Concurrent minimal change disease and retroperitoneal liposarcoma successfully treated by tumor resection and steroid th
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CASE REPORT
Concurrent minimal change disease and retroperitoneal liposarcoma successfully treated by tumor resection and steroid therapy Yuki Yasui1 · Ryoko Shibata1 · Natsumi Morita1 · Naoko Himuro1 · Aki Hamauchi1 · Maho Watanabe1 · Kenji Ito1 · Tetsuhiko Yasuno1 · Yasuhiro Abe1 · Katsuhisa Miyake1 · Fumihiro Yoshimura2 · Makoto Hamsaki3 · Satoshi Hisano3 · Kosuke Masutani1 · Hitoshi Nakashima1 Received: 28 April 2020 / Accepted: 28 August 2020 © Japanese Society of Nephrology 2020
Abstract A 54-year-old Japanese woman developed simultaneous abdominal distension and bilateral leg edema. Her medical history and results of periodic medical check-up were unremarkable. Blood tests revealed severe hypoproteinemia and acute kidney injury, and urinalysis revealed 4+ proteinuria and 2+ hematuria. Abdominal computed tomography revealed a large intraabdominal mass with fat tissue density. She underwent emergency tumor excision, splenectomy, and distal pancreatectomy. However, hypoproteinemia and acute kidney injury worsened. Therefore, she was transferred to the nephrology division for confirmation of diagnosis and for treatment of acute kidney injury and nephrotic syndrome. We conducted percutaneous kidney biopsy and diagnosed minimal change disease (MCD). Intravenous prednisolone was started, and heavy proteinuria and systemic edema were gradually alleviated. She achieved complete remission 2 months later, and oral prednisolone was tapered. Histopathological diagnosis of abdominal tumor was dedifferentiated liposarcoma of retroperitoneal origin. Immunohistochemical staining revealed strong expression of vascular endothelial growth factor in the tumor cells in the dedifferentiated component. Currently, her clinical course is stable without recurrence of liposarcoma and nephrotic syndrome. MCD develops in patients with Hodgkin’s lymphoma, solid organ cancers, hematological malignancies, and thymoma, whereas concurrent MCD and liposarcoma are rare. Remission of nephrotic syndrome and normalized kidney function induced by steroid therapy are important for better management of patients with malignancy. Keywords Computed tomography · Kidney biopsy · Nephrotic syndrome · Prednisolone · Surgical excision
Introduction Nephrotic syndrome occasionally develops in patients with malignancy, and it is often difficult to distinguish from idiopathic disease. Membranous nephropathy (MN) often develops in patients with solid organ cancer, whereas minimal change disease (MCD) is associated with Hodgkin’s * Kosuke Masutani kmasutani@fukuoka‑u.ac.jp 1
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7‑45‑1, Jonan‑ku, Fukuoka 814‑0180, Japan
2
Department of Gastrointestinal Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
3
Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
lymphoma [1, 2]. MCD can also develop widely in patients with solid organ cancers, lymphoid malignancies, myeloid malignancies, and thy
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