An 80-year-old man was hospitalized in our institution for hematuria and loss of weight. Computed tomographic scan and ultrasonography revealed a huge right renal mass with thrombus of the vena cava and renal vein. A right radical nephrectomy was performed. On gross examination, a large tumor of 7 cm was found in the kidney. Microscopic examination revealed a neoplasm composed of sheets of clear tumor cells with irregular nuclei and nucleoli (Furhman grade 3). Areas of hemorrhage were identifiable. Within the tumor, we noted well-circumscribed nodules composed of dark brown, rod-shaped formations with bamboo-shaped encrustations, mimicking mycelian structures (Figures 1 and 2). Perls and von Kossa stains confirmed that these structures were made of iron and calcium deposits and that they corresponded to the entity called Gandy-Ganna nodules (Figure 3).1
Gamma-Gandy nodules are sclerosiderotic granulomas composed of various amounts of calcium and hemosiderin in hyalinized fibrous tissue, occasionally with a foreign body giant cell reaction. These nodules are usually encountered in splenic tissue and more rarely in lymph nodes, thyroid, or cardiac myxoma.2,3 The pathogenesis remains unclear, but it seems that it could represent a peculiar evolution of hemorrhage foci. To the best of our knowledge, this is the first report of Gamna-Gandy nodules arising in a renal clear cell carcinoma.
References
1. Gamna C. On vascular lesions of the spleen in haemolytic siderosis. G Acad Med Torino. 1921;84:291-297.
2. Tedeschi LG. The Gamna nodule. Hum Pathol. 1971;2:182-183.
3. Trotter SE, Shore DF, Olsen EGJ. Gamna-Gandy nodules in a cardiac myxoma. Histopathology. 1991;270-271.
Xavier Leroy, MD; Sebastien Aubert, MD; Bernard Gosselin, MD
Accepted for Publication October 14, 2002. From the Department of Pathology, University Hospitals, Lille, France. Reprints: Xavier Leroy, MD, Service d'Anatomie et de Cytologie Pathologiques, Faculte de medecine, Pole recherche, CHRU, 59045, Lille, France (e-mail: x-leroy@chru-lille.fr).
Copyright College of American Pathologists Mar 2003
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