Renal metastasis from squamous cell carcinoma of the hypopharynx

We present a rare case of metastatic renal tumor originating from squamous cell carcinoma of the hypopharynx. A 67-year-old man treated with irradiation for hypopharyngeal carcinoma was referred to our hospital with gross hematuria and a left renal mass, which was delineated as a heterogeneously enhanced mass by CT scan. Left nephrectomy was performed, and the non-encapsulated mass was gray in color macroscopically. Histological examination of the specimen revealed alveolar proliferation of small cancer cells, which was consistent with the original tumor of the hypopharynx. The left renal tumor was diagnosed as poorly differentiated squamous cell carcinoma metastasized from the hypopharynx. The patient remains alive, with no evidence of disease, 8 months following left nephrectomy. This case was thought to be the first report of a renal metastasis from a hypopharyngeal carcinoma that was diagnosed clinically and treated with nephrectomy.     

Multilocular cystic nephroma of the kidney in a young adult: Case report

We report the case of a 20-year-old female patient who presented with a left abdominal mass of 4 years duration. Ultrasonography showed a multicystic left renal mass, and intravenous urography revealed a non-functioning kidney. Based on these findings a multicystic renal cell carcinoma was suspected and radical nephrectomy was performed. Histological examination of the resected specimen confirmed the diagnosis of multilocular cystic nephroma. This is a very rare renal tumor with only few cases described in the literature. Based on our case and a review of the literature the epidemiology, pathogenesis and diagnostic features are discussed.     

Two case reports of unilateral adrenal hyperplasia with contralateral renal cell carcinoma

We report two cases of unilateral adrenal hyperplasia with contralateral renal cell carcinoma. First case was a 66-year-old man with right renal mass who came to our hospital for study. Although no major symptoms were complained, blood pressure was consistently above normal. Hypokalemia, low plasma renin activity and high plasma aldosterone level were detected. CT revealed that he had a right renal mass and a left adrenal tumor. Preoperative diagnosis was right renal tumor and primary aldosteronism due to left adrenal adenoma. Second case was a 59-year-old man with right renal mass who also came to our hospital for study. He also had a left adrenal tumor, however his blood pressure was normal and serum hormonal analysis showed normal adrenal cortical function. Preoperative diagnosis was right renal tumor and non-functional left adrenal adenoma. Two patients were performed right radical nephrectomy with contralateral adrenarectomy. Pathological diagnosis were right renal cell carcinoma and left adrenocortical hyperplasia. One Patient clinically showed primary aldosteronism and the other had no clinical symptoms. These patients were rare cases with unilateral adrenal hyperplasia.     

Choroid plexus metastasis of renal cell carcinoma causing intraventricular hemorrhage: a case report]

We report a rare case of choroid plexus metastasis of renal cell carcinoma causing intraventricular hemorrhage. A 75-year-old female was admitted to our hospital for SAH. Preoperative examination evoked suspicion of an anterior communicating aneurysm as a cause of SAH. Furthermore, there were lesions on the tuberculum sellae and in the left trigone of the lateral ventricle, which were enhanced by Gd-DTPA on MRI. The patient was operated on via the pterional approach on December 3, 1996, but no aneurysm was found. She underwent total removal of the tuberculum sellae mass, which was postoperatively proved to be a meningioma by histological examination. The intraventricular tumor was supposed to be a meningioma, but it was not treated surgically. Two months later, the patient presented hematuria and was diagnosed as having a right renal cancer and underwent right nephrectomy on March 18, 1997. However, postoperatively, disturbance of consciousness continued. A CT scan revealed intraventricular hemorrhage around the tumor in the trigone of the lateral ventricle on March 21. An emergency operation for tumor and clot removal succeeded in improving the patient's condition. Histological examination of the tumor revealed clear-cell type renal cell carcinoma. Solitary choroidal plexus metastasis from renal cell carcinoma is quite rare: only 5 cases have been reported. But only our case was accompanied by intraventricular hemorrhage. Renal cell carcinomas are divided into two types: a slowly progressive type and a rapidly progressive type. Four cases among the reported 5 cases were the slowly progressive type, and our case was regarded as being of the same type.     

