Benign hepatic masses mimicking metastatic renal cell carcinoma

Making the distinction between a benign hepatic mass and renal cell carcinoma metastatic to the liver is crucial in evaluating a patient with renal cell carcinoma. The erroneous diagnosis of metastatic renal cell carcinoma may deter the surgeon from performing a potentially curative nephrectomy. In this report, we present 1 patient with cavernous hemangiomas and another patient with focal nodular hyperplasia of the liver. In each case the benign liver lesion was incorrectly diagnosed initially as metastatic renal cell carcinoma. The radiographic appearance of these lesions is discussed in detail.     

Surgical management of renal cell carcinoma invading into the liver: radical nephrectomy en bloc with right hepatic lateral sector

Renal cell carcinoma demonstrates expansive growth and invasion of adjacent structures. Direct liver extension, although uncommon, is a dismal prognostic sign. We propose radical nephrectomy en bloc with right lateral sector (segments 6 and 7) of the liver. The operative procedure was performed in 2 male patients, 61 and 81 years of age, both with renal cell carcinoma and direct hepatic extension. The patients had no evidence of disease at 100 and 57 months after resection. This procedure may help cure selected patients with renal cell carcinoma invading the liver.     

Stauffer's syndrome--diagnostic help in hypernephroma.

Dysfunctions of the liver known as Stauffer's syndrome have been observed in various cases of renal cell carcinoma. In a case history of renal cell carcinoma the most common clinical symptoms and laboratory findings of early presentation are displayed. During the first clinical investigations the evidence of typical laboratory values indicating unusual hepatic dysfunction, did not lead to the true diagnosis until symptoms became clearer two year later. Intensified renal diagnosis are asked for in any case of unexplained abnormalities of liver function in order to exclude a renal cell carcinoma or to force its early diagnosis.     

Analysis of renal cell carcinoma with tumorous legion in the liver

We presented 3 cases of renal cell carcinoma with hepatic lesion, for which it was difficult to make a diagnosis preoperatively. The hepatic lesion was cavernous hemangioma of the liver, liver metastasis of renal cell carcinoma or hepatocellular carcinoma. To discuss the strategy of treatment for liver metastasis of renal cell carcinoma at the time of nephrectomy, or in the follow-up period after nephrectomy, we reviewed the 188 cases of renal cell carcinoma which were nephrectomized from December, 1962 to June, 1988. At the time of nephrectomy, there was only 1 case that had concurrent liver metastasis. In 4 cases, liver metastasis was found at autopsy, and in 15 cases, in the follow-up period after nephrectomy. We analysed these 15 cases and classified them into 2 groups. One was "early metastasis group", i.e., liver metastasis was found within 18 months after nephrectomy, and the other was "late metastasis group", i.e., liver metastasis detected more than 6 years after nephrectomy. In the "early metastasis group", 2 lived 10 months or 57 months, but 5 died within 1 month after the appearance of liver metastasis. In the "late metastasis group", 4 of 7 lived more than 2 years after the appearance of liver metastasis and the median survival was 21 months. In both groups, when liver metastasis was found, there were metastases in multiple organs and the hepatic lesions were multiple.(ABSTRACT TRUNCATED AT 250 WORDS)     

Remote recurrence of renal cell carcinoma

A fifty-nine-year-old man with abnormal liver function tests, fever, and weight loss was found to have a recurrence of renal cell carcinoma which had been latent for twenty-two years. Reactive hepatitis was a prominent associated finding. The important features of remote recurrence of renal cell carcinoma are discussed.     

Large mixed epithelial and stromal tumor of the kidney masquerading as metastatic renal cell carcinoma

We report the case of a 39-year-old woman with a large right renal mass 20 cm in size with heterogeneous solid and cystic components as well as concurrent liver lesions suspicious for metastatic renal cell carcinoma. Surgical extirpation of the renal mass and liver lesions was performed laparoscopically with the pathological analysis revealing a rare renal neoplasm--mixed epithelial and stromal tumor of the kidney--and adenomas of the liver.     

Cavernous hepatic hemangioma simulating metastatic renal cell carcinoma

A case of cavernous heinangioma of the liver resembling a metastatic deposit is reported in a patient with renal cell carcinoma. The clinical and angiographic features that distinguish hepatic hemangiomas from metastatic renal cell carcinoma are discussed. The importance of this distinction in patient management is emphasized.     

Ipsilateral synchronous neoplasms of kidney presenting as acute pyelonephritis and bladder metastasis

Ipsilateral multiple synchronous primary renal neoplasms is an uncommon presentation, and only a few cases have been reported in published studies. We report the case of a 57-year-old woman with acute pyelonephritis as the initial presentation, in whom conservative treatment had no effect. Surgical intervention revealed the presence of concomitant renal cell carcinoma, collecting duct carcinoma, and urothelial carcinoma (transitional cell carcinoma) of the kidney. Metastatic renal cell carcinoma to the bladder, liver, and lung subsequently developed. Deceptive inflammatory presentations can occur in aggressive synchronous renal malignancies. Recognition of this rare disease entity could prevent delays in diagnosis and treatment.     

