- Open Access
Review of juxtaglomerular cell tumor with focus on pathobiological aspect
© Kuroda et al; licensee BioMed Central Ltd. 2011
- Received: 10 June 2011
- Accepted: 26 August 2011
- Published: 26 August 2011
Juxtaglomerular cell tumor (JGCT) generally affects adolescents and young adults. The patients experience symptoms related to hypertension and hypokalemia due to renin-secretion by the tumor. Grossly, the tumor is well circumscribed with fibrous capsule and the cut surface shows yellow or gray-tan color with frequent hemorrhage. Histologically, the tumor is composed of monotonous polygonal cells with entrapped normal tubules. Immunohistochemically, tumor cells exhibit a positive reactivity for renin, vimentin and CD34. Ultrastructurally, neoplastic cells contain rhomboid-shaped renin protogranules. Genetically, losses of chromosomes 9 and 11 were frequently observed. Clinically, the majority of tumors showed a benign course, but rare tumors with vascular invasion or metastasis were reported. JGCT is a curable cause of hypertensive disease if it is discovered early and surgically removed, but may cause a fatal outcome usually by a cerebrovascular attack or may cause fetal demise in pregnancy. Additionally, pathologists and urologists need to recognize that this neoplasm in most cases pursues a benign course, but aggressive forms may develop in some cases.
- Partial Nephrectomy
- Urothelial Carcinoma
- Solitary Fibrous Tumor
- Glomus Tumor
Juxtaglomerular cell tumor (JGCT) is a very rare cause of hypertension that was first described by Robertson et al. in 1967 and the name was coined by Kihara in 1968 [1, 2]. To date, approximately 100 cases with JGCT have been reported. Clinically, this tumor is characterized by hypertension, hyperaldosteronism and hypokalemia secondary to excessive renin secretion by tumor cells [3–8]. In this article, we introduce the general overview of JGCT with focus on pathobiological aspects.
This tumor affects adolescents and young adults, with peak prevalence in the second and third decades of life with a female predominance [8–10]. Haab et al. (1995) detected eight JGCTs among 30,000 patients at a hypertensive clinic .
Patients with JGCT present with various symptoms including headaches, retinopathy, double vision, dizziness, nausea, vomiting, polyuria and proteinuria [8, 12]. Most of these symptoms may be attributed to hypertension or hypokalemia. Clinically, JGCT is subdivided into three categories . The typical variant, which accounts for the majority of JGCT, has characteristically high renin concentration, hyperaldosteronism, hypokalemia and hypertension [4, 5]. Second most common presentation is the atypical variant showing hypertension with normal potassium level . The third, non-functioning variant is very rare and is characterized by a normal blood pressure and normal potassium level [14–16]. Clinicians should strongly suspect JGCT if they encounter adolescent or young adult patients with severe or even moderate hypertension associated with an unexplained secondary hyperaldosteronism . JGCT may cause malignant hypertension . A case of JGCT associated with membranous glomerulonephritis was also reported .
Ultrasonography of the kidneys usually shows a hypoechoic mass [19, 20]. Computed tomography (CT) scan is very useful for the detection of renal tumor, even when other imaging analyses is negative [8, 21]. CT scan shows finding of low, low-to iso- or low- to high-density without enhancement [20, 22–24]. In dynamic CT scan, JGCT is not stained during early phase, but stains moderately during late phase after contrast enhancement [24–26]. Magnetic resonance imaging is also a powerful diagnostic procedure [12, 23, 25]. MRI shows an iso-signal intensity area on T1-weighted images and a high-signal intensity area on T2-weighted images, but MRI findings seem to variable [23, 26, 27].
Grossly, the tumor is well circumscribed and complete or partial fibrous capsule is observed in most cases [9, 28]. The cut surface of the tumor imparts yellow to gray-tan in color with frequent hemorrhage . The tumor is usually small solitary and unilateral, but the tumors exceeding 3 cm are occasionally observed [8, 29, 30]. A case of extrarenal JGCT arising in bone has been reported .
Intracytoplasmic granules suggestive of renin storage may be detected by Bowie, periodic acid-Aschiff, and phostotungstic acid-hematoxylin-azan stains [2–4, 28, 29, 40–42]. Toluidine blue stain is useful in the detection of mast cells in the stroma .
