A case of renal cell carcinoma metastasizing to the contralateral kidney and renal pelvis

Extremely rarely renal cell carcinoma metastasizes to the contralateral renal pelvis or ureter. A 42-year-old man had undergone left radical nephrectomy for renal cell carcinoma (pT1b, grade 2) in March, 2000. Fifteen months later, he complained of macroscopic hematuria. Computed tomographic scanning and retrograde pyelography showed a right renal pelvic tumor. Enucleation of pelvic tumor was performed and a parenchyma mass incidentally identified in the right kidney was also resected. Histopathological examination of each tumor revealed renal cell carcinoma identical to the primary tumors in the left kidney suggesting metastasis to renal pelvis and de novo tumor or metastasis in the right kidney.     

Metastatic Biliary Polypoid Thrombus from Renal Cell Carcinoma: Report of a Case

We report an extremely rare case of metastatic biliary polypoid thrombus with hepatic metastases from renal cell carcinoma. A 74-year-old man was admitted with a low-grade fever and obstruction of the left hepatic duct. He had undergone left nephrectomy 17 years previously due to a diagnosis of renal cell carcinoma. A preoperative diagnosis of left hepatic duct carcinoma was made, and a left lobectomy and left caudate lobectomy with right biliary anastomosis of jejunal loop were performed. The resected specimen showed a polypoid mass in the left hepatic duct with metastases in the caudate lobe, and a histological examination revealed both tumors to be clear cell-type renal cell carcinoma. The mechanism of biliary metastatic thrombus formation was speculated to be as follows: caudate lobe metastases invade the adjacent bile ducts, and a tumor fragment in the bile duct then becomes implanted in the intraluminal left hepatic duct, thus leading to the growth of the biliary polypoid thrombus. Received: April 16, 2001 / Accepted: November 20, 2001     

Renal metastasis of thyroid carcinoma

We report here the sixth known case of metastatic renal tumor of thyroid carcinoma. In 1999, a 37-year-old man was referred to us with a left renal mass found incidentally by ultrasound during an annual check-up. Computed tomography (CT) revealed a well-defined, hyperdense mass 3 cm in diameter in the middle of the left kidney. Left radical nephrectomy was performed under the preoperative diagnosis of renal cell carcinoma. Histologically, the tumor was metastatic of typical papillary thyroid carcinoma.     

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 histological examination revealed that the tumour was a metastatic renal cell carcinoma of the clear cell type.     

Case of nephrotic syndrome due to AL-type primary amyloidosis associated with renal cell carcinoma

An 80-year-old man was admitted because of appetite loss, mild proteinuria, and leg edema. A computed tomography examination revealed a tumor in his left kidney, and a left nephrectomy was performed. The tumor was histologically diagnosed as a clear cell type renal cell carcinoma, and hematoxylin eosin staining of the non-tumor region of the resected kidney showed an almost normal morphology. Three months later, he was readmitted because of the development of nephrotic syndrome with a urinary protein excretion of 4.2 g/day, a serum total protein concentration of 5.0 g/dL, a serum albumin concentration of 2.4 g/dL, a serum total cholesterol concentration of 214 mg/dL, and generalized edema. A full examination revealed no evidence of metastasis or recurrence of the renal cell carcinoma or any other malignant tumor. Congo red staining and immunohistochemical staining were performed using the non-tumor region of his resected kidney, and the presence of amyloid deposits in the microvascular walls and glomeruli that did not disappear when treated with potassium permanganate was disclosed. In this manner, the patient was diagnosed as having AL-type primary amyloidosis. Bence-Jones proteinuria and gastric amyloidosis were also observed, but a bone marrow examination showed no signs of multiple myeloma. Previous studies have reported an association between renal cell carcinoma and renal amyloidosis, mainly AA-type secondary amyloidosis. To our knowledge, only two cases of renal cell carcinoma associated with primary amyloidosis have been previously reported. Therefore, the present patient not only represents a rare case of renal cell carcinoma associated with primary amyloidosis, but also reminds us that careful histological examination of the non-tumor region of the resected kidney is needed to evaluate the proteinuria associated with renal cell carcinoma, particularly in elderly patients.     

