Spontaneous rupture of renal cell carcinoma: a case report]

A 74-year-old man with severe right flank pain and hypochondralgia, was admitted to a hospital where he was found to have an abnormality of the right kidney on computed tomographic (CT) scan. He was referred to our department for further examination and treatment on the next day. Spontaneous rupture of the right renal cell carcinoma was mostly suspected from preoperative clinical findings obtained by ultrasonography. CT scan and angiography. Extravasation was not recognized on angiography. We chose emergent transcatheter arterial embolization prior to radical nephrectomy. The surgical specimen contained a solid and yellowish mass invading into the renal pelvis. Subcapsular rupture was identified. Histopathological diagnosis was renal cell carcinoma consisting of invasive growth of highly atypical epithelial cells with a sarcomatous pattern, and the tumor cells were present in the renal pelvis. He died of lung cancer 26 months after the operation.     

A case of renal cell carcinoma with multiple lung metastases refractory to interferon-α showing complete remission by interleukin-2 monotherapy

We report a case in which a regimen of interleukin-2 (IL-2) achieved pathologically complete remission against renal cell carcinoma with multiple lung metastases. A 63-year-old man was admitted to the Osaka University Hospital with a right renal tumor and multiple lung metastases. Right radical nephrectomy was performed and the histological diagnosis was clear cell carcinoma, G3 > G2, INFbeta, pT3a, pN0. Postoperatively, despite treatment with interferon-alpha, the lung metastases progressed. Consequently, intravenous administration of IL-2 was started at a dose of 70 x 10(4) JRU/day five times per week. After 16 weeks of IL-2 therapy, most of the multiple lung metastases completely vanished and the largest metastatic lung mass was reduced in size. Resection of this residual lung mass was performed and pathological examination revealed no viable cancer cells.     

Advanced renal cell carcinoma showing a different response to two types of interferon-alpha

Interferon (IFN)-alpha has been widely used in systemic therapy for advanced renal cell carcinoma (RCC). IFN-alpha is represented by a large family of structurally related genes expressing at least 14 subtypes, each of which shows quantitatively distinct patterns of biological activities. Although those distinct patterns of biological activities of IFN-alpha subtypes against renal cancer cell lines have been demonstrated, there is no report that demonstrates the difference in each subtype-induced antitumor activity in patients with RCC. Herein, we present a unique case of advanced RCC that is resistant to interleukin-2 and IFN-alpha administration, and we describe its response to another IFN-alpha administration. The difference between the two IFN-alpha types lies in the distribution of the subtypes: this case, therefore, suggests that the difference in the subtype distribution may cause the different response of the RCC. A 47 year-old male was diagnosed as left RCC with multiple lung metastases and underwent radical nephrectomy. The histological diagnosis was pT3b G2 clear cell carcinoma. He received intramuscular administration of 6 x 10(6) units of natural human IFN-alpha (Sumiferon) three times a week following the operation. However, the lung metastases showed progression. Thereafter, he received intravenous administration of 1.4 x 10(6) units of human interleukin-2 everyday. However, the lung metastases showed further progression and the hemoptysis, dyspnea, and chest pain deteriorated. Finally, he was given intramuscular administration of 5 x 10(6) units of another natural human IFN-alpha (OIF) three times a week. After the OIF administration, his complaints subsided and a chest CT scan revealed reduced lung metastases and diminished pleural effusion. He had not received any anti-tumor agents other than IFN-alpha or interleukin-2 since the operation. However, although he remained free of hemoptysis, dyspnea, and chest pain after OIF administration, the lung metastases increased again and multiple brain metastases were also observed five months after the first OIF administration. He died of metastatic RCC one year after the operation.     

Lobectomy for lung cancer in an elderly man on maintenance hemodialysis

An 82-year-old man who had been undergoing hemodialysis for chronic renal failure, 3 times a week for the last 3 years, was admitted to our hospital for the treatment of lung cancer. Under careful perioperative management, we successfully performed a lobectomy. Histological examination revealed well differentiated squamous cell carcinoma and the postoperative staging was pT1N0M0. On postoperative day 1, he was commenced on hemodialysis with nafamostat mesilate instead of heparin sodium, and there was no postoperative bleeding. The patient had an uneventful postoperative course and was discharged 3 weeks after his operation.     

