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.     

A rare case of early carcinoma of the gallbladder

A 38-year-old woman was diagnosed preoperatively to have a benign polyp of the gallbadder with a delineated polypoid mass, as demonstrated with drip infusion cholangiography and ultrasonography. Cholecystectomy was performed. Postoperatively, however, this tumor proved to be an early stage carcinoma of the gallbladder. In the neck of the gallbladder, there was a protruded polypoid elastic tumor of 1.1×0.9 cm in width and 2.5 cm in height. The tumor was supported by a stem of 0.1 cm in diameter and 0.2 cm in height. Hispotopathological examination revealed a well differentiated papillotubular adenocarcinoma, which exhibited no invasion of the stem itself or its basal region. This is a rare case of early carcinoma of the gallbladder (Stage I) which grew only towards the lumen of the gallbladder cavity, and did not invade the wall. Postoperatively, cholecystectomy alone was thought to be sufficient for cure.     

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     

Metastatic carcinoma of the gallbladder after a renal cell carcinoma

The gallbladder is rarely the site of distant metastases and in most cases malignant melanoma is the primary tumor. We report a case of a 64-year-old man with a gallbladder metastasis secondary to a renal cell carcinoma. Renal cell carcinoma has a tendency toward metastatic disease, the most notable features of this tumor being its unusual pattern of metastatic disease. Pre-operative imaging studies are often futile in the differentiation between primary and secondary tumors of the gallbladder. Since primary tumors of the gallbladder often coexist with gallstones, a polypoid lesion in an acalculous gallbladder is more consistent with metastasis than a primary tumour. If feasible, surgical resection of the gallbladder is mandatory because it could guarantee better chances of survival for patients with metastatic renal carcinoma.     

Metastatic Carcinoma of the Gallbladder after a Renal Cell Carcinoma

The gallbladder is rarely the site of distant metastases and in most cases malignant melanoma is the primary tumor.

We report a case of a 64-year-old man with a gallbladder metastasis secondary to a renal cell carcinoma. Renal cell carcinoma has a tendency toward metastatic disease, the most notable features of this tumor being its unusual pattern of metastatic disease.

Pre-operative imaging studies are often futile in the differentiation between primary and secondary tumors of the gallbladder. Since primary tumors of the gallbladder often coexist with gallstones, a polypoid lesion in an acalculous gallbladder is more consistent with metastasis than a primary tumour.

If feasible, surgical resection of the gallbladder is mandatory because it could guarantee better chances of survival for patients with metastatic renal carcinoma.     

Cystic Lymphangioma of the Gallbladder: Report of a Case

Abdominal lymphangioma is usually diagnosed within the first 2 years of life and is extremely rare in adults. The most common location of abdominal lymphangioma is the mesentery, but there are sporadic reports of its development in the gallbladder. A 66-year-old woman was found to have a cystic lesion near the gallbladder. Preoperative studies, including endoscopic ultrasonography, computed tomography, and magnetic resonance imaging, showed a tumor with multilocular cystic structure, originating in the gallbladder fossa. The patient underwent exploratory laparotomy, and the mass was resected en bloc with the gallbladder, as there was no evidence of malignancy on intraoperative ultrasonography. Macroscopically, the tumor was a multilocular cystic mass, 6 × 3 × 2 cm in size, with a rough, sponge-like appearance. Histologically, the cystic tumor was diagnosed as a lymphangioma, originating in the gallbladder. To our knowledge, only three other cases of a cystic lymphangioma originating in the gallbladder have been reported in the medical literature of the world.     

Solitary Thyroid Metastasis of Renal Clear Cell Carcinoma: Report of a Case

A case of solitary thyroid metastasis of renal clear cell carcinoma is described. The patient was a 77-year-old Japanese woman, who was referred to our department after a thyroid tumor was identified in May 1999. She had a history of renal clear cell carcinoma of the left kidney, which had been partially resected 3 years previously. Ultrasound sonography demonstrated that a well-demarcated hypoechoic mass containing high-echo spots representing small calcifications, which measured 45 × 34 × 31 mm in size, occupied the left lobe. Computed tomography revealed a low-density mass containing small calcifications. The results of preoperative fine-needle aspiration cytology strongly suggested a clear cell carcinoma metastasizing to the thyroid. A left hemithyroidectomy was performed on July 27, 1999. A histological examination revealed that the neoplasm was composed of tumor cells with abundant clear cytoplasm and round nuclei. The histological characteristics of this thyroid tumor were virtually identical to the renal cell carcinoma resected3 years previously. Thyroglobulin stained negatively in the clear cells of the resected thyroid tumor in an immunohistochemical analysis. Clinically, the thyroid gland is a rare site of tumor metastasis; however, we should also consider the possibility of metastasis in the case of thyroid tumor patients with a history of renal cell carcinoma. Received: March 3, 2000 / Accepted: September 26, 2000     

