The Investigation Of The Clinical And Pathological Characteristics Of Renal Epithelioid Angiomyolipoma Influence Of Clinical Characteristics And Tumor Size On Symptoms Of Bladder Leiomyoma

BACKGROUND AND OBJECTIVE Renal angiomyolipomas (RAML) are recognized as clonal neoplasms with clonal chromosomal aberrations and a common progenitor cell, the perivascular epithelial cell (PEC). The epithelioid variant is a recently identified entity, characterized by predominance of PEC and a unique morphologic and immunohistochemical profile. The renal epithelioid angiomyolipoma (REA) comprises<1%of all renal epithelial neoplasms and about7.7%of renal angiomyolipoma. There is accumulating evidence suggesting that renal epithelioid angiomyolipoma (REA) is a malignant disease. As in most published studies about EAML were rare cases, only the clinical and pathological characteristics is still unclear. Therefore, we aim to present our experience with10cases of renal epithelioid angiomyolipoma to investigate the clinicopathologic characteristics of this rare disease and the influence of Ki-67(proliferation marker) and tumor size on the prognosis of patients.MATERIALS AND METHODS We reviewed medical records of10consecutive cases diagnosed renal epithelioid angiomyolipoma from January2005to February2012at our department. Clinical data were collected and analyzed and pathology slides were reviewed. The immunohistochemical reactions for Ki-67were performed and tumors showed positive expression were estimated. Active follow-up was performed in these patients. According to the survival status, patients were divided into two groups:living and dead. The association between the clinical and pathological characteristics and the prognosis was evaluated. Analysis of data was performed with Statistic Package for Social Science (SPSS)18.0software. The comparisons of the general information such as age and tumor size between the two groups used Independent Sample T-test while gender and the tumor location were analyzed with Chi-square test. What’s more, the role of Ki-67in predicting the prognosis nd the association between tumor size and prognosis was assessed using Kaplan-Meier analysis and with Log Rank test. Any P<0.05was considered to indicate statistically significant differences.RESULTS The mean age and tumor size of the patients was43.6years (range32-56) and8.2cm (range2-15cm), respectively. Seven were females while three were males. Radical nephrectomy was performed in6patients, partial nephrectomy in3, and renal artery ligation in1. The immunohistochemical reactions for HMB-45(Human Melanoma Black), SMA (Smooth Muscle Actin) were positive but for S-100were negative. The number of patients showing positive/negative Ki-67expression was5/5. The survival rate of the positive group was20%(1/5) while100%(5/5) of the negative group during the median follow-up time of26.75months (range1-53). Meanwhile, the survival rate of the patients with tumor larger than100mm was only20%(1/5) yet the ones with smaller tumors were all alive. Recurrence, metastasis and death due to disease occurred in1(10%),3(30%) and4(40%) patients, respectively.CONCLUSIONS The renal epithelioid angiomyolipoma is a rare disease which frequently occurs in females and could present malignant behavior. Higher expression (positive) of Ki-67indicates the presence of EAML and poor prognosis of patients.The tumor size shows influence on the prognosis which is larger tumor may indicate the poor prognosis of patients. Surgical excision including radical and partial nephrectomy is a considerable approach to the treatment for its malignant potential. BACKGROUND AND OBJECTIVE Bladder leiomyoma is an uncommon type of bladder neoplasms. Most publications are reports of isolated cases. The influence of tumor size on patients’ early symptoms was seldom analyzed. Benign mesenchymal tumors are rare and take less than1%of all bladder neoplasms. Even so, bladder leiomyoma is the most common benign soft tissue neoplasm of the bladder. Two hundred cases approximately were reported to date. Most publications regarding these tumors are reports of isolated cases. The influence of tumor size on patients’early symptoms and strategy for treatment options was seldom analyzed. Therefore, a comprehensive study on clinical characteristics of bladder leiomyoma and the impact of tumor size on patients’symptoms is needed. Therefore, we aim to investigate the clinical characteristics of bladder leiomyoma and the influence of tumor size on patients’symptoms in Chinese population.METHODS We reviewed the medical records of eight patients diagnosed with bladder leiomyoma at our department, collected53cases from Chinese National Knowledge Infrastructure (CNKI), Wangfang data base, and Chinese Biological Medicine Disk, and performed a pooled analysis. The clinical characteristics of the patients were analyzed and then classified into symptomatic and asymptomatic groups. The association between tumor size and the occurrence of symptoms was evaluated. Data analysis was performed by SPSS18.0software (SPSS Inc., USA). The mean size of tumor of symptomatic and asymptomatic groups and patients with/without early symptoms was calculated with independent sample t test. The X2test was applied to compare differences among the different groups. When20%cells had expected counts of less than five, Fisher’s exact test was used. A Logistic regression model was constructed to discriminate symptomatic or asymptomatic patients. Variables such as age and tumor size were transformed into categorical variables by grouping them where appropriate. Two-sided confidence level P<0.05was considered statistically significant.RESULTS Women comprised the majority of the patients (49/61,80.3%). The mean age and tumor size were (42.3±14.0) years and (45.0±25.7) mm, respectively. Among all the symptoms, irritative symptoms occurred most frequently (37.7%,23/61), followed by obstructive urinary symptoms (31.1%,19/61), hematuria (24.6%,15/61), and abdominal bulge or pain (14.8%,9/61). In our study, patients who were45years old or younger tended to be asymptomatic compared with elder ones (14/36vs.3/25, P=0.021). The histological, as well as anatomical, location of tumor, did not show significant differences between symptomatic and asymptomatic patients (P=0.306and0.700). Tumors larger than30mm in thegreatest diameter would cause clinical symptoms such as obstructive urinary symptoms (P=0.048) and irritative symptoms (P=0.037). Logistic regression confirmed the association between tumor size and the occurrence of symptoms, which was related with age.CONCLUSIONS Bladder leiomyoma occurs mainly in women and most frequently with irritative symptoms. The occurrence of symptoms is related to tumor size rather than the location. In this setting, patients with endovesical tumors smaller than30mm in the greatest diameter tended to be asymptomatic, which were usually treated with transurethral resection of bladder tumor.