A case of renal cell carcinoma with lung metastases successfully treated by interferon-beta

A case of renal cell carcinoma with multiple lung metastases successfully treated with interferon (IFN) following nephrectomy is reported. A 46-year-old man consulted our institute complaining of left flank pain for 3 months on June 18, 1983. Macroscopic hematuria consisting of blood clot had also been found 1 week before. For a diagnosis of left renal carcinoma with multiple lung metastases, he was admitted. After total nephrectomy, 30 x 10(6) units per day of natural IFN-beta were administered intravenously every other day for 2 months (total dose; 269 x 10(6) units). One of the pulmonary lesions disappeared, but another increased in size and a new lesion was also found. Therefore, this trial was evaluated to be progression. Thereafter, he was treated with 600 mg/day of carmofur (HCFU) and was in a stable condition. As his lung lesions progressed at 11 months after nephrectomy, 9 x 10(6) units/day of recombinant IFN-beta were additionally administered 5 days a week for 4 weeks. When the treatment was completed (total dose; 180 x 10(6) units), the pulmonary lesions disappeared. The complete response lasted for 9 months. However, on May, 1985, bone metastasis to lumbar vertebra was found and he died on November 4, 1985 without any evidence of relapse at lung field.     

A case of erythropoietin-producing renal cancer

A case of renal cell carcinoma with erythrocytosis is reported. A 58-year-old male had a right renal tumor with retroperitoneal lymph node and lung metastases. Preoperative laboratory data revealed a red blood cell count of 6.31 million/mm3, a hemoglobin concentration of 17.2 g/dl, a hematocrit of 52.1, and an erythropoietin (EPO) level of 47.3 mU/ml, which was determined by RIA method (normal range: 8-30). The patient underwent radical nephrectomy and retroperitoneal lymph node dissection without any blood transfusion because blood loss was only 300 g. The removed kidney weighed 400 g. Pathological examination showed a renal cell carcinoma not invading the fibrous capsule with lymph node metastasis. The EPO activities of extracts from the normal kidney and cancer tissues were less than 18 and 50.8 mU/g, respectively. At present, 3 months postoperatively, he receives daily UFT and HLBI every other day for the lung disease left, which does not change in size, and all laboratory data mentioned above have returned to normal ranges. These results enabled us to diagnose the present case as EPO-producing renal cell carcinoma.     

Successful treatment for renal cell carcinoma with lung metastases by interleukin-2 and interferon-alfa: a case report

We report a case in which a regimen of interleukin-2 (IL-2) and interferon alfa (IFN-alpha) was effective against renal cell carcinoma with lung metastases. A 69-year-old man diagnosed with right renal tumor had not received treatment for 28 months. He was admitted to our hospital for treatment. Computed tomographic (CT) findings showed a right renal tumor 11.5 cm in diameter and multiple lung metastases. Right nephrectomy was performed, and pathological examination was renal cell carcinoma (clear cell carcinoma, G2, pT3a). A regimen of IL-2 and IFN-alpha was selected as an adjuvant therapy. He received 70 x 10(4) JRU/day of IL-2 (div) 5 times a week, and 600 x 10(4) IU/day of IFN-alpha intramuscularly 3 times a week for 8 weeks. Thereafter, both treatments were continued 3 times a week. CT scan showed a complete response on lung metastases 12 months and no recurrence has been observed on CT scan for 16 months after operation.     