In situ hybridization findings
Messenger RNA of renin is found in the cytoplasm of tumor cells of JGCT. Some investigators suggest that renin synthesis and storage may be concordant , whereas others consider that the positivity of messenger RNA in the tumor cytoplasm may be due to uptake of renin rather than renin production .
The cytoplasm of tumor cells contains characteristic rhomboid-shaped renin protogranules, abundant rough endoplasmic reticulum and prominent Golgi apparatus [4, 9, 10, 22, 29, 34, 40–42, 44, 46]. Secretory granules of various size and shapes are also observed . Micropinocytotic vesicles and submembranous plaques suggestive of smooth muscle differentiation may be also contained in the cytoplasm [32, 47]. The presence of nerve fibers have been reported . Ultrastructural immunocytochemistry showed that immunoreactive renin is observed not only in crystalline protogranules or round membrane bound granules but also in intermediate form .
The distinction from glomus tumor, hemangiopericytoma, metanephric adenoma, papillary RCC, collecting duct carcinoma (CDC), urothelial carcinoma (UC), renal epithelioid angiomyolipoma (AML) and Wilms tumor should be considered. JGCT may possess the growth pattern reminiscent of glomus tumor. However, glomus tumor contains no epithelial component and is immunohistochemically negative for renin. Hemangiopericytoma lacks polygonal cells and thick-walled vessels. Solitary fibrous tumor often shows the hemangiopericytomatous pattern, but this tumor is frequently reactive for CD99 and bcl-2. JGCT with prominent papillary growth pattern may resemble papillary RCC . However, papillary RCC lacks biphasic pattern of round to polygonal cells and epithelial cells. Metanephric cells typically show acinar growth pattern and psammoma bodies are often seen in the stroma. Solid sheets growth pattern of JGCT may evoke the diagnosis of CDC or poorly differentiated UC. However, CDC or urothelial carcinoma is macroscopically located in the renal medulla or hilar region, respectively, but the location of many JGCTs is the renal cortex. Renal angiomyolipoma may contain minor adipose tissue component and show the immunoreactivity for melanosome-related antigen. Wilms' tumor typically contains blastemal cells showing nuclear overlapping.
Molecular genetic findings
There are only a few limited reports on genetic abnormalities of JGCT. Using karyotype, comparative genomic hybridization (CGH) and interphase fluorescence in situ hybridization (FISH), the gain of chromosome 10 as well as losses of chromosomes 9 and X and most of chromosome 11q may be important pathogenetic events in JGCT . One case demonstrated monosomy of chromosomes X, 6, 9, 11, 15 and 21 using FISH analysis . Two tumors revealed losses of chromosomes 9 and 11 by CGH . Aneuploid karyotype and complex genomic imbalance observed in two cases may reflect a possible development for local recurrence or distant metastasis, namely uncertain malignant potential [50, 52].
The complete tumor resection by radical or partial nephrectomy is the best modality for JGCT [35, 53]. Antihypertensive agents should be treated for hypertension until accurate diagnosis is made, but blood pressure, plasma renin level usually normalize after the nephrectomy in most cases with JGCT [2, 23, 25, 54–56]. However, hypertension may continue because of hypertensive angiopathy even after the complete tumor removal in approximately 10% of all cases [10, 25, 47].
The majority of cases with JGCT have behaved in a benign manner and neither local recurrence nor metastasis has occurred with either radical or partial nephrectomy. However, one metastatic case with JGCT has been reported to date . Additionally, a case of JGCT that caused death due to massive brain hemorrhage secondary to severe hypertension has been reported . A case of JGCT causing fetal demise has been noted .
Since the discovery of this tumor approximately 40 years ago, many common histological features including histochemistry, immunohistochemistry and ultrastructure have been elucidated and, as a result, JGCT gained the status as the distinct mesenchymal tumor entity from other renal tumor. However, there are only a few genetic studies of JGCT because of the rarity of this disease. As we encountered a case of JGCT with vascular invasion, the true biological behavior of JGCT will be needed to be elucidated. Accordingly, genetic features of JGCT need to be clarified by the future investigations.
