甲状腺转移性肾透明细胞癌一例

患者女,71岁.因发现左侧甲状腺肿块3个月于2009年12月入院.患者自述3个月前发现左侧甲状腺肿块,无疼痛、声嘶、吞咽困难、咳嗽、发热及心悸等,未行治疗.近1个月肿块有所增大而住院诊治.5年前因"肾透明细胞癌"行肾脏切除.体检:左颈部触及一个大小约3.5 cm×3.0 cm×3.0 cm的包块.与周围组织界限清楚,质软.CT检查示:左侧甲状腺占位性病变,大小3.2 cm×2.6 cm×2.2 cm.血甲胎蛋白(AFP)、癌胚抗原(CEA)正常,甲状腺功能检查正常.临床诊断:甲状腺腺瘤.     

Myoepithelial carcinoma of soft tissue: a case report

Myoepithelioma of soft tissue is a recently categorized entity and myoepithelial carcinoma is extremely rare. We describe a case of myoepithelial carcinoma of soft tissue in a 30-year-old male patient, who presented with a painless mass located at the back of left leg involving popliteal fossa that was present since childhood. A wide local excision was performed. The distinct histopathological features included infiltrative margins, cytologically moderate to severely atypical epithelioid/spindled cells with prominent nucleoli, 3-4 mitoses/10HPF, tumor necrosis and lymphovascular invasion. No heterologous elements were identified. The myoepithelial origin was confirmed by positive immunohistochemical staining for S100 protein, epithelial membrane antigen and smooth muscle actin. Mib-1 (Ki-67) proliferation index was 20-25%. These carcinomas have variable clinical presentation and can have an indolent course for several years. Recognition of myoepithelial carcinoma is clinically significant because compared to its benign counterpart, this has increased frequency of local recurrences and metastases that warrants a close clinical follow-up.     

Sarcomatoid renal cell carcinoma metastatic to the heart: report of a case.

An unusual case of metastatic sarcomatoid renal cell carcinoma is presented. Fifteen months after nephrectomy for a typical clear cell carcinoma, a 63-year-old man presented with bilateral pleural effusions, cardiomegaly, and tamponade. A pericardial biopsy showed an anaplastic spindle cell tumor that was strongly keratin positive and showed desmosomes ultrastructurally. The patient died shortly thereafter, and the autopsy revealed massive tumor infiltration of the heart, pulmonary and adrenal metastases, and tumor nodules at the incision site of his nephrectomy. The differential diagnosis of sarcomatoid renal cell carcinoma is discussed.     

Tumor-to-tumor metastasis: case report of a pulmonary adenocarcinoma metastatic to a clear cell renal cell carcinoma

Tumor-to-tumor metastasis is a very rare event. The recipient tumor may be benign or malignant. Renal cell carcinoma is the most common tumor recipient of metastasis while lung carcinoma is the most common donor tumor. We report a 57-year-old Caucasian male who presented with chest pain. On PET CT Scan, he was also found to have a large renal mass for which he underwent left nephrectomy. On histology of the renal mass, the tumor was a conventional renal cell carcinoma with areas of metastatic non-small cell lung carcinoma. The two components had a distinctive morphology which was confirmed on subsequent immunohistochemistry. The physiopathological mechanisms making clear cell renal cell carcinoma an avid recipient of a metastatic carcinoma have been speculated upon, but are still unknown.     

Microscopic polyangiitis with renal mass-like lesion: a case report

A 63-year-old man was admitted to our hospital because of persistent fever, weight loss, painful foot, and purpura on his extremities. He had lower extremity peripheral neuropathy, and skin biopsy of the purpura revealed vasculitis. Serum tests for myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA), proteinase 3-ANCA, and ANCA (indirect fluorescent antibody method) were all negative. Computed tomography revealed a 6-cm large, irregularly shaped lesion in the right kidney, while the nasal sinuses and lungs were intact. Based on these findings, a diagnosis of suspected systemic vasculitis associated with renal cell carcinoma was made. Thus, right nephrectomy was performed. However, the pathological findings showed a large infarct with necrotizing vasculitis of the arcuate, interlobular, and perinephric small arteries and a crescent formation in the glomerulus. Based on these findings, he was diagnosed with microscopic polyangiitis. Due to rapidly worsening symptoms of purpura and neuropathy, treatment with a high dose of corticosteroid was initiated on postoperative day 2, which led to improvement of his symptoms. Vasculitis accompanied with a mass-like lesion is occasionally confused with malignancy. The lesion in our patient was considered to have originated by asymptomatic renal infarction. This case suggests that a renal mass-like lesion with vasculitis should be diagnosed with care.     

