Metastatic renal cell carcinoma presenting as gastric polyps: A case report and review of the literature

INTRODUCTIONRenal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and is responsible for over 13,000 deaths in the U.S. annually. The fatalities are largely due to distant metastasis, with lung, liver, bone and brain being most commonly affected organs. Gastric metastasis from RCC is a rare event (less than 20 cases reported in the English language literature) and usually presents as a large, solitary mass or ulcer (average size of 4.8 cm) resembling primary gastric cancer. Here we report the first case of metastatic RCC presenting as small gastric polyps.PRESENTATION OF CASEThe patient was a 60-year-old African American woman with a history of clear cell RCC (pT1bNX). She underwent esophagogastroduodenoscopy and colonoscopy 5 months after nephrectomy due to anemia. Two non-ulcerated, 0.6-cm benign-appearing polyps were found at the greater curvature of the gastric body, which were subsequently removed endoscopically. Unexpectedly, histopathologic examination of the gastric polyps revealed nested collections of vacuolated epithelioid cells in a background of delicate, arborizing vasculature, immediately beneath the congested and hyperplastic foveolar epithelium. A diagnosis of metastatic RCC was rendered after confirming the renal epithelial origin by immunohistochemical stains.DISCUSSIONGastric metastasis from RCC usually presents as a large, solitary mass or ulcer, but it can be subtle and present as multiple, small benign-appearing polyps.CONCLUSIONA careful follow up and thorough endoscopic and histopathologic examinations should be conducted in patients with a history of RCC who present with gastrointestinal manifestations.     

Renal cell carcinoma: case report and literature review

Renal cell carcinoma arising from epithelial cells of the renal tubule is a highly aggressive and malignant tumor in all ages. Less than 2% of cases occur in childhood, relatively in older age group. Only a few pediatric series have been presented in the English literature. Tumor is presented with characteristic findings of flank pain, gross hematuria, and palpable mass. Although one half of the patients have metastasis at the time of diagnosis, most cases are currently being incidentally detected using improved imaging techniques. The overall prognosis in children appears to be similar to that in adults. Tumor stage and complete surgical resection have been reported as the most meaningful prognostic factors for the outcome. The incidence of metastatic disease is same as in adults. The effect of chemotherapy and immunotherapy, either preoperatively or postoperatively, is unclear. Cure is the most likely consequence in localized and completely resected tumors. Here, we present an 8-year-old boy with renal cell carcinoma demonstrating only hematuria without any pathological physical examination findings. The mass was described by abdominal ultrasonography and computed tomography in the left kidney. After the left nephroureterectomy, the patient was given no therapy.     

Renal cell carcinoma presenting as solitary foot metastasis

Skeletal metastases from genitourinary tract are common, but metastatic tumors involving the hand and foot are rare. We herein present a case of 55-year-old man who presented with painful swelling of right foot and no urological complaints. Investigations revealed left renal mass and fine needle aspiration cytology from the swelling revealed findings consistent with metastatic clear cell carcinoma.     

Renal adenocarcinoma presenting as a groin swelling: a case report

Renal cell carcinoma (RCC) is known to have myriad presentations due to the extremely vascular nature of the organ. RCC are known to metastasize extensively to various organs of the body. We report a case of a 70-years-old male who presented with multiple inguinal lymph node enlargements which on excision biopsy showed metastatic adenocarcinomatous deposit. Search for the primary revealed a RCC arising from the left kidney. Inguinal lymph nodal metastasis, an uncommon site of distant metastasis in renal neoplasm, as a fi rst clinical sign leading to the diagnosis is not yet reported in literature.     

Renal cell carcinoma with concomitant solid pseudopapillary tumor of the pancreas: A case report

INTRODUCTIONSolid pseudopapillary tumor (SPT) of pancreas is an unusual low-grade malignant epithelial tumor that usually occurs in young women and can be treated with surgical resection. Renal cell carcinoma (RCC) is the most common solid lesion of the kidney and primarily a disease of the elderly patient.PRESENTATION OF CASEIn this article we present a case of RCC with concomitant SPT of the pancreas who was treated successfully with a radical nephrectomy and distal pancreatectomy.DISCUSSIONRCC with concomitant SPT may associated in β-catenin gene mutation. But no prior reports have described RCC with concomitant SPT of the pancreas in the same patient.CONCLUSIONTo the best of our knowledge, this is the first report of RCC with concomitant SPT of the pancreas in the same patient.     