A case of liposarcoma of the renal capsule

A 58-year-old woman was referred to our institution for treatment of a left renal tumor revealed by follow-up computed tomography (CT) of a pancreatic tumor. The CT showed a heterogeneous, perirenal mass containing areas of fat density. Angiography showed no feeding artery. Left nephrectomy was performed and pathological examination revealed a well-differentiated liposarcoma of the renal capsule. At the third-month follow-up, the patient was completely asymptomatic and free of recurrence. Primary tumors of the renal capsule are uncommon and liposarcoma of the renal capsule is distinctly rare. There have been only 17 reports of liposarcoma arising from the renal capsule in Japan. We, herein, report a case of liposarcoma of the renal capsule.     

Extraabdominal desmoid tumor of the chest wall

We report a rare case of desmoid tumor of the chest wall. A 75-year-old female visited our hospital due to a feeling of oppression in the left chest. A chest X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large mass in the left thorax. Surgical resection of the tumor was performed under the left standard thoracotomy. The tumor was 90 x 80 x 75 mm in size and diagnosed pathologically as desmoid tumor which showed proliferation of spindle shape cells and collagen fibers. Immunohistochemistry revealed that the tumor cells were positive for vimentin, alpha-smooth muscle actin and negative for CD34. The patient has been well without recurrence for 2 years and 2 months after surgery.     

Pleomorphic leiomyosarcoma of the adrenal gland: case report and review of the literature

Primary adrenal leiomyosarcomas (LMS) are extremely rare mesenchymal tumors. To the best of our knowledge only 12 cases (9 cases of conventional and 2 cases of pleomorphic LMS) have been reported in the literature until the present date. Herein we report a case of pleomorphic LMS in a 47-year-old woman who presented with severe abdominal pain. Computed tomography showed a large heterogeneous left adrenal mass abutting the renal vessels. The adrenal mass was resected and histopathologic examination revealed a highly pleomorphic malignant spindle cell neoplasm diffusely infiltrating the adrenal parenchyma with an immunoprofile consistent with that of a leiomyosarcoma. Clinical management and subsequent follow-up of this patient is presented.     

Bilateral adrenal metastases from renal cell carcinoma: a case report

We report a case of renal cell carcinoma with bilateral adrenal metastases. A 57-year-old man was admitted to our hospital for a left renal mass. Computerized tomography and magnetic resonance imaging revealed a 4.5 cm left renal tumor and bilateral adrenal masses (3.0 cm on the right side and 2.0 cm on the left). A left nephrectomy and bilateral adrenalectomies were performed. The pathological findings showed clear cell carcinoma, G2 of left kidney metastasizing to both adrenal glands. The patient was administered supplementary hydrocortisone and was well 8 months after the nephrectomy and adrenalectomies without evidence of recurrence. Bilateral adrenal metastases from renal cell carcinoma are relatively rare. Our case seems to be the thirteenth case in the Japanese literature.     

A case report of retroaortic left renal vein with tumor thrombus of renal cell carcinoma

A 75-year-old woman was referred to our department for evaluation of a left renal tumor. Computed tomography and other imaging studies demonstrated a left renal mass and tumor extension into the left renal vein passing caudally behind the aorta. We clinically diagnosed the tumor as renal cell carcinoma (RCC) associated with a retroaortic left renal vein thrombus, and performed a radical nephrectomy. Pathological examination of the surgical specimen showed a grade 2, clear cell carcinoma with a renal vein thrombus and negative surgical margin. Retroaortic left renal vein is a rare anomaly with a prevalence of 1.8–2.4%. RCC associated with a retroaortic left renal vein thrombus is rarer still. To our knowledge, this is only the third case report to describe an RCC associated with a tumor thrombus in the retroaortic left renal vein.     