Spontaneous regression of hepatic metastases after nephrectomy and metastasectomy of renal cell carcinoma

We report a case of clear cell carcinoma of the kidney with multifocal metastases to the lymph nodes, vagina and liver. Spontaneous regression of liver metastasis has been described after nephrectomy. Surgical management of primary and metastatic tumors should be considered in all patients with renal cell carcinoma.     

Bladder metastasis of renal cell carcinoma : report of a case

A 65-year-old man presented with gross hematuria in 2004. Computed tomography (CT) showed a left renal mass, and he underwent laparoscopic radical nephrectomy. Pathological diagnosis was clear cell carcinoma (pT2N0M0, G2＞G3). Four years later, a right adrenal tumor was disclosed by follow-up CT. Then laparoscopic adrenectomy was performed. Histology showed metastasis of the renal clear cell carcinoma. In 2009, he noticed gross hematuria, and cystoscopy revealed a 2cm solitary, non-papillary tumor at the anterior wall of the bladder. At the same time, small solitary liver metastasis (6 mm) was observed on abdominal CT. Transurethral resection of the bladder tumor and resection of liver tumor was performed, and pathological diagnosis was clear cell carcinoma both in vesical and hepatic masses. Nine months after the last surgery, he is living with no obvious tumor recurrence. To our knowledge this case is the 34th case of bladder metastasis from renal cell carcinoma in the Japanese literature. We reviewed literature and discuss the clinical features of bladder metastasis of renal cell carcinoma.     

Cost effective analysis of prenephrectomy radioisotope scans in renal cell carcinoma

To evaluate the cost-effectiveness of liver and bone isotope scans, results of scans were reviewed in 60 patients with renal cell carcinoma. In no patient did the results of the scans influence or change the treatment plan. Routine utilization of radioisotope scans as part of the preoperative evaluation of patients with renal cell carcinoma should be discouraged.     

Sarcomatoid Squamous Cell Carcinoma of the Right Renal Pelvis with Liver Metastasis: Case Report

We report on a man with sarcomatoid squamous cell carcinoma of the right kidney with liver metastases. Bilateral renal lithiasis and well differentiated squamous cell carcinomas of the right renal pelvis were also noted. This uncommon case is discussed and the literature is reviewed.     

Renal cell carcinoma occurring with contralateral adrenal metastasis: a clinical and pathological trap.

Because renal cell carcinoma occasionally occurs in manifestations referable to a single metastatic lesion, there is a risk that a metastasis will be mistaken for the primary tumor. Histologic examination can compound the confusion, particularly when a clear cell carcinoma of the kidney metastasizes to an organ, such as lung, liver, adrenal, or skin, where clear cell tumors may occur as primary lesions. Although advanced renal cell carcinoma not infrequently involves the adrenal gland, the clinical and pathologic setting establishes the tumor in the adrenal as a metastasis. Two patients are described to illustrate what is to our knowledge the heretofore undescribed occurrence of renal cell carcinoma as a metastasis to the contralateral adrenal gland.     

Renal cell carcinoma detected in a cadaveric donor after orthotopic liver and contralateral renal transplantation in two recipients: four-year follow-up

BACKGROUND: Although rare, renal cell carcinoma has been found during renal recovery for cadaveric organ transplantation. Previously, we reported this incidence to be 0.9%. In one cadaveric donor, the liver and left kidney had been transplanted before the discovery of renal cell carcinoma (T1) in the right kidney. METHODS: We retrospectively reviewed the medical records of two patients who had received cadaveric allografts from a donor with a known renal cell carcinoma. RESULTS: Both patients have been followed for 4 years with blood chemistries and chest x-ray every 3 months for year 1, every 4 months for years 2 and 3, and every 6 months thereafter. They also underwent allograft ultrasound every 6 months and an annual CT scan of the abdomen. Both patients have shown no evidence of metastatic disease throughout their follow-up. DISCUSSION: In the rare instance that a patient receives an organ from a cadaveric donor with a known renal cell carcinoma, it is mandatory to follow these patients closely observing for both allograft recurrence and metastatic disease.     

Metastatic renal cell carcinoma with partial response to sunitinib complicated by ureteral obstruction from necrotic tumor

The development of molecular therapeutic agents has revolutionized the treatment of metastatic renal cell carcinoma, but the long-term complications of these novel medications are not yet well-defined. We report the case of a 61-year-old woman who presented with metastatic renal cell carcinoma to the liver and contralateral kidney and renal pelvis 6 years after nephrectomy. Treatment with four cycles of sunitinib malate resulted in an initial near-complete radiographic response. Subsequently, the patient presented with flank pain, acute renal failure, and hydronephrosis of her solitary kidney during her fourth cycle of treatment. A temporizing percutaneous nephrostomy tube was placed, and antegrade contrast studies showed a filling defect and complete distal ureteral occlusion. Ureteroscopy revealed ureteral obstruction by a soft-tissue mass. Pathologic examination demonstrated necrotic renal cell carcinoma, presumably due to sloughing of the previously identified renal pelvic metastasis. We discuss the implications of this unusual complication of complete ureteral obstruction from necrotic tumor in a patient with a near-complete response to sunitinib.     

