Renal Cell Carcinoma with Gallbladder Metastasis

The nature of polypoid masses within the gallbladder is difficult to define preoperatively. Tumors larger than 1 cm in size are strongly related to malignancy, but they are not always primary tumors of the gallbladder. We present a patient who underwent radical surgery for renal cell carcinoma and the preoperative finding of a polypoid mass within the gallbladder turned out to be a metastatic lesion.     

Gallbladder Metastasis of Renal Cell Carcinoma: Report of Two Cases

We report two extremely rare cases of metastasis to the gallbladder from renal cell carcinoma. In both men, aged 63 and 80 years, a pedunculated polypoid gallbladder tumor was incidentally found 27 and 8 years after surgery for renal cell carcinoma, respectively. The tumors showed hypervascularity on diagnostic imaging. A histopathological examination showed no tumor cells in the gallbladder mucosa, but clear cell carcinoma was predominantly observed below the mucosal layer. Furthermore, based on various specific and immunohistochemical studies as well as the electron-microscopic findings, the patients were pathologically diagnosed to have gallbladder metastasis of renal cell carcinoma. Received: February 16, 2001 / Accepted: September 11, 2001     

Resection of a Solitary Pancreatic Metastasis from Renal Cell Carcinoma with a Gallbladder Carcinoma: Report of a Case

Most metastatic pancreatic tumors are detected at an advanced stage and are not considered suitable for surgery; however, resection is sometimes indicated for a solitary pancreatic metastasis from renal cell carcinoma (RCC) and improves the prognosis. We report such a case, in which the hilar liver was resected with lymph node dissection and distal pancreatectomy. Histological examination revealed regional lymph node metastasis of gallbladder carcinoma (GBC), but all the surgical margins were free of cancer. Postoperative extra-beam radiation therapy was delivered to the hepatic portal lesion to prevent GBC recurrence. The patient remains disease-free 14 months after the completion of radiation therapy. Thus, if all affected areas can be resected, the prognosis associated with pancreatic metastasis from RCC may be favorable.     

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。     

Adenoendocrine Cell Carcinoma of the Gallbladder: Report of a Case

Adenoendocrine cell carcinoma of the gallbladder is an uncommon form of cancer. We treated a 36-year-old woman who came to us with a chief complaint of abdominal pain. The abnormality was diagnosed to be a tumor-like mass in the gallbladder, and adenomyomatosis of the gallbladder was strongly suspected. A laparoscopic cholecystectomy was successfully performed, and the histopathological finding was adenoendocrine cell carcinoma of the gallbladder. The tumor cells of the small round cell carcinoma partly stained positively for synaptophysin, neuron-specific enolase, and CD 56, while adenocarcinoma cells showed positive reactions to keratin, which was thus suggestive of adenoendocrine cell carcinoma. The patient is alive and doing well at 12 months after the treatment.     

Solitary Colonic Metastasis of Renal Cell Carcinoma Seven Years after Nephrectomy: A Case Report

An 83-year-old man, who had undergone right radical nephrectomy for renal cell Carcinoma about 7 years previously, experienced melena and abdominal mass. Barium enema, colonoscopy, computed tomography, and arteriography showed a hypervascular mass on the transverse colon, and a partial transverse colectomy was performed. The postoperative histologic examination revealed that the tumor was a metastatic clear cell carcinoma.     

Cytoreductive Nephrectomy in Patients with Synchronous Metastases from Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium

Background

The benefit of cytoreductive nephrectomy (CN) for overall survival (OS) is unclear in patients with synchronous metastatic renal cell carcinoma (mRCC) in the era of targeted therapy.

Objective

To determine OS benefit of CN compared with no CN in mRCC patients treated with targeted therapies.

Design, setting, and participants

Retrospective data from patients with synchronous mRCC (n = 1658) from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) were used to compare 982 mRCC patients who had a CN with 676 mRCC patients who did not.

Outcome measurements and statistical analysis

OS was compared and hazard ratios (HRs) adjusted for IMDC poor prognostic criteria.

Results and limitations

Patients who had CN had better IMDC prognostic profiles versus those without (favorable, intermediate, or poor in 9%, 63%, and 28% vs 1%, 45%, and 54%, respectively). The median OS of patients with CN versus without CN was 20.6 versus 9.5 mo (p < 0.0001). When adjusted for IMDC criteria to correct for imbalances, the HR of death was 0.60 (95% confidence interval, 0.52–0.69; p < 0.0001). Patients estimated to survive <12 mo may receive marginal benefit from CN. Patients who have four or more of the IMDC prognostic criteria did not benefit from CN. Data were collected retrospectively.

