肾类癌1例报道并文献复习

目的探讨肾类癌的临床病理特征。方法对1例肾类癌的临床资料进行分析并结合文献复习。结果 59岁女性患者体检时偶然发现无症状左肾肿物,患者无类癌综合征。CT示左肾下极肿物,直径约3.8 cm,边界清楚,强化不明显。患者行经腹膜后途径根治性左肾切除术。免疫组织化学染色显示突触素,CD56,神经元特异性烯醇酶,波形蛋白,CK18呈阳性。病理诊断：左肾类癌T1a期。术后未行辅助治疗,随诊17个月未见肿瘤复发或转移。结论肾类癌极其罕见,确诊依赖病理学及免疫组织化学检查。局限性肾类癌的治疗首选完整的外科切除,其预后相对较好。     

原发性肾脏类癌2例报告并文献复习

目的：探讨原发性肾脏类癌的临床特征及诊治方法。方法：总结2例原发性肾脏类癌患者的临床资料结合文献复习讨论。例1,女,48岁。因右腰酸痛1个月入院。B超示右肾中上极中等回声占位,边界清楚,内有血流信号。CT示右肾中上极10．0cm×7．5cm实性占位,增强后病灶均匀轻度强化。例2,男,44岁。体检发现左肾占岱40天入院。B超示左肾门处中等回声占位,边界清楚,内有血流信号。CT示左肾中极肾门处3．7cm×3．5cm实性占位,增强后病灶均匀轻度强化;其内伴-钙化点。结果：2例均行根治性肾切除术。病理检查镜下肿瘤细胞形态为多边形,嗜酸性颗粒状细胞质,边界不清,呈柱状或缎带状排列混合有实性巢状排列;细胞核呈园形大小一致,核分裂像难见。免疫组化：突触素、波形蛋白均为阳性。病理诊断为肾脏类癌伴淋巴结转移。例1术后30个月死于肝骨转移;例2术后随访26个月,未见肿瘤复发转移。结论：原发性肾脏类癌临床罕见,易发生淋巴结转移,确诊依靠病理学检查,根治性肾切除应为治疗原发性肾类癌的首选方法。     

Recurrent thymic carcinoid tumor--report of a case

A previously operated 62-year-old male with recurrent thymic carcinoid tumor was reported. This patient underwent resection of the thymic carcinoid tumor through left thoracotomy 7 years ago. Although the postoperative clinical course was uneventful, an anterior mediastinal tumor on the patient's chest was discovered after an X-ray examination due to a traffic accident in July, 1989. With the diagnosis of recurrent thymic carcinoid tumor, he underwent an excision of the anterior mediastinal tumor and residual thymus. He also underwent partial resection of the pericardium, mediastinal pleura, and left upper lobe of the lung. 42 cases with thymic carcinoid tumor that have been reported in the Japanese literature were reviewed. A perusal in the relevant literature suggested that total thymectomy was advisable because partial thymectomy was associated with a high risk of local recurrence and metastases.     

Rare pleural recurrence of typical pulmonary carcinoid tumor 30 years after lobectomy

A 68-year-old man, who underwent a left lower lobectomy for a typical carcinoid tumor 30 years previously, presented with a 2-year history of left-sided chest pain. A computed tomographic scan, an octreotide scan, and pleural biopsy all showed recurrence of carcinoid tumor in the pleura. He underwent left chest wall resection, and histopathologic examination confirmed the diagnosis of typical carcinoid tumor. A review of the literature indicates that this is only the second reported case of pleural recurrence after previous complete resection of typical pulmonary carcinoid tumor. This case is even more unusual in that the recurrence presented so long after surgery.     

