International Urology and Nephrology 34: 193–195, 2002. © 2003 Kluwer Academic Publishers. Printed in the Netherlands. 193 Right upper quadrant swelling due to Leiomyosarcoma Satish Gunwant, Chandra Shekhar Biyani & David Almond Department of Urology, Princess Royal Hospital, Saltshouse Road, Hull HU8 9HE, UK Abstract. Reports of leiomyosarcoma occurring in the extremely elderly are quite rare. We describe a case of leiomyosarcoma in an 85-year-old patient and discuss magnetic resonance findings. Key words: Leiomyosarcoma, Magnetic resonance imaging Case report An 85-year-old man presented to his general prac- titioner with swelling arising from right lower chest extending to the upper abdomen. He also complained of pain in the back, mostly over the dorsal lumber spine, and also over the anterior abdominal wall. He had long-standing anaemia that had been investi- gated by his general practitioner with upper and lower gastrointestinal (GI) endoscopy. The upper GI endoscopy showed a grade II oesophagitis; colono- scopy was unremarkable. On this occasion, he initially was referred to the plastic surgeons with a possible diagnosis of lipoma in the right upper quadrant; he then was transferred to the general surgeons. On examination he was found to be midlly anaemic. Abdominal examination revealed a large mass occupying the right upper and lower quadrant. An ultrasound showed the mass to be separate from liver, but the right kidney could not be visualized. The tumour appeared hypointense on T 1 -weighted images, but T 2 -weighted sequence showed the tumour to be hyperintense. Magnetic resonance imaging (MRI) (Figures 1–4) demonstrated a cystic mass arising from and replacing the right kidney. The impression was of a cystic renal cell carcinoma. The patient was referred to the Urology Department. At laparotomy, a large indistinguishable vascular retroperitoneal mass was seen which was inoperable. The patient succumbed to the disease process. The histological report showed the mass to be a neoplasm formed of markedly pleomorphic cells that included spindle-shaped, irregular stellate-shaped, rounded, and tumour giant cells with a high mitotic Figure 1. Coronal T 1 -weighted image shows a large lesion of low signal intensity. Figure 2. Coronal T 2 -weighted image shows abnormally high signal intensity.