Renal pelvis squamous cell carcinoma with inferior vena cava infiltration: Case report and review of the literature

INTRODUCTION

Renal squamous cell carcinoma (RSCC) is a rare tumor that is usually diagnosed late as a locally advanced malignancy with adjacent structure involvement. Radical surgical resection with negative margins is the mainstay of treatment, as it is correlated with improved survival, while other modalities of treatment have been shown to have limited efficacy.

PRESENTATION OF CASE

We report a case of a 56 year old gentleman with right RSCC with tumor encasing the inferior vena cava (IVC), treated successfully with surgical resection.

DISCUSSION

The surgical management of vascular involvement of similar tumors has not been discussed in-depth in the literature. Surgical resection of the IVC without reconstruction can be done successfully in the circumstance of good collateral circulation; otherwise IVC resection with reconstruction will be necessary.

CONCLUSION

Radical resection with clear margins of RSCC tumors with vascular involvement is feasible in selected circumstances.     

Metastasizing malignant peripheral nerve sheath tumor initially presenting as intracerebral hemorrhage. Case report and review of the literature

BACKGROUND: Malignant peripheral nerve sheath tumors, infrequent sarcomas arising within a peripheral nerve, mostly metastasize to the lung at terminal stage of disease. However, metastasis to the brain without pulmonary involvement is quite unlikely to occur. CASE DESCRIPTION: A 21-year-old man was brought in the emergency department due to sudden unconsciousness, and imaging studies showed huge intracerebral hemorrhage. Surgical removal and adjuvant therapy was performed for pathologically proven MPNST. Concurrent painful chest masses were also confirmed as MPNST through surgical resection. Nine months after craniotomy, multiple masses in the lung field and axilla region were uncovered, and surgical resection followed. Despite postoperative irradiation, the patient died of the respiratory complications at 16 months after craniotomy. CONCLUSION: To our knowledge, this kind of metastatic cerebral bleeding is the first case that was ever reported. The MPNST actually can exhibit an apoplectic manifestation even without pulmonary involvement in a young adult, albeit this is quite rare. Thus, high index of suspicion should be paid to minute complaints regarding MPNST in peripheral locations so as not to overlook an advanced or metastasized disease.     

Total calcanectomy for metastasis of renal cell carcinoma in the calcaneus: A case report

We present a rare case of metastasis of renal cell carcinoma to the calcaneus in a 59-year-old man who presented with pain and inability to bear weight on the left foot 3 years after right nephrectomy for renal cell carcinoma. He successfully underwent en bloc resection of his right calcaneus with a limb salvage procedure, total calcanectomy without bony reconstruction. Histological findings identified the lesion as a metastasis originating from a renal cell carcinoma. Recent follow-up examination showed no recurrence. To the best of our knowledge, this is the first reported case to be treated with total calcanectomy for renal cell carcinoma metastasis.     

Metastatic involvement of sacral nerve roots from uterine carcinoma: a case report

BACKGROUND CONTEXT: Metastatic involvement of peripheral nerves is considered common in carcinoma of the head and neck with perineural invasion. It is also possible that perineural and endoneural invasion occur in presacral local recurrence. Little is reported about metastasis in pelvic lesions including sacral nerve roots. PURPOSE: We describe the clinical presentation and diagnosis of metastatic involvement of sacral nerve roots retrogradely from uterine carcinoma, and its implication for spine surgeons, along with a brief review of literature. STUDY DESIGN/SETTING: A case report of a patient with metastatic lesions in S1 and S2 nerve roots originating from uterine adenocarcinoma is presented. METHODS: A 39-year-old woman with history of uterine cancer presented with persistent severe low back pain, intractable radicular pain, and neurological deficit in the right lower extremity. She had undergone radical hysterectomy for uterine adenocarcinoma 4 years ago followed by chemotherapy and radiotherapy. Magnetic resonance imaging (MRI) revealed abnormal swelling of the S1 and S2 nerve roots along with a soft-tissue mass in the retroperitoneal space. RESULTS: The patient underwent surgical rhizotomy and histology of the roots revealed metastatic tumor in the dorsal root ganglion. The patient had good pain relief, she died of metastatic disease 3 years later. CONCLUSIONS: Despite being uncommon, sacral nerve root metastasis should be considered in some patients with history of cancer of pelvic organs including the uterus. MR images were of little value in differentiating a carcinomatous lesion from a benign lesion.     