Extraosseous osteogenic sarcoma arising from the retroperitoneum: a case report

A 44-year-old housewife with a mass in the left upper quadrant of the abdomen was admitted. The tentative diagnosis was cystadenocarcinoma arising from the pancreatic tail, as determined by CT and selective angiography. Excision of the mass with removal of the spleen, pancreatic tail, left renal capsule and surrounding lymphnodes was performed. Photomicroscopic sections revealed proliferation of malignant cells and malignant osteoids. The final diagnosis was osteogenic sarcoma arising from the retroperitoneum. Among the extraosseous osteogenic sarcoma arising from the somatic soft tissue, involvement of the retroperitoneum is rare. Only 12 cases including our own case have been reported as being of retroperitoneal origin. No patient survived for five years and in our patient, there are signs of recurrence one year after the surgery.     

Ganglioneuroma of the adrenal gland: report of a case

A 38-year-old man was referred to our clinic with the complaint of upper abdominal discomfort. Ultrasonography and computerized tomography showed a mass occupying the left retroperitoneal space. Endoclinological results were within the normal range except for 17-OHCS and 17-KS. Preoperative diagnosis was left non-functioning adrenal tumor. Exploration was done via transperitoneal approach. The specimen weighed 100 g and was 11 x 6 x 5 cm in size. Histopathological diagnosis was ganglioneuroma of the left adrenal gland. There have been 35 reported cases with ganglioneuroma of the adrenal gland including our case in the Japanese literature and we reviewed the pathogenesis and treatment of this rare disease.     

Renal carcinoma relapse presenting as a peripheral nerve sheath tumor: A case report and brief review of the literature

We report a rare case of renal carcinoma metastasis involving a lumbar nerve root. Metastases to nerve roots are rare occurrences, and to our knowledge, only six cases have been reported so far in the literature. The patient in this report presented with weakness in the right lower limb and intractable pain irradiating along the L5 dermatome. MRI findings revealed a right-sided L5 nerve root mass, suggestive of a schwannoma, involving the spinal ganglion and its extraforaminal region. Complete macroscopic resection of this mass was performed, and histopathologic analysis confirmed the lesion to be a metastasis of a renal clear cell carcinoma. Local radiotherapy was given and tyrosine kinase inhibitors administered. At 5 months, the patient was pain-free and his right limb weakness had completely resolved. A tumoral recurrence could be observed on the control MRI 5 months after surgery. This report presents the first case of a patient with a renal clear cell carcinoma metastasis to a L5 nerve root, as well as a brief review of previous cases of metastases to peripheral nerve roots.     

Extraosseous osteogenic sarcoma arising from the retroperitoneum: A case report

A 44-year-old housewife with a mass in the left upper quadrant of the abdomen was admitted. The tentative diagnosis was cystadenocarcinoma arising from the pancreatic tail, as determined by CT and selective angiography. Excision of the mass with removal of the spleen, pancreatic tail, left renal capsule and surrounding lymphnodes was performed. Photomicroscopic sections revealed proliferation of malignant cells and malignant osteoids. The final diagnosis was osteogenic sarcoma arising from the retroperitoneum. among the extraosseous osteogenic sarcoma arising from the somatic soft tissue, involvement of the retroperitoneum is rare. Only 12 cases including our own case have been reported as being of retroperitoneal origin. No patient survived for five years and in our patient, there are signs of recurrence one year after the surgery. A part of this study was reported at the 135th meeting of the Kinki Surgical Society on April 28, 1984 at Nishinomiya, Hyogo, Japan     

An unusual case of cystic nephroma protruding into the renal pelvis

Cystic nephroma is a relatively rare and benign renal lesion of uncertain etiology. Approximately 200 cases have been described, but only a few cases of cystic nephroma with prominent renal pelvis involvement have been reported. Here, we report an unusual case of cystic nephroma that protruded into the renal pelvis. A 45-year-old woman hospitalized because of a right renal mass detected on clinical examination. The diagnosis of a malignant or benign lesion was not clear. A right nephroureterectomy was performed. The characteristics of the resected specimen were consistent with those of cystic nephroma. Macroscopic examination revealed that the giant lesion originated from the upper renal pelvis and extended into the renal pelvis. The patient is currently free from disease at eight months after the surgery. In general, this tumor arises from the renal parenchyma. To our knowledge, this is the fifth case report on cystic nephroma with prominent renal pelvis involvement.     