Metastasis from Renal Cell Carcinoma Presenting as Skeletal Muscle Mass: a Case Report

Renal cell carcinoma can metastasize to virtually any site. Skeletal muscle metastasis is not common. The correct diagnosis of metastatic renal cell carcinoma to skeletal muscle is difficult in comparison with soft-tissue metastasis diagnosis.

We report the case of a 58-year-old man with skeletal muscle metastasis from a clear-type renal cell carcinoma 5 years after total nephrectomy. The tumour was located in the proximal left tight at the level of the great adductor muscle. Clinical work-up included both 18 fluorodeoxyglucose positron emission tomography combined with non-contrast computed tomography and magnetic resonance imaging. The mass was widely excised and was confirmed to be a metastasis from renal cell carcinoma.

Maintaining a high degree of suspicion of metastatic renal cell carcinoma is required for patients with a history of renal cell carcinoma. Positron emission tomography, combined with computed tomography, appears to be an effective surveillance tool. Magnetic resonance imaging is helpful in the differential diagnosis from primary soft-tissue tumours.     

Kidney metastasis from gallbladder cancer

A case of kidney metastasis from primary gallbladder cancer is presented. Five years after operation for gallbladder cancer, a 73-year-old woman exhibited hematuria. Imaging disclosed a 5×4cm solid mass in the right kidney and enlarged lymph nodes behind the inferior vena cava adjacent to the right renal vein. The right kidney and adjacent tissues, including retroperitoneum and regional lymph nodes, were resected en bloc. The renal tumor was diagnosed as a metastasis from the primary adenocarcinoma of the gallbladder, based on histological similarities, absence of other primary adenocarcinoma, and fluctuations in CA19-9 levels during the progress and after the resection of the metastatic tumor. The initial operation had been an extended cholecystectomy with wedge resection of the liver bed, plus regional lymphadenectomy. The excised gallbladder had a 2.3 ×1.2cm nodular tumor in the fundus. Histological examination indicated the gallbladder tumor to be a moderately differentiated tubular adenocarcinoma invading the subserosal layer. Mild lymphatic invasion was recognized in the gallbladder wall, although lymph node metastasis was negative. We believe this patient represents the first case of kidney metastasis from gallbladder cancer. The mode of spread of the gallbladder cancer to the kidney appeared to be lymphogenous.     

Bellini duct carcinoma of the kidney: a case report

We report a case of Bellini duct carcinoma. A 65-year-old man visited our hospital because of an asymptomatic right renal mass directed by ultrasonography and computed tomography in an other hospital. His urine cytology was negative. The tumor showed a minimal enhancement in computed tomography. Under the preoperative diagnosis of an atypical right renal tumor, laparoscopic right radical nephrectomy was performed. The tumor is 50 mm in diameter and the surface was grayish-white in color. The histopathological diagnosis was low-grade Bellini duct carcinoma. Immunohistostaining revealed positive staining for UA-1 and EMA in the tumor tissue. No evidence of recurrence or metastasis was noted 36 months after surgery without any adjuvant therapy.     