Renal cell carcinoma presenting as a perineal mass: case report and review of the literature

Perineal involvement in renal cell carcinoma (RCC) has not been reported. Vaginal metastases of RCC are also rare. We present a case of metastatic RCC, initially presenting as a perineal cyst. A 53-year-old woman presented with a perineal cyst, which was excised and diagnosed as clear cell carcinoma. A workup further revealed a vaginal mass and a renal tumor. A nephrectomy and local vaginal excision were performed, leading to the diagnosis of metastatic RCC. This case illustrates the variability in RCC presentation. Also, because vaginal clear cell carcinoma is rare, all such lesions should be considered potentially renal in origin.     

Malignant peripheral nerve sheath tumour of the trigeminal nerve: case report and literature review

Although all trigeminal nerve schwannomas are uncommon, malignant schwannomas are extraordinarily rare. We describe a patient who presented with clinical and radiological features of a trigeminal schwannoma; however, pathological analysis showed a malignant peripheral nerve sheath tumour (WHO Grade IV). We discuss these extremely rare tumours and their management.     

Metastasis from renal cell carcinoma to thyroid presenting as rapidly growing neck mass

INTRODUCTION

Renal cell carcinoma (RCC) is commonly known as the “internist''s tumor” because of its unpredictable behavior. Metastasis to the thyroid gland is rarely found in clinical practice.

PRESENTATION OF CASE

We report a rare case of non-thyroid malignancies NTM from renal cell carcinoma 1.5 years after radical nephrectomy in a 58-year-old man with a rapidly growing neck mass.

DISCUSSION

Malignant melanoma, breast carcinoma, lung, and skin cancer are the most common sources of non-thyroid malignancies (NTM). Although metastases of NTMs to the thyroid gland are uncommon in clinical practice, it should be considered in patients with a history of prior malignancy and a new thyroid mass.

CONCLUSION

Isolated thyroid metastasis should be considered in patients with a previous history of cancer and newly developing thyroid mass.     

Renal cell carcinoma in a patient with cystinosis and inflammatory bowel disease: a case report

An 18-year-old male patient with a history of cystinosis and inflammatory bowel disease, who was being treated with cysteamine and 6-mercaptopurine, had an incidental finding of a mass in the right kidney on a renal ultrasound to evaluate worsening renal insufficiency. Excisional biopsy demonstrated papillary renal cell carcinoma, Type 2. Renal cell carcinoma is typically a disease of older adults, and it is not known to be associated with cystinosis. This is the first published report of renal cell carcinoma in a patient with cystinosis.     

Renal tuberculosis: a case report

Tuberculosis or TB (tubercle bacillus) remains a major public health problem in developing countries. Over the last decades extra-pulmonary locations of the disease have become more frequent due to the increased prevalence of acquired immune deficiency syndrome and the increase number of organ transplants. The urogenital localization represents about 27% of all extra-pulmonary localizations of TB and may be due either to a disseminated infection or to a primitive genitourinary localization. The majority of patients, has pyuria, sometimes with hematuria. The diagnosis of urinary tuberculosis is based on the finding of pyuria in the absence of infection by common bacteria. The initial medical treatment includes isoniazide, rifampicin, pyrazinami-de, ethambutol and streptomycin. This disease should be suspected in patients with unexplained urinary tract infections, especially if immunocompromised and/or coming from endemic areas.     

