An extrarenal renin-producing tumor associated with a 3 cm mature cystic teratoma

Extrarenal renin-producing tumors are a cause of secondary hypertension and are most commonly reported to arise in the adrenal gland, lung, and pancreas; however, they rarely occur in the ovary, and renin-producing ovarian tumors are mainly larger than 5 cm or malignant. We report a case of a 3 cm renin-producing ovarian tumor. A 27-year-old woman presented with newly diagnosed hypertension. Laboratory evaluation revealed hyperreninemic hyperaldosteronism. Renal artery ultrasonography and abdominal magnetic resonance angiography showed no renal artery stenosis or adrenal abnormalities, making primary aldosteronism and renovascular hypertension unlikely. Contrast-enhanced abdominopelvic computed tomography identified a 3 cm left ovarian tumor without other lesions. Based on these findings, an extrarenal renin-producing ovarian tumor was suspected. Laparoscopic left ovarian cystectomy was performed. Histopathology showed a mature cystic teratoma without malignancy, and immunohistochemistry demonstrated renin-positive cells. Blood pressure normalized rapidly after surgery. This case suggests that surgical intervention is useful for both the diagnosis and treatment of secondary hypertension when an extrarenal renin-producing tumor is suspected. Renin-producing ovarian tumors should be considered in the differential diagnosis of secondary hypertension, and surgical treatment may be warranted in selected patients when biochemical suspicion is strong.