- Robertson PW, Klidijan A, Harding LK, Walters G, Lee MR, Robb-Smith AHT: Hypertension due to a renin-secreting renal tumor. Am J Med. 1967, 43 (6): 963-976. 10.1016/0002-9343(67)90256-2.View ArticlePubMedGoogle Scholar
- Kihara I, Kitamura S, Hoshino T, Sieda H, Watanabe T: A hitherto unreported vascular tumor of the kidney: A proposal of "juxtaglomerular cell tumor". Acta Path Jap. 1968, 18 (2): 197-206.PubMedGoogle Scholar
- Eddy RL, Sanchez SA: Renin-secreting renal neoplasm and hypertension with hypokalemia. Ann Int Med. 1971, 75 (5): 725-729.View ArticlePubMedGoogle Scholar
- More IA, Jackson AM, MacSween RNM: Renin-secreting tumor associated with hypertension. Cancer. 1974, 34 (6): 2093-2102. 10.1002/1097-0142(197412)34:6<2093::AID-CNCR2820340633>3.0.CO;2-B.View ArticlePubMedGoogle Scholar
- Valdes G, Lopez JM, Maritinez P, Rosenberg H, Barriga P, Rodriguez JA, Otipka N: Renin-secreting tumor. Case report. Hypertension. 1980, 2 (5): 714-718.View ArticlePubMedGoogle Scholar
- Baruch D, Corvol P, Alhenc-Celas F, Dukloux M-A, Guyenne TT, Gauz J-C, Raynaud A, Brisset J-M, Duclos J-M, Menard J: Diagnosis and treatment of renin-secreting tumors. Report of three cases. Hypertension. 1984, 6 (5): 760-766.View ArticlePubMedGoogle Scholar
- Tomita T, Posner A, Inagami T: Immunohistochemical localization of renin in renal tumors. Am J Pathol. 1987, 126 (1): 73-80.PubMed CentralPubMedGoogle Scholar
- McVicar M, Carman C, Chandra M, Abbi RJ, Teichberg S, Kahn E: Hypertension secretory to renin-secreting juxtaglomerular cell tumor: case report and review of 38 cases. Pediatr Nephrol. 1993, 7 (4): 404-412. 10.1007/BF00857553.View ArticlePubMedGoogle Scholar
- Martin SA, Mynderse LA, Lager DJ, Cheville JC: Juxtaglomerular cell tumor. A clinicopathologic study of four cases and review of the literature. Am J Clin Pathol. 2001, 116 (6): 854-863. 10.1309/B10J-FKQ5-J7P8-WKU4.View ArticlePubMedGoogle Scholar
- Kim H-J, Kim CH, Choi Y-J, Ayala AG, Amirikachi M, Ro JY: Juxtaglomerular cell tumor of kidney with CD34 and CD117 immunoreactivity. Report of 5 cases. Arch Pathol Lab Med. 2006, 130 (5): 707-711.PubMedGoogle Scholar
- Haab F, Dulcos JM, Guyenne T, Plouin PF, Corvol P: Renin-secreting tumors: diagnosis, conservative surgical approach and long-term results. J Urol. 1995, 153 (6): 1781-1784. 10.1016/S0022-5347(01)67304-X.View ArticlePubMedGoogle Scholar
- Agrawal R, Zafar S, Jafri H, Gibson DP, Bis KG, Al-Reza A: Juxtaglomerular cell tumor: MR findings. J Comput Assist Tomogr. 1995, 19 (1): 140-142. 10.1097/00004728-199501000-00028.View ArticlePubMedGoogle Scholar
- Dong D, Li H, Yan W, Xu W: Juxtaglomerular cell tumor of the kidney-a new classification schema. Urol Oncol. 2010, 28 (1): 34-38. 10.1016/j.urolonc.2009.08.003.View ArticlePubMedGoogle Scholar
- Kihara I: Comments on different states of secretory autonomy of juxtaglomerular cell tumors of the kidney. Int Med. 1996, 35 (4): 239-240. 10.2169/internalmedicine.35.239.View ArticleGoogle Scholar
- Endoh Y, Motoyama T, Hayami S, Kihara I: Juxtaglomerular cell tumor of the kidney: report of a non-functioning variant. Pathol Int. 1997, 47 (6): 393-396. 10.1111/j.1440-1827.1997.tb04513.x.View ArticlePubMedGoogle Scholar
