007 Leiomyomas are rare, benign and solid tumors of the kidney. Although the developments in radiological imaging methods provide early detection of kidney tumors, it is difficult to differentiate leiomyomas radiologically from other malignant renal tumors. Moreover, the definitive diagnosis of leiomyomas can only be achieved by histopathological and also immunohistochemical evaluation after surgical intervention. Immunohistochemically, positive staining with smooth muscle actin and vimentin, whereas negative staining with cytokeratin, S100, Mart1 and HMB45 are the methods used in the differential diagnosis of leiomyomas. In this case series, after preoperative radiological evaluation, two female and two male patients between 45 and 89 years of age underwent laparoscopic treatment with the diagnosis of a malignant mass in the kidney. We aimed to illustrate the clinical, radiological and histopathological relationship of four adult patients who were managed by laparoscopic approach and diagnosed with renal leiomyoma. Renal leiomyomas should be kept in mind in patients with a renal mass before definitive treatment.

Leiomyoma is a mesenchymal tumor which arise from any structure or organ containing smooth muscle, but is frequently seen in the female genital tract. Renal leiomyoma is extremely rare benign lesion with low incidence (1:1000), has been reported mostly in adults and very few cases have been described in the pediatric age-group. It is often asymptomatic and can be diagnosed when reaches large sizes. Hereby, we present a case of renal leiomyoma in a smaller size, in the pediatric age group., Highlights • Renal leiomyoma is extremely rare benign lesion in the pediatric age. • Leiomyoma may rarely arise from almost every part of the genitourinary system. • Leiomyoma must be considered in differential diagnosis of benign-looking renal mass. • Definitive diagnosis requires histological examination.

Renal leiomyoma (RL) is a rare benign tumor originating from muscle cells and has been rarely described in the pediatric age-group. A case of a large RL in an 11-year-old girl is reported with a literature review. The girl was admitted for abdominal pain due to mass effect. Contrast-enhanced CT showed a circumscribed low density mass (22 × 19 × 12 cm) arising from the right kidney. A right nephrectomy was performed. The mass was well defined and encapsulated. Only the histopathology and immunohistochemistry confirmed the diagnosis of RL. Even though partial nephrectomy may be possible, radical nephrectomy remains the recommended treatment for large leiomyoma.

Leiomyoma is an uncommon tumor of the kidney. The authors report a rare case of renal leiomyoma in a 39-year-old male patient who presented with a right flank mass. Laparoscopic nephrectomy was performed. The histopathology and immunohistochemistry confirm the diagnosis of renal leiomyoma. The review of literature in the clinicoradiopathological correlation was illustrated.

Renal leiomyomas mas are rare and benign tumors. It is not possible to differentiate between renal leiomyomas and other malignant renal tumors with imaging methods; the diagnosis is established only with histopathological examination. Herein, we present a case of renal leiomyoma which was treated with laparoscopic partial nephrectomy with the prediagnosis of renal cell carcinoma.

Many different masses can involve the kidney other than the commonly encountered renal cell carcinoma (RCC). The purpose of this article is to review the characteristic clinical and imaging findings of common and uncommon masses that predominantly present unilaterally in the adult patient, other than RCC. Awareness of such lesions and knowing the clinical scenario is important for appropriate diagnosis and management, especially in a multidisciplinary care setting.

Renal leiomyomas are rare benign tumours of the kidney originating from muscle cells. They are usually found by an autopsy,whether the patient is asymptomatic or has symptoms (i.e., abdominal/flank pain, hematuria, palpable mass). Today the widespread use of ultrasonography and computed tomography has increased the detection of clinically asymptomatic renal leiomyomas. The differential diagnosis between leiomyomas and other malignant lesions (above all renal cell carcinoma or leiomyosarcoma) is still possible by histological examination. Radiological examinations are not sufficient for the differential diagnosis. Renal leiomyomas have no aggressive behaviour and they usually do not metastasize. The prognosis, after surgery, is excellent without recurrence. We report a case of leiomyoma in a 31-year-old man who presented hematuria and flank pain. We also review the literature and provide a summary of clinical, radiological and histological features of renal leiomyomas.