Contralateral ureteral metastasis from renal cell carcinoma: a case report]

A case of contralateral ureteral metastasis from renal cell carcinoma is reported. A 52-year-old man underwent left nephrectomy for renal cell carcinoma of November 20, 1986. He was clinically asymptomatic for 4 years 8 months after the operation. He was admitted on August 14, 1991, because of right loin pain. Right retrograde pyelography and percutaneous pyelography showed a filling defect in the right ureter at the level of L3. After the right ureter was explored, the tumor lesion of ureter was resected and end to end anastomosis of the ureter was performed. Histopathologic examination showed a metastatic clear cell carcinoma consistent with a renal primary. The contralateral ureteral metastasis from renal cell carcinoma is very rare and only 15 cases have been reported previously.     

Renal cell carcinoma metastatic to the base of tongue: a case report

A 66-year-old male patient underwent left radical nephrectomy for stage III renal cell carcinoma (RCC) two years and eight months previously. He complained of discomfort at his pharynx. An otolaryngeal examination revealed a tumor about 1.3 cm in size at the base of tongue, and the tumor was resected. It was pathologically diagnosed as clear cell carcinoma and as tongue metastasis of RCC. The subsequent appearance of a minute pulmonary metastasis caused the administration of interferon-alpha and interleukin-II. At present, two years after the treatment, neither growth of lung metastasis nor recurrence of tongue tumor are noticed. Tongue metastasis of RCC is rare and its prognosis is poor. This is the 17th case reported in Japan.     

Bladder recurrence of renal cell carcinoma: report of two cases

We present two rare cases with renal cell carcinoma which recurred at urinary bladder. The first case is an 87-year-old female who had been undertaken right nephrectomy 17 years earlier. Through the examination of hypercalcemia, bone metastases and a bladder tumor were found. Transurethral resection of the bladder tumor was performed and histological examination revealed that the tumor was clear cell carcinoma similar to the right renal tumor. The second case is a 67-year-old male who had been undertaken left nephrectomy 4 and half years earlier. In spite of the adjuvant immunotherapy including interferon alpha, gamma and interleukin-2, 16 months later multiple lung metastases appeared. One month before admission he noticed asymptomatic hematuria. Cystoscopy revealed 3 non-papillary pedunculated tumors, which were resected transurethrally. Histologically the tumor was clear cell carcinoma similar to the left renal tumor. In both cases the metastasis was confirmed histologically. As in both cases the recurrent bladder cancers were confined in the mucosa, these metastases were thought to be caused by implantation.     

Simultaneous resection of pancreas and liver metastases from different metachronous primary cancers

Resection of a pancreatic head tumor and partial resection of the liver for metastatic lesions were carried out simultaneously in a 72-year-old woman. The patient had a history of two previous operations, right nephrectomy for renal cell carcinoma (clear cell type), done 14 years previously, and an Autincloss procedure for cancer of the left breast (solid tubular carcinoma); (T1N0M0; stage I) done 7 years previously. At the current presentation, preoperative radiographic examination showed a hypervascular tumor in each of the pancreatic and hepatic lesions, but with different patterns. On the basis of histological findings in the two resected specimens, it was difficult to establish whether the hepatic tumor originated from the renal cell carcinoma or the breast cancer, but postoperative immunohistochemical studies for carcinoembryonic antigen (CEA), estrogen receptors, and gross cystic disease fluid protein (GCDFP)-15 showed that the pancreatic tumor had metastasized from the renal cell carcinoma, and the liver tumor from the breast cancer. The immunohistochemical investigation of different markers thus proved to be useful in making the final diagnosis of metastatic lesions from different and metachronous cancers. Received: February 27, 2001 / Accepted: August 1, 2001     

Hilar lymph node metastasis in renal cell carcinoma.

