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Recurrence of a renal myogenic tumor presented as a duodenal ulcerated lesion.

BACKGROUND/AIM
The authors report on an extremely rare case of a recurrent myogenic tumor of renal origin presented exclusively with gastrointestinal signs and symptoms resulting from duodenal invasion.


PATIENTS AND MATERIALS
A 49-year-old woman was admitted for epigastric pain and recent history of melenae. She had been submitted to right nefrectomy due to a smooth muscle tumor five years ago.


RESULTS
Pathology described it as a bizarre leiomyoma. Diagnostic procedures showed lobulated and ulcerated lesions in the duodenum, a nodule within the anterior abdominal wall, a large neoplasm fulfilling the right renal loca and invading the duodenum, and another nodule at the left kidney. Histological features of all tumors were similar to those seen in the primary renal tumor. The abdominal wall nodule was the only resectable lesion. Although biopsies taken initially from the duodenal lesions failed to reveal smooth muscle tissue, they were repeated one year later and disclosed duodenal invasion from a leiomyosarcoma.


CONCLUSION
This extremely rare case illustrates the striking disagreement between pathological diagnosis and clinical course of smooth muscle tumors that sometimes occur.