INTRODUCTIONLeiomyoma of kidney is an exceptional finding in the urinary tract. Though most of these tumors are detected on autopsy, still it remains a diagnostic challenge.PRESENTATION OF CASEWe report three adult cases of renal leiomyoma in our institute who presented with abdominal mass and haematuria in last 8 years.DISCUSSIONLeiomyoma has been reported in other organs but renal leiomyoma is rare tumour, though in autopsy series they are second in order of frequency among the renal mesenchymal neoplasms, and few cases have been described in the literature. Still no Indian experience is evaluated on this rare site of occurrence.CONCLUSIONConsidering the difficulty of clinical diagnosis of this tumour, strong suspicion is indicated when a patient presents with voluminous, well circumscribed renal lesions.

Renal leiomyomas large enough to be clinically diagnosed are extremely rare. We review 30 cases of clinically diagnosed renal leiomyoma from the literature in Japan, including our 2 new cases. Case 1: In a 52-year-old man with no symptoms a renal mass was found accidentally on an ultrasonogram. CT scan showed a mass with a cystic area at the upper pole of the right kidney. Angiogram showed a hypovascular mass. Case 2: CT scan revealed a cystic mass and angiogram showed an avascular mass at the upper pole of the left kidney in a 19-year-old man having gross hematuria and left flank pain. Transperitoneal nephrectomy was done in both cases. Histologically each tumor was composed of monotonous proliferation of spindle shaped cells without atypia, which showed intense immunoreactivity for alpha-smooth muscle actin. The diagnosis of benign leiomyoma was made in each case. In a review of 30 cases, we found that renal leiomyomas occur most often in female (77%), between decades 2 and 5 of life (median: 46 years). On the angiogram it appears most often as an avascular or hypovascular mass. CT scan shows cystic or mixed solid/cystic or solid lesion, occasionally with calcification. Preoperative diagnosis is extremely difficult to be made. Histologically, fibroma, angiomyolipoma, congenital mesoblastic nephroma and leiomyosarcoma should be differentiated.

Renal leiomyoma is a rare neoplasm. We report such a case in a 57-year-old Japanese woman who was found to have a mass in the left kidney. The histological examination disclosed the proliferation of spindle cells showing a benign appearance. Entrapped tubular cells were observed in the peripheral area of the tumor. The immunohistochemical examination of spindle neoplastic cells showed a positive reaction for alpha smooth muscle actin, h-caldesmon, l-caldesmon, calponin, muscle actin, myosin and desmin. Additionally, the ultrastructural examination of the tumor showed membrane caveolae and myofilaments in the cytoplasm. This tumor was considered to show a differentiation into smooth muscle cells. The comparative genomic hybridization of the tumor detected the combined losses of chromosomes 4, 6, 12 and 14 which has not been previously described in renal tumors. Finally, the immunohistochemical panel of smooth muscle markers and ultrastructural and genetic study may be useful in diagnosing renal leiomyoma.

Renal leiomyomas large enough to be clinically diagnosed are extremely rare. We review 30 cases of clinically diagnosed renal leiomyoma from the literature in Japan, including our 2 new cases. Case 1: In a 52-year-old man with no symptoms a renal mass was found accidentally on an ultrasonogram. CT scan showed a mass with a cystic area at the upper pole of the right kidney. Angiogram showed a hypovascular mass. Case 2: CT scan revealed a cystic mass and angiogram showed an avascular mass at the upper pole of the left kidney in a 19-year-old man having gross hematuria and left flank pain. Transperitoneal nephrectomy was done in both cases. Histologically each tumor was composed of monotonous proliferation of spindle shaped cells without atypia, which showed intense immunoreactivity for alpha-smooth muscle actin. The diagnosis of benign leiomyoma was made in each case. In a review of 30 cases, we found that renal leiomyomas occur most often in female (77%), between decades 2 and 5 of life (median: 46 years). On the angiogram it appears most often as an avascular or hypovascular mass. CT scan shows cystic or mixed solid/cystic or solid lesion, occasionally with calcification. Preoperative diagnosis is extremely difficult to be made. Histologically, fibroma, angiomyolipoma, congenital mesoblastic nephroma and leiomyosarcoma should be differentiated.

A case of renal leiomyoma in a 35-year-old female is presented. Since 1948, fifteen cases including our own case of renal leiomyoma, have been reported in the Japanese literature. They were discovered either from clinical symptoms or incidentally by on image diagnostic study. Some diagnostic and therapeutic problems are discussed.

A case of renal leiomyoma in a 35-year-old female is presented. Since 1948, fifteen cases including our own case of renal leiomyoma, have been reported in the Japanese literature. They were discovered either from clinical symptoms or incidentally by on image diagnostic study. Some diagnostic and therapeutic problems are discussed.