Pulmonary large cell carcinoma contiguous to bullae with massive bullous hematoma and hemoptysis; with special reference to 20 cases of Japanese reports

A 50-year-old man with continuous hemosputa and large hematoma of left upper lobe contiguous to bilateral emphysematous bullous disease was admitted for surgery to stop hemorrhage and to resect left lung hematoma and multiple bullae. Bullectomy and neodymium yttrium aluminum garnet (Nd-YAG) laser irradiation to bullae of left upper lobe performed successfully with maximum preserved pulmonary function of it. Pathological examination, however, revealed anaplastic carcinoma inside bulla of S(1+2)c with minimal invasion into adhered parietal pleura (p 3). Left upper lobectomy was carried out with complete mediastinal lymph node dissection (ND 2 b). The final pathological diagnosis was large cell carcinoma of left S(1+2)c with the staging pT3N0M0 and stage II. The patient lives actively in daily life more than 7 years without any recurrence. Clinical analysis of Japanese 20 cases of lung carcinoma with initial signs of hemosputa and/or hemoptysis contiguous to emphysematous bullae elucidate following important facts. Hemosputa and hemoptysis play important role for early finding and diagnosis of lung cancer contiguous to bullous disease, especially in patients of early clinical stage with or without computed tomography (CT) exams and promise to better surgical prognosis and survivals as compared with non hemosputa ones.     

Renal metastasis originating from pulmonary carcinoma: a case report

A 61-year-old woman, who had undergone total right pneumonectomy 22 months before due to lung cancer (adenosquamous cell carcinoma) was admitted for macroscopic hematuria. Abdominal CT showed two renal tumors in the right kidney. Right radical nephrectomy was performed, because no imaging study showed any other metastasis. Pathological examination revealed adenosquamous cell carcinoma, which was the same pathology as the lung cancer had been. She died of the left lung metastasis 24 months after right radical nephrectomy. Her prognosis was thought to have been prolonged by the operation of right radical nephrectomy.     

A surgically treated case with lung cancer on maintenance hemodialysis

Maintenance hemodialysis for chronic renal failure has spread all over the country, and the number of patients in whom surgical indications are considered to concomitant diseases has been increasing. A 76-year-old male was admitted due to lung cancer on maintenance hemodialysis. The chest roentgenogram showed a 2.5 cm sized coin lesion in the right middle lung field. Preoperative examinations, chest tomography, chest CT-scanning, bone scintigraphy, bronchofiberscopic biopsy, etc. led to a diagnosis of primary lung cancer (squamous cell carcinoma). Hemodialysis with prescribing nafamostat mesilate (40 mg/hour) was performed the day before the operation and on the first, fourth and sixth postoperative days. There was no postoperative bleeding. The patient has been well for 27 months postoperatively.     

Pulmonary metastasis of renal cell carcinoma 20 years after nephrectomy

A 70-year-old man underwent right nephrectomy for clear cell renal carcinoma in 1985. After nephrectomy, he was routinely followed up as an outpatient. Solitary chest tumor was detected on pulmonary CT in 2005. A wedge resection of pulmonary tumor was performed under diagnosis of primary lung cancer. The histological feature was not of primary lung cancer, but the previous nephrectomised specimen, i.e., clear cell renal carcinoma.     

Small cell carcinoma of the urinary bladder with synchronous esophageal cancer and incidental lung cancer: a case report]

We present a case of triple primary cancers occurring synchronously in the urinary bladder, esophagus, and incidentally in the lung. A 65-year-old man with a chief complaint of gross hematuria was admitted to our hospital. Cystoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a non-papillary broad-based bladder tumor. Histological diagnosis was transitional cell carcinoma of the urinary bladder and he underwent one course of neoadjuvant chemotherapy (M-VAC) with the preoperative diagnosis of T3bN0M0. After one course of chemotherapy, chest CT, lymph node biopsy and esophagoscopy revealed squamous cell carcinoma of the esophagus. He first underwent radiochemotherapy (total 70 Gy, CDDP 5 mg x 41, 5-FU 250 mg x 24) for esophageal cancer and achieved complete remission. Then, he underwent radiotherapy for a total of 60 Gy for bladder cancer. However, his general condition gradually became worse and he died from metastatic cancer. The autopsy proved that he died from multiple metastases of small cell carcinoma of the urinary bladder and incidentally squamous cell carcinoma of the lung was identified.     