Radical nephrectomy with en bloc resection of liver, diaphragm, and lung for locally invasive sarcomatoid renal cell carcinoma

Despite the widespread use of abdominal imaging, some patients with renal cell carcinoma still present with advanced disease. We report 1 case of locally invasive sarcomatoid renal cell carcinoma requiring resection of the kidney, adrenal glands, liver, diaphragm, and lung, with diaphragmatic reconstruction with a polytetrafluoroethylene patch. The patient was alive and well 5 years postoperatively. However, we acknowledge that the success experienced with this case does not represent the typical outcome for a patient with such advanced disease.     

Cytoreductive surgery with liver-involved renal cell carcinoma

The purpose of this study was to demonstrate the benefits of cytoreductive surgery for renal cell carcinomas that also involve the liver. Between 1994 and 1997, four patients with renal cell carcinoma with liver involvement were surgically treated with nephrectomy and hepatectomy. Two of them underwent a simultaneous hepatectomy and nephrectomy (group 1), and the remaining two patients underwent a hepatectomy after a nephrectomy and had a diagnosis of postoperative recurrence (group 2). Two patients, one from each group, died of multiple bone metastasis and lung metastasis 30 months and 12 months after the hepatectomy; the second patient from group 1 died 40 months after the first operation due to gastrointestinal hemorrhaging. The second patient from group 2 displayed no evidence of recurrence 18 months after the second surgical procedure. The survival rates for these patients were 66% and 33% at 1 and 3 years, respectively. Autopsy studies revealed that one patient from group 2 had a local recurrence in the liver while the other two patients from group 1 did not. Our results suggested that a progressive approach may therefore be useful for patients demonstrating renal cell carcinoma where there is liver involvement.     

Chromophobe renal cell carcinoma with osteosarcoma-like differentiation

Sarcomatoid differentiation in renal cell carcinoma is thought to be the result of the dedifferentiation of the parent tumor, and it can be found in the chromophobe renal cell carcinoma just as other subtypes. We report a case of chromophobe renal cell carcinoma, which showed osteosarcoma-like differentiation. This is the first known case ever to be clearly identified as such. The patient was a 74-year-old man, and the CT scan revealed a huge retroperitoneal mass, which protruded from the lower half of the kidney and directly invaded the colon. Intraabdominal dissemination and metastases to the liver and lungs were also found. The resected tumor histologically showed sarcoma-like spindle cell proliferation and partly produced massive osteoid, which simulated the osteosarcoma. In addition, a typical histology of chromophobe renal cell carcinoma was found in part of the tumor. Immunohistochemically, spindle cells were reactive for epithelial membrane antigen, cytokeratin, and vimentin. The cell nests that were labeled by epithelial membrane antigen and cytokeratin were also found in the osteosarcoma-like area. We think that these phenomena were the result of "dedifferentiation" and metaplasia of the chromophobe renal cell carcinoma.     

Primary small cell carcinoma of the kidney: a case report

A 43-year-old male visited our hospital with the complaint of right flank colicky pain. Computed tomographic (CT)-scan and angiography showed large renal tumor with liver invasion and tumor thrombosis in the vena cava. Multiple lung and bone tumors were also recognized. Percutaneous biopsy of the renal tumor revealed small cell carcinoma. Multiple lung masses were diagnosed as metastatic tumors according to the results of bronchoscopic biopsy. Chemotherapy including cisplatinum and etoposide was performed without success. He died 6 months after the diagnosis. Autopsy specimen revealed primary small cell carcinoma of the right kidney. To our knowledge, this is the seventh case as primary renal small cell carcinoma in the world literature.     

γ-GT和ALP在预测肾癌转移中的作用

为了明确γ-GT及ALP在预测肾癌转移中的作用,我们回顾性研究了15例肾癌转移病人的γ-GT及ALP检测结果,分析其与转移部位、病理类型的关系,并与24例无临床转移的肾癌病人作对照研究。结果发现:转移组中有80％的患者γ-GT增高,40％出现ALP异常,明显高于对照组(分别为12.5％及O,P<0.001)。另外,有肝转移的病人γ-GT全部升高,而骨转移组ALP增高的比例又明显高于其它转移部位的患者;就病理类型而言,透明细胞癌γ-GT增高的比例明显高于其它类型。说明γ-GT可作为预测肾癌转移的一个指标,ALP则对有骨转移的病人有较好的补充作用。