Ostéosarcome primitif du rein avec évolution métastatique au foie.Étude de cas et revue de la littérature
DOI:
https://doi.org/10.5489/cuaj.1054Abstract
L’ostéosarcome primitif du rein est une pathologie très rare dontl’histogénèse n’est pas claire. Les récidives locales et les métastasessont fréquentes et le pronostic est très mauvais. Nous décrivons icile cas d’une patiente de 59 ans qui présentait des douleurs lombairesgauches et un amaigrissement. Une échographie abdominaleet une tomodensitométrie abdominale ont révélé une masserétropéritonéale de 13 × 8 × 9 cm avec macrocalcifications. Lebilan d’extension n’a pas révélé d’autres lésions. On a procédé àune néphrectomie élargie gauche; l’examen histologique a révéléune prolifération tumorale constituée de cellules fusiformes de taillevariable, ces cellules manifestement atypiques produisant directementdu tissu ostéoïde évoquant un ostéosarcome rénal. Dix moisplus tard, la patiente présentait des lésions métastatiques au niveauhépatique sans autre lésion secondaire ni récidive locale. La patienteest actuellement en cours de traitement par chimiothérapie pardoxorubicine et cisplatine avec un recul de 17 mois. Les caractéristiquesanatomocliniques et les modalités thérapeutiques decette pathologie rare sont discutées ci-dessous.
Primary osteosarcoma of the kidney is very rare. Its exact histogenesisremains unclear. It has a tendency to recur locally and metastasize,and the prognosis is very poor. We present a case of a59-year-old woman with left flank pain and weight loss. Abdominalultrasonography and bone scan revealed a large solid retroperitonealmass with calcifications. The patient underwent radicalnephrectomy; microscopic examination showed atypical cells withthe characteristic pattern of classic osteosarcoma with immatureneoplastic osteoid. Ten months later, the patient developedmetastatic lesions in the liver, without local recurrence or othersites of metastases. The patient is currently receiving chemotherapywith doxorubicin and cisplatin, with a follow-up in 17 months.The most important clinical findings, the pathogenesis and thetreatment modalities of this rare neoplasm are discussed.
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