Endobronchial metastasis from renal cell carcinoma: a case report

A 46-year-old man had primary pulmonary symptoms of intermittent fever, cough and dyspnoea. Radiological investigations revealed a mass at right hilum with right upper lobe collapse. Bronchoscopy showed a luminal mass of which the biopsy showed a tumour with predominantly clear cell change. Subsequent investigations revealed primary renal adenocarcinoma. The differential diagnosis of clear cell lung tumour is discussed. This case of endobronchial metastasis from renal cell carcinoma is being presented because of its rarity.     

Ocular metastasis as first presentation of renal cell carcinoma: report of 2 cases

Authors report the cases of 2 patients who had an ocular lesion as the first sign leading to diagnosis of renal cell carcinoma, an uncommon presentation of this neoplasm. The first patient was a 59-year-old man presented with a mass in the right eye. The histological and immunohistochemical profile of the biopsy showed a probable renal cell carcinoma. A CT scan showed a solid mass in the left kidney. The patient underwent radical nephrectomy and excision of the ocular lesion and had an uneventful evolution. The second patient was a 72-year-old man presenting with an ulcerated lesion on the right inferior tarsal conjunctiva. An excisional biopsy of the lesion showed histological and immunohistochemical patterns of a clear cell carcinoma. Abdominal tomography disclosed a right peripheral renal tumor. A right radical nephrectomy was performed. Renal cell carcinoma may present atypically with metastases to quite uncommon organs. Nephrectomy may be of value in selected cases; the ocular metastases are usually excised for aesthetic and functional reasons.     

Alpha-fetoprotein producing renal cell carcinoma: a case report.

We report a case of alpha-fetoprotein (AFP) producing renal cell carcinoma. A 53-year-old man with fever was found to have a left renal mass on computed tomography. No mass was detected in the liver. Serum AFP was 1,460 ng/ml. Radical nephrectomy showed a 10 cm mass in the upper half. A half of the tumor was whitish yellow and firm whereas another half was soft and bright yellow with hemorrhagic and necrotic areas. Histologically, the two areas were different. The lower part consisted of the clear cell renal cell carcinoma and the upper part consisted of granular cells. On immunohistochemistry, the granular tumor cells only were positive for AFP. Serum AFP level dropped abruptly to 383 ng/ml on the 6th postoperative day and gradually returned to normal during the 6 months. Multiple metastatic nodules were found in the lungs, liver and bone in 9th postoperative month and the AFP was less than 1 ng/ml. This suggest metastatic lesions are non-AFP producing clear cell type. It can be concluded that serum AFP elevation was due to synthesis by the renal cell carcinoma in the absence of liver neoplasm. Although AFP producing renal cell carcinoma is a rare entity, serum AFP can be a useful marker for the detection of the tumor.     

Extramedullary hematopoiesis presented as solitary renal mass: a case report with review of literature

In this article, we described a case of extramedullary hematopoiesis (EMH) in a 12-year-old boy with the clinical and hematological features of hemolytic anemia of unknown cause. The patient presented with a solitary well circumscribed mass in right kidney. Ultrasound guided fine-needle aspiration cytology showed myelocytes, metamyelocytes, megakaryocytes, and immature erythroid cells. A cytological diagnosis of EMH was made.     

Metastatic renal cell carcinoma in a meningioma: a case report

Tumor-to-tumor metastasis is rare. We report a case of metastatic renal cell carcinoma in meningioma. A 67-year-old woman presented a two-week history of motor dysphagia and decreased short-term memory. She had undergone a left radical nephrectomy for a renal cell carcinoma 7 years ago, and had not received any adjuvant therapy. MRI disclosed a 3.0 x 3.0 x 3.0-cm sized round tentorial-based extraaxial mass with peritumoral edema in the left posterior temporal lobe. During operation, the tumor was found to be an encapsulated mass firmly attached to the tentorium. Histologically, the tumor was a meningotheliomatous meningioma extensively infiltrated by metastatic renal cell carcinoma, accompanying widespread coagulative necrosis. Immunohistochemical staining for cytokeratin revealed strong positivity only in the renal cell carcinoma component. The patient's postoperative course was uneventful. Post-operative radiation therapy was applied to the whole brain. Three months after operation, the patient developed right hemiparesis and dysphagia. Brain MRI at that time did not reveal recurrence or any other causative lesions, although the whole body scan disclosed uptake at the second lumbar vertebra and rib. The patient refused further treatment.     

Inflammatory myofibroblastic tumor of the perirenal soft tissue misdiagnosed as renal cell carcinoma

Inflammatory myofibroblastic tumor (IMT) of the kidney or perirenal soft tissue is a rare benign lesion that can mimic a malignant renal neoplasm. We describe the case of a 51-year-old woman that had originally been misdiagnosed as renal cell carcinoma in another hospital. Histologic re-evaluation of the tumor in our institution showed that it was in fact an IMT. Awareness of this entity is required for rendering the accurate diagnosis. An association with inflammatory infiltrate, frequent erythrocyte extravasations, edematous or myxoid stroma, absence of atypical mitosis, and the results of a detailed immunohistochemical panel might help in the differential diagnosis. Our patient is recurrence-free in the 18th month of post-operative follow-up.     