A case of small simple renal cyst associated with renal cell carcinoma

A 61-year-old male was admitted to our clinic for the purpose of further examination of the small renal mass discovered incidentally by ultrasonography. Subtraction angiography disclosed a small renal cell carcinoma of the upper-lateral margin of the left kidney dramatically. Enucleating surgery of the tumor was performed successfully (about 2 cm in diameter). Histological examination revealed a small simple renal cyst associated with renal cell carcinoma. The patient is well without evident metastasis 1 year postoperatively. Since this is a very rare case in the literature, we report this case and discuss the preoperative diagnosis of small renal cell carcinoma. We believe that ultrasonography is a simple and very useful method for mass screening of small urological malignancies.     

Renal parencymal malacoplakia successfully treated with conservative therapy; a case report

Malacoplakia is a relatively rare form of chronic granulomatous inflammation. Which occurs most frequently in the genito-urinary system, but renal parenchymal involvement is rare. We present a case of malacoplakia of the renal parenchyma. A 69-year-old woman with left renal mass was referred to our department. Abdominal enhanced CT scan revealed heterogeneous mass in the left kidney (50 x 45 mm). CT-guided percutaneous left renal needle biopsy confirmed the diagnosis of renal malakoplakia. We successfully treated her with oral levofloxacin. The lesion resolved after the 4-months-therapy, and there has been no recurrence for 22 months since the treatment.     

Liposarcoma arising from the renal capsule

Liposarcoma is one of the most common soft tissue sarcomas, but liposarcoma arising from the renal capsule is rare. We report a case of liposarcoma arising from the renal capsule. Preoperative diagnosis was achieved by computerized tomography and and selective renal angiography. The tumor resected with he left kidney which weighed 4,370 g. Postoperative adjuvant chemotherapy with cyclophosphamide, bleomycin, actinomycin D, adriamycin and vinblastine was carried out. Although the patient's general conditions was fine, local recurrence occurred after 24 months postoperatively. Five cases of liposarcoma arising from the renal capsule including our case have been reported in Japan.     

Renal oncocytomatosis in a long-term hemodialysis patient treated by laparoscopic surgery

A 50-year-old female, who had been on maintenance hemodialysis for 22 years, consulted our clinic because of a left renal mass detected incidentally by ultrasonography. Computed tomography (CT) demonstrated a solid hypervascular mass, suggesting a renal cell carcinoma (RCC), in the left atrophic kidney. Left hand-assisted laparoscopic nephrectomy (HALN) was performed. The histopathological diagnosis was renal oncocytomatosis. Renal oncocytomatosis in a long-term hemodialysis patient is extremely rare. We report the first case of renal oncocytomatosis in a long-term hemodialysis patient treated with hand-assisted laparoscopic nephrectomy.     

A case of metastatic renal tumor: review of 74 cases reported in Japan

A 76-year-old man, who had undergone surgery for lung cancer, was referred to our department for further examination for left renal mass. Exploration was done through a transperitoneal approach and the left kidney was removed. A metastatic renal tumor originating from a pulmonary squamous cell carcinoma was diagnosed histologically. There have been 73 reported cases with metastatic renal tumor in Japanese literature and we reviewed the pathogenesis and treatment of this rare entity.     

Coexistence of cyst and tumor in the same kidney: a case report

A case of renal cyst associated with renal tumor is presented herein. A 40-year-old male patient visited our outpatient clinic for left renal cyst which had been found by ultrasonography on routine clinical examination. CT scan demonstrated an irregular area in the cyst wall measuring about 2 cm in thickness which showed enhancement of density with contrast medium. Magnetic resonance imaging (MRI) also demonstrated a round mass with abnormal signal on the cyst wall, protruding into the cyst cavity. Transabdominal radical nephrectomy was performed on 13 July 1987, and to the resected kidney was attached a cyst measuring 7 cm in diameter in the lower pole. Grossly, the cyst contained amorphous red-brown material which turned out to be old blood clots and the wall harbored a tumor (3.0 x 2.5 cm). Histologically, the tumor was renal cell carcinoma, the surface of which was covered with necrotic tissue. The coexistence of renal cyst and tumor is rare and 62 cases were collected from the Japanese literature including our case, and discussion was made in relation to the etiological factors.