Renal cell carcinoma with unusual metastasis to the gallbladder

Gallbladder involvement in patients with renal cell carcinoma (RCC) is extremely rare. We present a report of a 61-year-old man with a synchronous RCC metastasis to the gallbladder presenting as an intraluminal polypoid mass simulating primary gallbladder carcinoma. Enhanced abdominal computed tomography demonstrated a well-enhanced polypoid lesion in the gallbladder. Intraoperative rapid pathological examination of the gallbladder tumor showed clear cell-type cancerous cells. Microscopically, tumor cells of both the resected kidney and gallbladder had round uniform nuclei, clear cytoplasm, and well-defined cytoplasmic borders, forming alveolar patterns. Immunohistochemically, the tumor cells were negative for cytokeratin 7 (CK7) and carcinoembryonic antigen (CEA), which is usually positive in primary clear cell carcinoma of the gallbladder. Therefore, the final diagnosis was RCC with a synchronous gallbladder metastasis.     

Hepatic sarcoidosis mimicking cholangiocellular carcinoma: A case report and literature review

IntroductionSarcoidosis is a multisystem disease characterized by the presence of non-caseating granulomas in affected organs. Almost 70% of patients with a sarcoidosis reaction have hepatic involvement. However, evidence-based clinical management or treatment strategies for hepatic sarcoidosis are poorly defined. Here, we present a case of a resected hepatic sarcoidosis patient. Additionally, we review the relevant hepatic sarcoidosis literature and discuss the clinical management of hepatic sarcoidosis.Presentation of caseA 20-mm liver tumor of segment 8 was incidentally detected in a 64-year-old female. Radiological images resembled the enhancement pattern of cholangiocellular carcinoma. Thus, this lesion was assigned a preoperative classification of pT1N0M0 stage I according to the 7th Union for International Cancer Control guidelines. The patient underwent a partial liver resection. Histologically, the tumor contained sarcoidosis lesions indicated by a conglomerate of epithelioid granulomas with giant cells. These histopathological findings were consistent with the diagnosis of hepatic sarcoidosis.DiscussionHistopathological examination has been established as the definitive diagnostic tool for hepatic sarcoidosis. Therefore, liver biopsy or surgical resection of a liver tumor should be considered in cases that are difficult to preoperatively distinguish from malignant tumors.ConclusionWe present the case of a patient with surgically resected hepatic sarcoidosis that was difficult to preoperatively distinguish from cholangiocellular carcinoma.     

阴茎转移性膀胱移行细胞癌一例报告并文献复习

目的 提高对阴茎转移性膀胱移行细胞癌的认识。方法 报告1例阴茎转移膀胱移行细胞癌患者资料,结合文献讨论其发病机理、临床特征及诊疗措施。患者,男,60岁,膀胱顶壁肿瘤行膀胱部分切除术后11个月余,病理报告为膀胱移行上皮细胞癌Ⅲ级,侵及深肌层,分期G3T3,发现阴茎海绵体硬结逐渐增大6个月余入院。结果 阴茎海绵体硬结细针穿刺活检示纤维组织中散在异型细胞及异型细胞巢,考虑为低分化癌,行阴茎全切术。术后病理报告示海绵体间质纤维中有成团的癌组织,符合膀胱移行细胞癌转移至阴茎,切缘未见癌组织,另送检耻骨前淋巴组织未见肿瘤细胞浸润。术后12d拔除导尿管。术后4周耻骨上区和双侧腹股沟区予^60Coγ射线3000cGy放射治疗,定期丝裂霉素膀胱灌注治疗和膀胱镜检查。现患者蹲式小便、排尿正常,随访16个月肿瘤无复发和转移。结论 阴茎海绵体硬结细针穿刺活检是诊断阴茎转移癌安全、有效的方法。盆腔内存在丰富、低压力、无静脉瓣的静脉丛及淋巴循环,当回流通路阻塞或压力升高时会发生逆流导致肿瘤细胞扩散或微转移,可能是阴茎转移性膀胱癌的发病机理。术后综合治疗措施可以预防肿瘤复发、提高治疗效果：