Primary carcinoid tumor arising in a retroperitoneal mature teratoma in an adult

An extremely rare case of a primary carcinoid tumor arising in a mature retroperitoneal teratoma is reported. A 53-year-old woman was admitted for further examination of an incidental retroperitoneal mass with calcification. Computed tomography scans demonstrated a tumor with fat, soft tissue and bone densities on the left renal hilum. Surgical excision of the tumor was performed with a preoperative diagnosis of retroperitoneal teratoma. The pathological diagnosis was mature teratoma, including all three germ layers. A carcinoid tumor was evident among teratoid tissues and it was thought to be a teratoma with malignant transformation. The patient did not have a carcinoid syndrome and had an uneventful recovery. She has been followed for 31 months with no recurrence. Carcinoid tumors rarely occur in teratomas of the ovary and the testis and, to our knowledge, this is the first case of carcinoid arising in a retroperitoneal mature teratoma.     

Atypical pulmonary carcinoid tumor with abnormal elevation of serum gastrin-releasing peptide precursor: report of a case

We report a rare case of atypical pulmonary carcinoid tumor accompanied by elevation of serum gastrin-releasing peptide precursor (ProGRP). A 55-year-old male presented to our hospital with a history of bloody sputum. The level of serum ProGRP was elevated to 781 pg/ml (normal < 46 pg/ml). Chest computed tomography (CT) revealed a solitary pulmonary tumor in the left lower lobe with sub-carinal lymph node enlargement. Transbronchial lung biopsy showed a pulmonary carcinoid, therefore left lower lobectomy with mediastinal lymph node dissection was performed. ProGRP decreased to normal level 1 month after operation. Histopathological diagnosis showed an atypical pulmonary carcinoid tumor.     

Renal carcinoid tumor presenting as bladder tamponade: a case report and review of the Japanese cases

A 65-year-old man presented with sudden onset of gross hematuria and urinary retention. Computed tomographic scan (CT) showed a cystic multilocular enhancing lesion (9 cm in diameter) at the left renal hilum causing thinning and lateral displacement of the left renal parenchyma. Left hydronephrosis and a renal calculi were observed. We performed radical nephrectomy suspecting a cystic renal cell carcinoma. Microscopic examination and immunohistochemical studies confirmed the diagnosis of the carcinoid tumor. The tumor cells were fully positive for neuron-specific enolase and keratin, and partially positive for chromogranin-A. One of the resected lymph nodes was positive for metastasis. Additional gastrointestinal tract examinations for carcinoid tumor were negative. However, he was concurrently diagnosed with poorly differentiated prostate cancer and hormonal therapy was started. He is free of recurrent carcinoid tumor nine months postoperatively. This case is the 31st report of renal carcinoid tumors in Japan.     

Primary testicular carcinoid tumor with teratoma: a case report

We report a case of primary testicular carcinoid with teratoma and review the literature. A 68-year-old man was hospitalized with an asymptomatic left testicular mass. Left radical orchiectomy was performed under a diagnosis of testicular tumor. Histologically, the tumor showed a typical appearance of teratoma with carcinoid components. Barium studies, computed tomographic scan could not demonstrate any other tumor anywhere else. He is now being followed at our clinic without any evidence of recurrence.     

Renal carcinoid tumor: a case report

A right renal tumor was incidentally found in a 38-year-old woman by annual medical check up. She visited our hospital for further examination and treatment. She did not show typical symptoms of carcinoid. A computed tomography (CT) revealed a calcified solid tumor in the upper portion of the right kidney. The tumor was 6.0 cm in diameter and was not enhanced in either early or late phase. There was no evidence of extrarenal invasion or distant metastasis. Based on a clinical diagnosis of stage 1 renal cell carcinoma, laparoscopic nephrectomy was performed. The pathological diagnosis was renal carcinoid tumor. The tumor had trabecular and ribbon-like structures with a thin fibrovascular stroma. Immunohistochemicaliy, the tumor cells stained positive for chromogranin A, synaptophisin and CD56. The cell proliferation rate was estimated to be under 1% with Ki67 staining. To find the primary lesion, we performed upper and lower gastric endoscopy and chest computed tomography, but could not find any/other carcinoid tumors. At 1-year follow up, she had no evidence of local recurrence or metastasis.     

Horseshoe Kidney is Associated With an Increased Relative Risk of Primary Renal Carcinoid Tumor

Purpose

Carcinoid tumor is a rare neoplasm of the kidney with an unknown histogenesis. Of only 31 cases previously reported in the literature 4 arose within horseshoe kidneys. We report a case of primary carcinoid tumor arising within a horseshoe kidney and discuss the unique insight it provided into the pathogenesis of this tumor.