Renal cell carcinoma in a renal cyst--observation of changes during the year: report of a case]

We report a case of renal cell carcinoma within a renal cyst. A 45-year-old man visited our hospital with the chief complaint of left back pain. Ultrasonography was examined by a physician, and it revealed a right renal cyst by chance. Computed tomography demonstrated a thick wall in the cyst which showed enhancement of density with contrast medium. The physician followed the cystic lesion periodically, by ultrasonography and computed tomography. The cyst on volume did not change, but the thick wall had a tendency to develop to inner space. The patient was referred to our department. Angiography was performed, and it showed neovascularity and tumor staining. We diagnosed the renal tumor in a renal cyst. Transabdominal right radical nephrectomy was performed on 18 June, 1991. The resected specimen involved a mall tumor (2.5 x 2.0 cm) in the cyst. Histological examination of the tumor was renal cell carcinoma which was well capsulated by connective tissue without invasion to normal parenchyma and perirenal fat. We speculated that the renal cell carcinoma originated from the cyst wall and it developed to inner cystic space. The natural history of the renal cell carcinoma in a renal cyst is not clear. Our case shows a type of its history. We reviewed and discussed the types and diagnosis of the renal cell carcinoma in a renal cyst.     

A case of renal angiomyolipoma with marked cystic degeneration and pseudoaneurysm

A 59-year-old woman consulted our hospital for a left renal mass which she had been aware of for 4 years. The tumor was in the lower portion of the left kidney. It was a cystic tumor whose wall was enhanced on computed tomography and magnetic resonance imaging. The lesion 3.0 cm in diameter, which was enhanced equally to the aorta, was found in a part of the wall. It was thought to be a pseudoaneurysm by renal angiography. We suspected a cystic renal cell carcinoma because of the plural feeding arteries and tumor staining, and performed left total nephrectomy. Pathological diagnosis was angiomyolipoma with few fat components. To our knowledge only 3 previous cases of renal angiomyolipoma with marked cystic degeneration have been reported in Japan. In all 3 cases, it was difficult in preoperative diagnosis to distinguish angiomyolipoma with cystic degeneration from cystic renal cell carcinoma complicated cyst. Moreover, this is the first reported case of renal angiomyolipoma with marked cystic degeneration and pseudoaneurysm.     

Pancreatic metastasis from renal cell carcinoma 25 years after radical nephrectomy

We report a case of pancreatic metastasis from renal cell carcinoma detected 25 years after radical nephrectomy. A 74-year-old man, who had undergone radical nephrectomy for renal cell carcinoma at age 49, was found by computed tomography to have a strongly enhanced mass on the pancreatic head. The patient underwent pancreaticoduodenectomy and the pathological diagnosis was metastatic renal cell carcinoma. This was evidently a slow growing tumor because the metastatic pancreas tumor was well demarcated and the metastasis was found 25 years after the primary operation. Aggressive surgical treatment of isolated metastatic lesions offers a chance of long-term survival. Patients with a history of RCC should undergo a long-term follow-up to detect and evaluate metastasis to pancreas as well as other organs.     

Collecting duct carcinoma with long survival treated by partial nephrectomy

A case is reported of collecting duct carcinoma of the left kidney treated with partial nephrectomy. A 57-year-old woman presented for evaluation of the left renal mass, which was detected by screening ultrasonography. A computed tomography scan and magnetic resonance imaging showed a solid mass at the upper pole of the left kidney. The renal tumor biopsy revealed a low-grade renal cell carcinoma or a tubulopapillary adenoma. Subsequently, left partial nephrectomy was performed. Microscopically, the tumor showed tubulopapillary proliferation with a fibrous capsule. Histochemically, the tumor cells reacted with lectins or antibodies against the collecting duct. Twenty-four months after partial nephrectomy, the patient is alive and has no distant metastatic lesions. We review the literature on collecting duct carcinoma, in addition to the case of partial nephrectomy.     

Extraskeletal mesenchymal chondrosarcoma of the kidney

A 61-year-old woman was referred for evaluation of an incidental mass found on the right kidney. Abdominal ultrasonography and computed tomography showed a 3-cm tumor with calcification and peripheral enhancement. Under the diagnosis of renal cell carcinoma, a transabdominal right radical nephrectomy was performed. The pathological diagnosis was extraskeletal mesenchymal chondrosarcoma of the kidney. No recurrence or metastasis occurred during a 6-year follow up. Primary renal chondrosarcoma is extremely rare, this being only the fifth case reported in the English literature, and the patient's extended survival is attributed to the small size of the tumor, as well as early diagnosis and treatment.     

