title: Spontaneous rupture of renal leiomyosarcoma in a 45-year-old woman.
abstract: OBJECTIVE
  Leiomyosarcoma is a rare histological subtype of renal sarcomas, accounting for approximately 50-60% of the reported cases. Spontaneous rupture of renal tumor is an uncommon event and the most frequent cause is angiomyolipoma. We report a case of spontaneous rupture of leiomyosarcoma in a 45-year-old woman, presenting with severe left flank pain and perirenal hemorrhage.
  
  
  METHODS
  A 45-year-old caucasian white woman was transferred to our department from emergency room of a different Hospital for acute left flank pain interpreted as a renal colic not responsive to medical therapy. On clinical examination patient was haemodynamically stable but with rapid decrease in hemoglobin, pale, without haematuria with a persistent left flank and hypochondrium pain as in acute abdomen. CT scan of abdomen showed a retroperitoneal haematoma around the left kidney, and a large heterogeneous mass.
  
  
  RESULTS
  Laparotomy was urgently performed. There was large retroperitoneal hematoma extending from left kidney to pelvic space. At the upper pole of the kidney a bleeding tumor was found. Radical nephrectomy was performed. The histological diagnosis was of low-grade leiomyosarcoma from renal angiomyolipoma.
  
  
  CONCLUSIONS
  We attract attention both on kidney cancer (at our knowledge only 3 cases described in literature) and on the need of imaging in the clinical approach of renal colic. We strongly believe that the patients presenting at emergency for renal colic must be scanned by ultrasounds or TC.
authors.affiliation: Department of Urology, Desio Hospital, Milan, Italy. marco.grasso@aovimercate.org
authors.forename: M
authors.initials: M
authors.lastname: Grasso
authors.forename: S
authors.initials: S
authors.lastname: Blanco
authors.forename: F
authors.initials: F
authors.lastname: Fortuna
authors.forename: S
authors.initials: S
authors.lastname: Crippa
authors.forename: C
authors.initials: C
authors.lastname: Di Bella
mesh_terms: D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications*; D007890:Leiomyosarcoma / Q000150:complications*; D008875:Middle Aged; D012422:Rupture, Spontaneous