Materials and Methods

We reviewed in detail all 31 reported cases of renal carcinoid tumor and, using reported incidence rates of horseshoe kidney, we calculated the relative risk of renal carcinoid tumor arising within a horseshoe kidney. Immunohistochemical staining for neuroendocrine related markers was performed on tissue sections from the present carcinoid tumor, the adjacent kidney and 5 control samples of normal renal parenchyma.

Results

Of the reported tumors 15.6% occurred in horseshoe kidneys, yielding a calculated relative risk of 62. The present tumor was multifocal, arising from the wall of a cystic lesion and possibly representing a dilated calix within the isthmus. Intestinal epithelium lining the cyst cavity exhibited multifocal neuroendocrine cell hyperplasia with an immunohistochemical profile identical to that of the carcinoid tumor cells.

Conclusions

The relative risk of renal carcinoid tumor developing in a horseshoe kidney is markedly greater than that for Wilms tumor or transitional cell carcinoma. The clinical course of renal carcinoid tumor arising within a horseshoe kidney appears to be more benign than that of the nonhorseshoe variant. Our observations support the hypothesis that renal carcinoid tumors may arise from neuroendocrine cells within foci of metaplastic or teratomatous epithelium within the kidney.     

Bronchial carcinoid arising in intralobar bronchopulmonary sequestration with vascular supply from the left gastric artery. Case report

We report the unique case of a large, nonmetastasizing bronchial carcinoid tumor that arose within an intralobar bronchopulmonary sequestration in a 45-year-old man. The vascular supply to the sequestrated area within the left lower lobe as well as to the carcinoid tumor originated from atypical branches of the left gastric artery and the thoracic aorta. A left lower lobe lobectomy was performed. Histologically, a typical carcinoid tumor without lymph node metastases was found (T2 N0 M0). Seven years postoperatively, the patient is without signs of recurrence.     

Primary carcinoid tumor in a horseshoe kidney

A case of primary carcinoid tumor arising within a horseshoe kidney in a 51-year-old woman is reported. The tumor was found incidentally by computed tomography (CT) during a check-up for a suspected gall bladder polyp. Histologic, immunohistochemical and electron microscopic analyses of this tumor revealed features typical of carcinoid tumor. Primary carcinoid tumor of the kidney is extremely rare and only 32 cases were previously reported, including five cases in horseshoe kidneys. None of these five cases in horseshoe kidneys demonstrated any evidence of local or distant metastases and all were alive at the time of reporting without evidence of disease after up to 3 years of follow up. The present case, even with accompanying lymph nodal metastasis, also has had no evidence of local recurrence or distant metastasis for 3 years post operation. Primary carcinoid tumor arising within horseshoe kidneys appear to be more benign than those within non-horseshoe kidneys.     

A case of bilateral renal cell carcinoma

A case of asynchronous bilateral renal cell carcinoma is reported. A 52-year-old man with the chief complaint of asymptomatic gross hematuria visited our hospital on November 16, 1981. Intravesicular pyelography showed poor secretion of the left kidney, compression of its pelvis and calyces and normal visualization of the right kidney. On computer tomographic (CT) scanning, abdominal aortogram and left selective renal angiogram, a round tumor lesion on the left kidney was recognized. Under the diagnosis of left renal tumor, radical left nephrectomy was performed in December, 1981. Histological diagnosis was clear cell carcinoma of the left kidney. He was administered medroxyprogesterone acetate. In December, 1985, CT showed a space-occupying lesion laterally on the right kidney and another suspected tumorous lesion. On the right selective renal angiogram, a round hypervascular lesion about 3 cm in diameter was found on the upper portion of the right kidney. On February 10, 1986 simple surgical enucleation of the 2 renal tumors was performed. Histological diagnosis was the same as that of the left kidney. Postoperative course was uneventful. He is well without recurrence or metastasis 8 months after operation.     