- Hayami S, Sasagawa I, Suzuki H, Kubota Y, Nakada T, Endo Y: Juxtaglomerular cell tumor without hypertension. Scand J Urol Nephrol. 1998, 32 (3): 231-233. 10.1080/003655998750015656.View ArticlePubMedGoogle Scholar
- Liborio AB, Marques Fde O, Testagrosse L, Leite CA, Leitao AA, Praxedes JN: Malignant hypertension with intestinal ischemia second to juxtaglomerular cell tumor. Am J Kid Dis. 2005, 46 (5): 957-961. 10.1053/j.ajkd.2005.07.032.View ArticlePubMedGoogle Scholar
- Ng SB, Tan PH, Chuah KL, Cheng CC, Tan J: A case of juxtaglomerular cell tumor associated with membranous glomerulonephritis. Ann Diagn Pathol. 2003, 7 (5): 314-320. 10.1016/j.anndiagpath.2003.08.002.View ArticlePubMedGoogle Scholar
- Merte UK, Niranjan J, Kusum J, Rajesh LS, Goswami AK, Sharma SK: Reninoma treated with nephron-sparing surgery. Urology. 2003, 61 (6): 1259-1260.View ArticleGoogle Scholar
- Gottardo F, Cesari M, Morra A, Gardiman M, Fassina A, Dal Bianco M: A kidney in an adolescent with severe hypertension and hypokalemia: an uncommon case-case report and review of the literature on reninoma. Urol Int. 2010, 85 (1): 121-124. 10.1159/000314339.View ArticlePubMedGoogle Scholar
- Caregaro L, Menon F, Gatta A, Amodio P, Armanini D, Fallo F, Corona MC, Pescarini L, Ruol A: Juxtaglomerular cell tumor of the kidney. Clin Exper Hypertens. 1994, 16 (1): 41-53. 10.3109/10641969409068583.View ArticleGoogle Scholar
- Schonfeld AD, Jackson JA, Somerville SP, Johnson CF, Anderson PW: Renin-secreting juxtaglomerular cell tumor causing severe hypertension: Diagnosis by computerized tomography-directed needle biopsy. J Urol. 1991, 146 (6): 1607-1609.PubMedGoogle Scholar
- Tanabe A, Naruse K, Kono A, Hase M, Hashimoto Y, Nakazawa H, Naruse M, Demura R, Demura H, Toma H: A very small juxtaglomerular cell tumor preoperatively identified by magnetic resonance imaging. Int Med. 1996, 35 (4): 295-300. 10.2169/internalmedicine.35.295.View ArticleGoogle Scholar
- Tanabe A, Naruse M, Ogawa T, Ito F, Takagi S, Takano K, Ohashi H, Tsuchiya K, Sone M, Nihei H, Toma H: Dynamic computer tomography is useful in the differential diagnosis of juxtaglomerular cell tumor and renal cell carcinoma. Hypertens Res. 2001, 24 (4): 331-336. 10.1291/hypres.24.331.View ArticlePubMedGoogle Scholar
- Rubenstein JN, Eggener SE, Pins MR, Rosner K, Chugh S, Campbell SC: Juxtaglomerular apparatus tumor: A rare, surgically correctable cause of hypertension. Rev Urol. 2002, 4 (4): 192-195.PubMed CentralPubMedGoogle Scholar
- Katabathina VS, Vikram R, Nagar AM, Tamboli P, Menias CO, Prasad SR: Mesenchymal neoplasms of the kidney in adults: Imaging spectrum with radiologic-pathologic correlation. Radiographics. 2010, 30 (6): 1525-1540. 10.1148/rg.306105517.View ArticlePubMedGoogle Scholar
- Watanabe M, Sugi M, Murota T, Kawakita M, Sakaida N, Okamura A, Matsuda T: Retroperitoneoscopic nephrectomy for juxtaglomerular cell tumor. Int J Urol. 2002, 9 (12): 704-706. 10.1046/j.1442-2042.2002.00549.x.View ArticlePubMedGoogle Scholar
- Furusato M, Hayashi H, Kawaguchi N, Yokota K, Saito K, Aizawa S, Ishikawa E: Juxtaglomerular cell tumor with special reference to the tubular component in regards to its histogenesis. Acta Pathol Jpn. 1983, 33 (3): 609-618.PubMedGoogle Scholar
