Masas renales infrecuentes: hematopoyesis perirrenal extramedular y linfangioma perirrenal / Uncommon renal masses: Perirenal extramedullary hematopoiesis and multiple lymphangiomatosis with a perirenal lymphangioma

RESUMEN

OBJETIVO: Presentar dos casos de masas renales infrecuentes, intentando llegar a su diagnóstico preoperatoriamente. MÉTODOS: Describimos un caso remitido por Hematología por hallazgos en TAC de masas perirrenales bilaterales, que al biopsiar refieren hematopoyesis extramedular. El otro caso se estudió por disnea, apreciando en el TAC pulmones con múltiples quistes y en abdomen, masa quístico sólida perirrenal izquierda. La biopsia pulmonar nos informó de Linfangiomatosis pulmonar, con lo que obviamos la biopsia renal. RESULTADOS: La mayoría de las masas renales sólidas son hipernefromas (85%). El resto de las masas son sarcomas, linfomas, tumores de vías infiltrantes y tumores benignos. Para su diagnóstico disponemos de la clínica y las pruebas radiológicas (ecografía, TAC, RNM y PET-TAC); pero ante hallazgos inespecíficos el diagnóstico se basará en el estudio histológico. CONCLUSIONES: La hematopoyesis renal extramedular y el Linfangioma perirrenal son tumores raros y su diagnóstico preoperatorio es difícil

ABSTRACT

OBJETIVE To present two cases of infrequent renal masses, trying to achieve the diagnosis before surgery. METHODS: We describe a case referred from the Department of Hematology in which bilateral perirrenal masses were described in the CT scan; after biopsy they where classified as extramedullary hematopoietic tissue. The other case was a patient presenting to the emergency room with dyspnea. CT Scan showed lungs with multiple cysts, chylothorax and a cystic-solid mass in the left perirenal space. In the lung biopsy they reported lung lymphangiomatosis, so we didn't perform renal biopsy. RESULTS: Most renal masses are renal carcinomas (85%). The less common diagnosis are sarcomas, lymphomas, upper urinary tract transitional cell carcinomas, metastases of other primary tumors, the Erdheim-Chester disease, the Castleman disease and benign tumors. All these diseases might show similar images in the CT scan and MRI, being the biopsy and histological study necessary for the diagnosis CONCLUSION: Perirenal extramedullary hematopoiesis and perirenal lymphangioma are rare diseases that need a pathologic study for their diagnosis