A case report of widely recurrent carcinoid tumor of the thymus

We performed wide resection of recurrent carcinoid tumor of thymus. A 62-year-old male patient admitted to our department because of swelling of anterior chest wall. He had received extirpation of thymic carcinoid tumor 5 years ago and he was pointed out large mass formation in anterior mediastinum before admission. Wide resection of tumor including pericardium, chest wall, left lung and left brachiocephalic vein was performed. Left brachiocephalic vein was reconstructed and pericardium was replaced with Gore-Tex patch. The carcinoid tumor of thymus sometimes invade to adjacent organs and is apt to recur long time after first operation.     

Metastatic renal carcinoid: case report and review of the literature

Primary renal carcinoid tumor is a rare tumor of the kidney. Metastatic renal carcinoid tumor has not been described in the medical literature. We report a case of renal metastasis of a primary bronchial carcinoid tumor and review the literature about renal carcinoid tumors.     

Composite tumor of mucinous cystadenoma and somatostatinoma of the kidney

Approximately 30 cases of carcinoid tumor of the kidney have been reported in the English literature, including three cases found as components of teratomas. Renal composite tumors associated with somatostatinoma have not been described. A 53-year-old female presented with an incidentally found right renal cystic lesion. Computed tomography demonstrated a cystic lesion associated with a solid nodule in the right kidney and postcontrast dynamic MRI revealed enhancement of the solid nodule. The patient underwent radical nephrectomy for the kidney lesion and is now well without recurrence 21 months after the operation. From the histopathological findings we diagnosed the cystic lesion as a composite tumor composed of mucinous cystadenoma and carcinoid tumor. Immunohistochemistry demonstrated the majority of cells of in carcinoid portion to be positive for antisomatostatin staining. The present case is the first documented composite tumor of mucinous cystadenoma and somatostatinoma of the kidney.     

Bronchial carcinoid tumor arising from an intralobar bronchopulmonary sequestration

We report a rare case of a 38-year-old woman with a bronchial carcinoid tumor arising from an intralobar bronchopulmonary sequestration. The vascular supply to the sequestered left lower lobe originated from the descending thoracic aorta. A left lower lobe lobectomy was performed. The findings of the pathological examination revealed an atypical carcinoid tumor that was immunopositive for chromogranin and synaptophysin. At the 3-year follow-up examination, the patient was healthy.     

Primary renal carcinoid tumor with liver metastases detected with somatostatin receptor imaging

If the final pathologic examination reveals a carcinoid tumor of the kidney, additional evaluation to rule out another occult primary tumor site is necessary. If the primary origin of the tumor is confirmed to be from the kidney, additional evaluation is required for the detection of metastasis. Renal carcinoid tumors are extremely rare; however, both primary and metastatic renal carcinoid tumors have been reported. We report a case of a 40-year-old woman with primary carcinoid of the kidney and metastatic disease in the liver not evident by computed tomography and magnetic resonance imaging but identified by somatostatin receptor scintigraphy.     

Carcinoid tumor and membranous glomerulonephritis: coincidence or malignancy-associated glomerulonephritis?

Membranous glomerulonephritis is known to be associated with malignancies. A 43-year-old man with a history of chronic renal insufficiency secondary to 20-year-old membranous glomerulonephritis was operated on for an infrarenal aneurysm. During surgical intervention, multiple nodular liver lesions were detected. Histologic examination of these lesions showed metastases of a carcinoid tumor. Despite extensive examination, the primary tumor site could not be detected. The patient remained asymptomatic 3 years postoperatively without any treatment for carcinoid tumor. This clinical report is the second case of a membranous glomerulonephritis associated with a carcinoid tumor. Whether the association is merely a coincidence or a real malignancy-related glomerulopathy remains unclear. Because survival of 23 years after the onset of symptoms of carcinoid tumor has occurred, it is possible that our patient already had an asymptomatic carcinoid tumor at the time the diagnosis of membranous glomerulonephritis was made. Comparison with other paraneoplastic glomerulonephritis as well as diagnosis of a carcinoid tumor in renal insufficiency are discussed.