Bilateral adrenal masses from renal cell carcinoma: a case report

We report a case of bilateral adrenal metastasis from renal cell carcinoma. A 65-year-old man was referred to our hospital for a right renal mass. A computed tomography revealed a 9 cm right renal tumor and bilateral adrenal masses (3.5 cm on the right side and 4.5 cm on the left). A right radical nephrectomy and bilateral adrenalectomy demonstrated renal cell carcinoma with metastasis to bilateral adrenal glands. The pathological findings of the right renal tumor showed clear cell carcinoma, G3 > G2 and both adrenal tumors showed the same pathology as the right renal tumor. The patient is alive with lung metastasis after 15 months postoperatively treated with interferon-alpha.     

Intramedullary spinal cord metastasis from renal cell carcinoma mimicking intramedullary hemangioblastoma

A rare case of intramedullary spinal cord metastasis from renal cell carcinoma mimicking intramedullary hemangioblastoma was described. A 57-year-old man had a nephrectomy for renal cell carcinoma in the left kidney 5 years ago, and no recurrence or metastasis was found in computed tomography and bone scintigraphy. Later, the patient was presented as having bilateral shoulder pain and severe palsy of bilateral upper and lower extremities, and a solitary tumor in the intramedullary spinal cord was found at the C4 level. Excision of the tumor was performed and the intraoperative pathological diagnosis suspected the tumor to be hemangioblastoma. However, a final pathological examination revealed characteristics consistent with metastasis of renal cell carcinoma. Although the patient’s neurological condition and neuralgia initially slightly deteriorated postoperatively, they then gradually improved. Twenty-two months after the operation, a follow-up magnetic resonance imaging showed no recurrence of intramedullary spinal cord tumor, and there were no other metastases found in other organs.     

Cystic renal cell carcinoma diagnosed as a simple cyst preoperatively with incidental renal tumor: a case report]

A 54-year-old man visited our hospital with right incidentally-found renal tumor detected by ultrasonography. Computed tomography, magnetic resonance imaging and angiography showed a small tumor, 1.5 cm in size, at the upper portion and a simple cyst, 4 cm in size, at the lower pole of the right kidney. We enucleated the small tumor and aspirated the cyst with outer part resection of the cyst wall. Pathological findings of the tumor showed renal cell carcinoma, alveolar type, common type, clear cell subtype, G1, pT1, INF-alpha. Microscopic appearance of the excised cyst wall also revealed sheets of renal cell carcinoma inside the wall. Therefore, two weeks after the first operation, we performed right radical nephrectomy. The resected specimen had severe inflammation without any evidence of residual tumor. Eight months after the nephrectomy, no recurrence has occurred.     

A case of renal oncocytoma with cystic formation

A 60-year-old man was admitted to our hospital because of a right renal mass incidentally detected by ultrasonography during a general health check. Computerized tomography (CT) and magnetic resonance imaging (MRI) revealed a solid mass measuring 6 cm diameter containing a cystic portion in the right kidney. Cystic renal cell carcinoma was suspected, and right nephrectomy was performed. The gross appearance showed a well circumscribed mahogany brown tumor in the lower portion. On cross section of the tumor, a solid mass was seen in the cystic portion. Microscopically, oncocytic cells with eosinophilic granular cytoplasm were scattered on the cystic wall, and tumor cells formed microcystic structures in the solid part. Therefore, the tumor was diagnosed as renal oncocytoma with cystic formation. Only twelve cases have previously been reported in the literature.     

Lymphoid hyperplasia detected as a single mass in the gallbladder: report of a case

We herein report a case of lymphoid hyperplasia of the gallbladder that showed unique images on computed tomography and ultrasonography. A 42-year-old female was referred to our hospital for evaluation and treatment of a gallbladder tumor. Ultrasonography and computed tomography showed a mass in the wall of the gallbladder neck, without typical findings of benign or malignant tumors. The serum levels of tumor markers, such as carcinoembryonic antigen, carbohydrate antigen 19-9, alpha-fetoprotein, and cytokeratin 19 fragment, were all within normal limits. Laparoscopic cholecystectomy was therefore performed. There were no stones in the gallbladder. Macroscopically, the submural tumor had a clear border without a capsule and a cystic portion. Its cut surface was grayish white. Microscopically, many lymph follicles with germinal centers were recognized in the subserosal layer. The lymphocytes were morphologically normal. We diagnosed lymphoid hyperplasia with chronic cholecystitis. Lymphoid hyperplasia of the gallbladder is extremely rare.