Botryoid-type of embryonal rhabdomyosarcoma of renal pelvis in a young woman
A 22-year-old female patient complaining of left loin pain which was colicky in nature without other urinary tract symptoms or history of trauma. Physical examination was unremarkable except for mild left loin tenderness, her hematocrit and kidney function laboratory test were normal and urine analysis showed microscopic hematuria. Ultrasonographic examination reveals left renal pelvic soft tissue mass around 3 × 4 cm [], MRI confirms this finding and a tumor is confined to the left renal pelvis without evidence of abdominal lymphadenopathy [Figure and ]. Left retrograde pyelography showed renal pelvic filling defect and lower group calyx hydronephrosis []. Ureterorenoscopy could confirm tumor and biopsies were taken, but histopathology report did not give definitive diagnosis other than the presence of a malignant process.\nA left nephureterectomy with transurethral ureter stripping and ureter ostium resection on a presumption of transitional cell carcinoma is carried out. The surgical resection specimen showed a polypoid tumor with a grape-like appearance in the left renal pelvis [].\nMicroscopically there was a condensation of epitheloid to spindle cells underneath the basement membrane, forming the cambium layer. Immunohistochemical examination stains for vimentin, WT1, CD117, CD99, HMB45, CEA, CK7, and S100 were negative, stains for desmin, MYO D1 and actin, confirming the diagnosis of Botryoid-type of embryonal rhabdomyosarcoma.