A 57-year-old man was seen for the first time in our consultations in March 2003.
She was referred by the Nephrology Department after being diagnosed with smooth muscle tumor of uncertain malignant potential.
Among his personal history he only referred right nephritic colic for which he was studied in this Service when renal failure was detected.
The CT scan described a polylobulated abdominal mass of 8 x 6 cm that enhanced in part with contrast and presented areas of necrosis inside and extending from the subphrenic space and splenic hilium.
The 13-2-03 ultrasound was performed: a large tumor with areas of necrosis likely located in the retroperitoneum, independent of the kidney and the tail of the pancreas that extended to the upper pole of the inazode that could not be diagnosed.
No lymphadenopathy was observed.
Surgery was performed on the 6-3-03, finding a multilobulated tumor between fornix and splenic hilium, performing total removal along the spleen and gastric wall to which it is attached.
Pathological Anatomy : Macroscopically and at the level of the splenic hilium a multinodular tumor of 11x9x6 cm of firm consistency and brownish coloration is observed that the cut presents frequent hemorrhagic areas
Microscopically, the spleen does not show evidence of tumor.
The gastric wall was unaltered.
The tumor described previously is well delimited by a thin fibrous capsule and consists of isomorphic spindle cells, without atypia or necrosis, presenting a mitotic index of 2 mitotic levels per 10 fields.
Immunohistochemistry (IMH) was positive for smooth muscle actin and negative for desmin, S-100, CD 57, EMA, CD68 and neurofilaments.
The diagnosis was "Tumour of smooth muscle of uncertain malignant potential" (11 cm).
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After an extension study, which was negative, a case review was requested for definitive cataloguing by determining the HI that included CD 117 on this occasion; this was intensely positive.
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Results: smooth muscle actin and specific muscle actin: weak and focal immunostaining; CD34 and c-kit (CD 117): intense immunostaining with negative and positive control for CDmin: 10% Ki67; S-100 and
Definitive diagnosis was stromal tumor located in retroperitoneum