Sarcomatoid chromophobe renal cell carcinoma with osteosarcoma-like differentiation which presented as a retroperitoneal mass: a case report

Sarcomatoid component can occur in all histological subtypes of renal cell carcinoma but most commonly accompanies chromophobe renal cell carcinoma. The majority of the sarcomatoid components consist of malignant fibrous histiocytoma, fibrosarcoma or undifferentiated sarcoma areas. Heterologous differentiation in the form of osteosarcoma or rhabdomyosarcoma is very rarely encountered. We report a very rare case of a chromophobe renal cell carcinoma with osteosarcomatous differentiation that presented as a retroperitoneal mass. Renal cell carcinoma with sarcomatoid change should be always kept in mind when a retroperitoneal mass with sarcomatoid differentiation is encountered.     

Primary squamous cell carcinoma of the renal pelvis masquerading as pyonephrosis: a case report

Squamous cell carcinoma of the renal pelvis is a rare tumor, which is usually associated with nephrolithiasis. It is rarely associated with pyonephrosis. We report the case of a 69-year-old man who presented with features of pyonephrosis and underwent nephrectomy. The postoperative histological evaluation revealed an unsuspected squamous cell carcinoma of renal pelvis with a concomitant pyonephrosis. The rarity of this tumor in the absence of renal calculi and its association with pyonephrosis is highlighted.     

Sarcomatoid renal cell carcinoma with osteosarcomatous differentiation--a case report

A rare case of sarcomatoid renal cell carcinoma (RCC) with predominantly osteosarcomatous differentiation occurring in a 36-year-old male is reported. Immunohistochemistry excluded the possibility of primary osteosarcoma of the kidney.     

肾血管平滑肌脂肪瘤伴发透明细胞癌

3例患者男性2例,女性1例,平均年龄57岁,均以腰痛不适于2004-2005年就诊,均未有合并结节性硬化症及其家族史,影像学诊断1例为脂肪瘤,另2例为肾癌,均行肾切除术,随访1-19个月均无复发转移。     

Leptomeningeal carcinomatosis as initial presentation in adenocarcinoma of lung with signet ring cell features: an autopsy case report

Signet ring cell (SRC) features are rare but well-recognized cytological changes of pulmonary adenocarcinoma (PA). PA with SRC features (PA-SRC) is frequently associated with anaplastic lymphoma kinase (ALK) gene rearrangement, and recognition of PA-SRC may be important for the administration of targeted treatment. To the authors’ knowledge, leptomeningeal carcinomatosis (LMC) as an initial presentation of PA-SRC has not yet been reported. We report an autopsy case from a 59-year-old female who presented with intractable headache for 6 weeks and died of LMC as a result of metastatic PA-SRC. Premortem brain MRI showed nonspecific leptomeningeal enhancement. At autopsy, a tan rubbery mass was found in the hilar area of the right lung, which also surrounded the lower trachea and carotid arteries. A right posteromedial middle lobe mass was also found. Leptomeninges were slightly thickened, without discrete masses. Microscopic examination of the lung mass and leptomeninges showed solid sheets and nests of malignant cells with pleomorphic nuclei and frequent SRC features which comprised 50% of the mass. Immunohistochemically, the tumor cells demonstrated strong diffuse expression of cytokeratin (CK)-7, TTF-1, and napsin-A. Immunostains for CK-20 and ALK were negative. These features were consistent with PA-SRC. It has been reported that approximately 70% of PAs demonstrate ALK gene rearrangement when SRCs comprised >10% of the tumor cells. The presence of SRCs can be indicative of a lung primary and, because of frequent ALK gene rearrangement in PA-SRC, proper recognition of PA-SRC may be important in determining whether further testing is advisable (e.g., ALK immunostaining and/or ALK gene rearrangement).     

脑膜腺泡状软组织肉瘤误诊为脑膜瘤一例

患者男,30岁.患者于7个月前在外院诊断为左侧蝶骨嵴外侧及颞下窝脑膜瘤,行手术治疗.4个月前胸片见"两肺散在结节影";头颅CT见"左侧中颅凹底颢下窝脑膜瘤复发".2个月前,胸CT示"双肺多发转移瘤";1个月前,患者自觉左侧面部麻木,左侧眼球突出,左侧视力下降明显,左眼球活动受限,左眼睑下垂,左侧结膜充血水肿,并伴有张口受限.为进一步治疗,于2007年1月22日入住本院.头颅MRI:左侧蝶骨嵴外侧及颞下窝可见一不规则异常信号影,病变向前方累及眼眶内,视神经受压明显,向内侧突入蝶窦,增强明显强化(图1).