- Abbi RK, McVicar M, Teichberg S, Fish L, Kahn E: Pathologic characterization of a renin-secreting juxtaglomerular cell tumor in a child and review of the pediatric literature. Pediatr Pathol. 1993, 13 (4): 443-451. 10.3109/15513819309048234.View ArticlePubMedGoogle Scholar
- Tamboli P, Ro JY, Amin MB, Ligato S, Ayala AG: Benign tumors and tumor-like lesions of the adult kidney Part II: Benign mesenchymal and mixed neoplasms, and tumor-like lesions. Adv Anat Pathol. 2000, 7 (1): 47-66. 10.1097/00125480-200007010-00007.View ArticlePubMedGoogle Scholar
- Chen WS, Chang JW: Extrarenal juxtaglomerular cell tumor in bone. Chin Med J. 1987, 100 (1): 78-82.PubMedGoogle Scholar
- Kuten A, Olumi A, Goldsmith J, Monahan-Earley RA, Dvorak AM, Genega EM: Pathologic Quiz Case. A symptomatic renal tumor. Arch Pathol Lab Med. 2004, 128 (9): e112-e114.PubMedGoogle Scholar
- Markey RB, MacLennan GT: Juxtaglomerular cell tumor of the kidney. J Urol. 2006, 175 (2): 730.-10.1016/S0022-5347(05)00544-6.View ArticlePubMedGoogle Scholar
- Tanaka T, Okumura A, Mori H: Juxtaglomerular cell tumor. Arch Pathol Lab Med. 1993, 117 (11): 1161-1164.PubMedGoogle Scholar
- Tetu B, Vaillancourt L, Camilleri J-P, Bruneval P, Bernier L, Touriginy R: Juxtaglomerular cell tumor of the kidney: report of two cases with a papillary pattern. Hum Pathol. 1993, 24 (11): 168-1174.View ArticleGoogle Scholar
- Hasegawa A: Juxtaglomerular cell tumor of the kidney: A case report with electron microscopic and flow cytometric investigation. Ultrastruct Pathol. 1997, 21 (2): 201-208. 10.3109/01913129709021319.View ArticlePubMedGoogle Scholar
- Kodet R, Taylor M, Vachalova H, Pycha K: Juxtaglomerular cell tumor: An immunohistochemical, electron-microscopic, and in situ hybridization study. Am J Surg Pathol. 1994, 18 (8): 837-842. 10.1097/00000478-199408000-00011.View ArticlePubMedGoogle Scholar
- Duan X, Bruneval P, Hammadeh R, Fresco R, Eble JN, Clark JI, Vigneswaran WT, Flanigan RC, Pickman MN: Metastatic juxtaglomerular cell tumor in a 52-year old man. Am J Surg Pathol. 2004, 28 (8): 1098-1102. 10.1097/01.pas.0000126722.29212.a7.View ArticlePubMedGoogle Scholar
- Beaudoin J, Perigny M, Tetu B, Lebel M: A patient with a juxtaglomerular cell tumor with histological vascular invasion. Nat Clin Pract Nephrol. 2008, 4 (8): 458-462. 10.1038/ncpneph0890.View ArticlePubMedGoogle Scholar
- Hanna W, Tepperman J, Logan AG, Robinette MA, Colapinto R, Phillips MJ: Juxtaglomerular cell tumor (reninoma) with paroxysmal hypertension. Can Med Assoc J. 1979, 120 (8): 957-959.PubMed CentralPubMedGoogle Scholar
- Lopez G-Asenjo JA, Blanco Gonzalez J, Ortega Medina L, Sanz Esponera J: Juxtaglomerular cell tumor of the kidney: Morphological, immunohistochemical and ultrastructural studies of a new case. Path Res Pract. 1991, 187 (2-3): 354-359.View ArticlePubMedGoogle Scholar
- Min KO, Kwon HJ, Ahn SJ, Chang SA, Chang YS, Bang BK, Kim J, Park MH, Jung ES, Choi YJ, Seo EJ, Kim BK: Juxtaglomerular cell tumor of the kidney: A case report. J Korean Med Sci. 2001, 16 (2): 233-236.PubMed CentralView ArticlePubMedGoogle Scholar
- Dennis RL, McDougal WS, Glick AD, MacDonell RC: Juxtaglomerular cell tumor of the kidney. J Urol. 1985, 134 (2): 334-338.PubMedGoogle Scholar
- Beevers DG, Mahesshwari MB, Ryan PG, Moss MS, Harding LK: Hypertension due to a renin-secreting juxtaglomerular cell tumor. Am J Hypertension. 2008, 21 (12): 1359-1361. 10.1038/ajh.2008.281.View ArticleGoogle Scholar