Conclusions

CN is beneficial in synchronous mRCC patients treated with targeted therapy, even after adjusting for prognostic factors. Patients with estimated survival times <12 mo or four or more IMDC prognostic factors may not benefit from CN. This information may aid in patient selection as we await results from randomized controlled trials.

Patient summary

We looked at the survival outcomes of metastatic renal cell carcinoma patients who did or did not have the primary tumor removed. We found that most patients benefited from tumor removal, except for those with four or more IMDC risk factors.     

p63 Immunohistochemistry Differentiates Salivary Gland Oncocytoma and Oncocytic Carcinoma from Metastatic Renal Cell Carcinoma

Metastatic renal cell carcinoma (RCC) can pose diagnostic challenges in the head and neck often resembling benign and malignant oncocytic lesions. Immunohistochemical panels have been reported to help with this differential but are not entirely specific or sensitive. We have noticed that p63 routinely stains salivary gland oncocytomas but not metastatic RCC. Nineteen oncocytomas, 9 cases of oncocytosis, 9 oncocytic carcinomas and 16 head and neck metastatic RCC were studied. Morphologic features evaluated were cytoplasmic character (clear versus oncocytic), Fuhrman nuclear grade, mitotic rate, growth pattern, presence of lumens/blood lakes and stromal characteristics. Tumors were stained with antibodies to p63, renal cell carcinoma marker (RCCm), CD10, and vimentin. Eight benign oncocytic tumors (29%) had clear cell features while 6 metastatic RCC (37%) had oncocytic features. Median Fuhrman nuclear grade was 2 in oncocytoma and oncocytosis and 3 both oncocytic carcinoma and metastatic RCC. Mitotic rates were only significantly different between benign oncocytic tumors and metastatic RCC. All oncocytomas had lumina compared to half of metastatic RCC, all of which also demonstrated blood lakes. Seven benign oncocytic tumors (25%) and 5 oncocytic carcinomas (56%) had RCC-like vascular stroma. All primary salivary gland tumors were positive for p63, predominately in basal cell-type distribution. None of the metastatic RCC was positive. RCCm was entirely specific but lacked sensitivity for metastatic RCC while CD10 and vimentin showed variable sensitivity and specificity. While clinical history and morphology usually are adequate, demonstration of p63 staining can definitively exclude metastatic RCC from the differential diagnosis of similar appearing tumors in salivary glands, namely oncocytoma and oncocytic carcinoma, with 100% specificity and sensitivity. While RCCm, CD10, and vimentin performed adequately, they were significantly less reliable than p63 with both false positives and false negatives. The results of this study were presented at the 96th Annual Meeting of the United States and Canadian Academy of Pathologists in San Diego, CA, March 2007.     

胆囊癌肝转移外科治疗的体会(附31例报告)

目的：探讨胆囊癌肝转移的手术治疗原则。方法：本组男１０例,女２１例,年龄３６～７６岁,均经病理证实为胆囊癌。８例行胆囊切除＋肝段切除＋淋巴结廓清的根治性手术,其中一例附加胰头十二指肠切除;姑息胆囊切除４例,姑息性旁路引流手术１０例,姑息胆囊切除加旁路引流手术３例,开腹探查术６例。结果：８例根治手术平均生存１５个月,３例至今仍存活。２３例未行根治手术者随访２１例,存活均未超过６个月。结论：胆囊癌肝转移病人选择性施行胆囊切除＋肝部分切除＋淋巴结廓清,必要时附加肝外胆管切除可取得较为满意的疗效。根治手术的关键是准确判断切缘。不能根治切除者,应尽可能行胆囊姑息切除或旁路手术。     

Tumor-to-Tumor Metastasis: Renal Cell Carcinoma Metastatic to Papillary Carcinoma of Thyroid—Report of a Case and Review of the Literature

Metastatic disease to thyroid gland is a rare event. Although renal cell carcinoma (RCC) has been reported to metastasize the thyroid gland, metastatic RCC to a thyroid neoplasm is very unusual. We report a case of a 68-year-old man with history of RCC who presented with a 2.5-cm thyroid nodule. Histologic examination demonstrates a renal cell carcinoma metastatic to a papillary carcinoma of the thyroid. The clinicopathologic features of metastatic disease into a thyroid gland neoplasm are shown, and a review of the literature is presented.     

Solitary Colonic Metastasis of Renal Cell Carcinoma

We report a rare case of a solitary metastasis of a renal cell carcinoma which manifested as a primary colonic tumour. A 60-year-old male patient who had undergone a right radical nephrectomy 5 years previously for renal cell carcinoma, presented with a history of dyspepsia and pain in the right upper abdomen. A mass on the hepatic flexure was detected by computed tomography and colonoscopy and right hemicolectomy was performed. Postoperative histo-logical examination revealed that the tumour was a metastatic renal cell carcinoma of the clear cell type.