Case Report: Renal hemangiopericytoma treated laparoscopical
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Hemangiopericytoma(HPC) is rare in the urogenital system, most frequently occurs in the pelvis, head and neck, and meninges; it is extremely rare in the kidney. US, CT, or MRI do not show any specific sign of renal HPC that might aid in the differential diagnosis with other renal tumors, that’s why almost all cases are diagnosed after pathological results. The majority of cases are identified in patients with an unspecific clinical manifestations associated with hematuria or hypertension, hypoglycemia or additional paraneoplastic syndromes

A 15 year old female was admitted in the pediatric clinic due to dizziness and vomiting. During the exam she was found to have high blood pressure 180-130 mmHg. Next 1 month the patient had fluctuation in the BP following medical treatment. From the abdominal ultrasonography the small lesion 1,5 cm., was found on the left kidney, under the renal vessels. CT confirmed heterogenic small lesion under the renal hilum, with double pyelocaliceal system and two ureters. No tumor infiltration was found in the pyelocaliceal system, vessels and lymph nodes. Laboratory tests, including complete blood count, serum electrolytes, creatinine, and urea, were normal. The patient underwent surgery. Surgeons performed transperitoneal partial nephrectomy by laparoscopic approach and used intraoperatively laparoscopic ultrasound to find the tumor and define its borders. A well shaped exophytic tumor was excised completely. The surgical specimen was 1,5 cm in diameter with white color. Microscopic pathology examination confirmed the diagnosis - HPC. Next day after the operation, the patient had normal BP without medications. She was discharged 3 days after surgery without complications. After the follow up of 3 months, the patient remains well with no evidence of increasing BP.

In conclusion HPC is a rare tumor in the urogenital system and patients may present with different clinical manifestation. The imaging features are not specific to make a preoperative diagnosis. Surgery is the most effective modality of treatment for the disease and with this case we showed that minimally invasive surgery including partial resection is possible, feasible with satisfactory outcomes for the patients. Accurate diagnosis of HPC is proven after surgical treatment with the immunohistochemical result.