- Bruneval P, Fournier J-G, Soubrier F, Belair M-F, Silva J-L, Guetier C, Pinet F, Tardivel I, Corvol P, Bariety J, Camilleri J-P: Detection and localization of renin messenger RNA in human pathologic tissues using in situ hybridization. Am J Pathol. 1988, 131 (2): 320-330.PubMed CentralPubMedGoogle Scholar
- Sanfilippo F, Pizzo SV, Croker BP: Immunohistochemical studies of cell differentiation in a juxtaglomerular cell tumor. Arch Pathol Lab Med. 1982, 106 (12): 604-607.PubMedGoogle Scholar
- Squires JP, Ulbright TM, DeSchryver-Kecskemeti K, Engleman W: Juxtaglomerular cell tumor of the kidney. Cancer. 1984, 53 (3): 516-523. 10.1002/1097-0142(19840201)53:3<516::AID-CNCR2820530325>3.0.CO;2-3.View ArticlePubMedGoogle Scholar
- Barajas L, Bennett CM, Connor G, Lindstrom RR: Structure of a juxtaglomerular cell tumor: The presence of a neural component. A light and electron microscopic study. Lab Invest. 1977, 37 (4): 357-368. 10.3109/00365517709092642.View ArticlePubMedGoogle Scholar
- Lindrop GBM, Stewart JA, Downie TT: The immunocytochemical demonstration of renin in a juxtaglomerular cell tumour by light and electron microscopy. Histopathology. 1983, 7 (3): 421-431. 10.1111/j.1365-2559.1983.tb02255.x.View ArticleGoogle Scholar
- Brandal P, Busund L-T, Heim S: Chromosome abnormalities in juxtaglomerular cell tumors. Cancer. 2005, 104 (3): 504-510. 10.1002/cncr.21205.View ArticlePubMedGoogle Scholar
- Shao L, Manalang M, Cooley L: Juxtaglomerular cell tumor in an 8-year-old girl. Pediatr Blood Cancer. 2008, 50 (2): 406-409. 10.1002/pbc.21048.View ArticlePubMedGoogle Scholar
- Capovilla M, Couturier J, Molinie V, Amsellem-Oquazana D, Priollet P, Baumert H, Bruneval P, Vieillefond A: Loss of chromosomes 9 and 11 may be recurrent chromosomal imbalances in juxtaglomerular cell tumors. Hum Pathol. 2008, 39 (3): 459-462. 10.1016/j.humpath.2007.08.010.View ArticlePubMedGoogle Scholar
- Dong D, Li H, Yan W, Xu W, Lu L, Zeng Z: The diagnosis and surgical management of juxtaglomerular cell tumor of the kidney. J Hypertens. 2010, 28 (3): 628-632. 10.1097/HJH.0b013e328333b056.View ArticlePubMedGoogle Scholar
- Moss AH, Peterson LJ, Scott W, Winter K, Olin DB, Garber RL: Delayed diagnosis of juxtaglomerular cell tumor hypertension. NCMJ. 1982, 43 (10): 705-707.PubMedGoogle Scholar
- Chambo JL, Junior RF, Lucon AM: Juxtaglomerular cell tumor as a rare cause of hypertension in adults. Int Braz J Urol. 2004, 30 (2): 119-120. 10.1590/S1677-55382004000200006.View ArticlePubMedGoogle Scholar
- Lin S-Y, Liu W-Y, Chen W-C, Chen R-H: Secondary hypertension due to a renin-secreting juxtaglomerular cell tumor. J Formos Med Assoc. 2010, 109 (3): 237-240. 10.1016/S0929-6646(10)60047-2.View ArticlePubMedGoogle Scholar
- Gherardi GJ, Arya S, Hickler RB: Juxtaglomerular body tumor: A rare occult but curable cause of lethal hypertension. Hum Pathol. 1974, 5 (2): 236-240. 10.1016/S0046-8177(74)80070-5.View ArticlePubMedGoogle Scholar
- Lachvac L, Svajdler M, Valansky L, Nagy V, Benicky M, Frohlichova L, Nyitrayova O: Juxtaglomerular cell tumor, causing fetal demise. Int Urol Nephrol. 2010, 43 (2): 365-370.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.