Bronchioloalveolar carcinoma with acute respiratory failure due to hemoptysis; report of a case

A 69-year-old male was admitted to our hospital for hemoptysis and dyspnea. Because of his deteriorating respiratory distress, he was intubated and controlled by respirator for 3 days. He was diagnosed with adenocarcinoma of the lung by the sputum examination and chest computed tomography (CT) revealed an infiltration shadow in the peripheral superior ventral segment (S3) of the right upper lobe. He underwent right upper lobectomy with video-assisted thoracic surgery. Microscopic findings of the resected specimen measuring 10 x 10 x 7 cm revealed mucin-producing bronchioloalveolar carcinoma (BAC) with metastases in lymph nodes and the same lobe (S2b). We reported a rare case of BAC with hemoptysis.     

A case of recurrence of a metastatic brain tumor which disappeared due to chemotherapy only

A rare case of recurrence of a metastatic brain tumor which disappeared due to chemotherapy only is reported. A 52-year-old male was noticed to have an abnormal shadow in his chest X-P at a routine medical examination, so a close examination was made. He was diagnosed as having right renal cell carcinoma which had metastasized to the lung. He was treated by intra-arterial infusion of anti-cancer drugs and embolization of the right renal artery. No renal symptom was seen, growth of the primary tumor stopped, and the abnormal shadow in his chest diminished. However, weakness in the left hand appeared 19 months after the first examination and he was admitted to our clinic. He was alert, but slight left hand weakness was observed. CT scan revealed a diffusely enhanced mass in the right parietal lobe. Total removal of the brain tumor was performed and the histology was metastasis of renal cell carcinoma. He was discharged and was able to walk but he had slight left hemiparesis. UFT 6 capsules a day were administrated in our out-patient clinic. However, CT scan revealed recurrence of the tumor 2 weeks after discharge, we followed up with conservative treatment, and no growth of the tumor was seen. It disappeared 5 months after discharge after being treated with UFT only. We regard UFT as having been effective in this case.     

Bilateral multilocular cystic renal cell carcinoma]

A case of bilateral renal cell carcinoma with multilocular cysts is described. A 42-year-old female was admitted to our hospital for the purpose of further examination or right renal cystic mass discovered incidentally by ultrasonography. After she was examined by CT-scan and angiography, right nephrectomy was performed under the diagnosis of right renal cancer. Histological diagnosis was multilocular cystic renal cell carcinoma. One year later a small cystic legion was found in the left kidney. Under the diagnosis of left renal cancer, left partial nephrectomy was performed. Histological diagnosis was multilocular cystic renal cell carcinoma same as the right kidney. Multilocular renal cyst is classified into several classes by its style of development. This case of bilateral renal cell carcinoma which grew to be multilocular cysts is the first case in Japan as far as we can search.     

A case of tumor-forming chronic pyelonephritis that was difficult to be differentiated from renal cell carcinoma

We experienced a rare case of tumor-forming type of chronic pyelonephritis that could hardly be differentiated from renal cell carcinoma. A 62-year-old man was admitted to our department with right renal tumor which was discovered when he underwent examination for gastric cancer. Abdominal ultrasound sonography and computed tomography revealed a mass in the middle portion of the right kidney, measuring 3.8 x 3.5 cm in diameter, with irregular surface and isoechoic and isodense inner mass. Renal angiography demonstrated a hypervascular area in the middle portion. Radical nephrectomy and subtotal gastrectomy were performed under a tentative diagnosis of right renal cell carcinoma and early gastric cancer. The excised specimen macroscopically demonstrated a yellowish mass in the middle portion and microscopically revealed many lymphocytes and few neutrophils, macrophages or foam cells. The patient was diagnosed as tumor-forming type of chronic pyelonephritis. Such obvious inflammatory findings very rarely exist in the tumor-forming type of chronic pyelonephritis. Therefore, caution should be exercised in the differential diagnosis between this disease and renal cell carcinoma.     

Successful resection and reconstruction of the left atrium, right atrium and atrial septum under extracorporeal circulation in a patient with invasive pulmonary carcinoma

A 69-year-old man was admitted to our hospital with a complaint of cough and hemoptysis. His chest X-ray showed an obstruction of the right intermediate bronchus and resultant atelectasis of the middle and lower lobes. Cytological examination by bronchoscopy showed squamous cell carcinoma. Although the cancer involvement of the left atrium could not be clearly defined by preoperative chest CT scan, the cancer invasion to the left atrial wall was recognized intraoperatively. Right pneumonectomy along with resection and patch reconstruction of the left atrium, right atrium and atrial septum was performed under extracorporeal circulation. Postoperative hemodynamic state was stable, and echocardiography showed normal volume of the left atrium. Histological examination of the resected specimen showed moderately differentiated squamous cell carcinoma with the involvement of the left and right atrial wall. The resected margins of the left and right atria were free of malignancy. Although he had been clinically in good condition and free from any sign of cancer recurrence, he died of aspiration pneumonia five months after the surgery.     

A case of spontaneous rupture of renal cell carcinoma

A case of spontaneous rupture of renal cell carcinoma is reported. A 53-year old man was admitted with the chief complaint of sudden gross hematuria and right flank pain on December 28, 1979. On the following day, the clinical impression was right ruptured kidney, and therefore right nephrectomy was done. Pathological diagnosis was renal cell carcinoma. He received the post-operative irradiation of a total of 5,000 rads. He was seen five years later, at which time there was no evidence of local recurrence or distant metastasis of cancer. Thirty three cases of spontaneous rupture of renal cell carcinoma were collected from Japanese and English literature. Most common chief complaint is abdominal or flank pain. Excretory urography, ultrasonography, CT scan and angiography are useful, but it is difficult to diagnose preoperatively when the tumor is small. Therefore, it is important to suspect occult cancer when a reasonable cause of rupture is undetermined. In these indeterminate cases primary nephrectomy should be considered strongly.     

A case report of ruptured mycotic aneurysm at the site of subclavian flap angioplasty]

Postoperative mycotic aneurysm of the thoracic aorta at the site of subclavian flap angioplasty (SFA) is very rare. A 6-year-old boy was admitted with a history of high fever for 10 days. He had undergone SFA at the age of 14 days and patch closure of VSD at 10 months. The chest X-ray film on admission revealed no abnormality. But, 7 days later, he suffered from frequent hemoptysis and chest X-ray film showed an abnormal mass shadow at the left upper lung field. Contrast enhanced CT scan and IV-DSA revealed a pseudoaneurysm of the aortic arch which had ruptured into the left upper lung. An extra-anatomical bypass was urgently made from the ascending aorta to abdominal aorta and the aneurysm was isolated by ligations of the aorta proximal and distal to the aneurysm. Aneurysmectomy combined with left upper lobectomy was carried out next day. Septic signs and hemoptysis dramatically improved after operation. Extra-anatomical bypass as a means of choice for the surgical treatment of the mycotic aneurysm greatly contributed to cure the severe ill patient. But a close follow up observation for the function of the graft is necessary.     

Intra-abdominal metastases from primary carcinoma of the lung

The case of a 56-year old male with an intra-abdominal metastasis from a primary lung cancer is presented. He was admitted for abdominal obstruction, toxic syndrome and paraumbilical pain. He had a previous history of squamous cell carcinoma of the right lung, for which he had undergone a right upper lobectomy in 1995, four years prior to the development of the abdominal obstruction. A debulking operation and bowel resection for the intestinal metastasis was performed. Eleven months after this operation the patient developed a recurrence: he underwent another debulking operation with resection of the sigmoid colon, jejunal segment and a small part of the bladder. The patient is alive and well 13 months after the initial operation. Intra-abdominal metastases of bronchial carcinoma may be observed with greater frequency, because of the improved survival of the patients with lung cancer. Metastatic small bowel carcinomas are rare and should be considered in the differential diagnosis of acute abdominal syndromes of patients with known history of the lung cancer. Bowel resection and debulking of the metastatic tumour mass give the best palliation and improve short-term survival.