A 48-year-old man, who underwent a right nephrectomy for renal cell carcinoma 7 years earlier, was found to have hilar lymph node metastasis alone, without lesions, in the pulmonary parenchyma. Chest X-ray and CT findings showed a left hilar mass about 4 x 2.5 cm in diameter. Left bronchial arteriography showed a hypervascular mass lesion in the left hilum. Macroscopic tumor invasion of the pulmonary artery and left main bronchus indicated left pneumonectomy. The resected specimen was found histologically to involve metastatic renal cell carcinoma in the left hilar lymph node about 3 cm in diameter. Tumor metastasis was limited to the lymph node. The metastatic pathway of renal cell carcinoma to the hilar lymph node was considered lymphogenous via either retrograde lymphatic flow from the thoracic duct or through the lymphatics in the inferior pulmonary ligament.     

Solitary pancreatic metastasis from renal cell carcinoma

A case of asynchronous bilateral renal cell carcinoma with pancreatic metastasis is described. Left nephrectomy and tumorectomy in the right kidney were performed. Solitary metastasis to the pancreas without symptoms was treated by distal pancreatectomy with tumor and splenectomy. Although bilateral renal cell carcinomas were histologically renal cell carcinoma (clear cell subtype, grade 2), the resected pancreatic tumor was renal cell carcinoma with sarcomatoid change. Therefore, the metastatic tumor had a more malignant potential than the primary tumor. The pancreatic metastasis was seen at 6 years 10 months and 2 years 6 months after left nephrectomy and enucleation of the right renal tumors, respectively. The patient is alive without disease and is being treated by alpha-interferon for 12 months after distal pancreatectomy. A careful long-term follow-up of the patient with renal cell carcinoma seems to be necessary.     

A case of solitary metastasis of renal cell carcinoma to the thyroid gland

A case of solitary metastasis of renal cell carcinoma to the thyroid gland is reported. A 63-year-old-woman had been found to have an abnormal mass in the neck since April, 1986. She had a past history of right nephrectomy owing to right renal tumor 6 months earlier. Histological examination of the renal tumor revealed, common type, alveolar type, G1, INF alpha renal cell carcinoma. No metastasis was found on abdominal CT, chest tomography and bone scintigram at that time. Radical thyroidectomy was performed on June, 23, 1986. Histological examination by hematoxylin and eosin staining revealed metastasis of renal cell carcinoma, and immunohistochemical technique ruled out primary thyroid carcinoma. Postoperatively no other metastasis was found on head-chest-abdomen-CT, chest-tomography or bone scintigram. Therefore no particular adjuvant therapy was performed.     

Solitary psoas muscle metastasis after radical nephrectomy for renal cell carcinoma

Skeletal muscle is a very rare location for the metastasis of renal cell carcinoma (RCC) and only one case of solitary metastasis to the psoas muscle has been reported. We present a 63-year-old male patient with late recurrence (14 years) after left side radical nephrectomy for RCC. He first visited Chikushi Hospital, Fukuoka University, Japan in January 2000 for a postoperative follow-up because he had shifted residence to the area. Follow-up was by abdominal computed tomography (CT) and chest X-ray. In December 2001, a CT scan showed a 1.5 cm enhanced mass in the right psoas muscle without any other metastasis. The mass was resected that month and histological study showed RCC metastasis.     

A case of metastatic renal cell carcinoma to the ovary

A 52-year-old woman had a pathological fracture of the right femur. On histopathological examination bone metastasis from renal cell carcinoma was suspected. Abdominal computed tomography showed a heterogeneous mass (9.1 x 7.8 x 6.5 cm) in the left kidney and a cystic multilocular mass (12 x 10 cm) in the pelvis. Bone scintigraphy revealed an abnormal uptake in the left coracoid process, right third rib, and right distal femur and proximal tibia. Clinical diagnosis was left renal cancer with multiple bone metastases (cT2NOM1, stage IV) and a right ovarian tumor. We performed left radical nephrectomy and resection of right ovarian tumor by bilateral adnexectomy. On histopathological examination, the left kidney tumor was diagnosed as renal cell carcinoma (clear cell carcinoma with chromophobe component, G2 > G1). The ovarian tumor consisted of carcinoma of clear cell type (G2) that resembled components of left renal cell carcinoma, confirming the diagnosis of metastatic renal clear cell carcinoma to the ovary. Although she underwent immunotherapy with interferon, she died 10 months after nephrectomy. Metastasis to the ovary from renal clear cell carcinoma is very rare and only 18 cases have been reported in the literature. This rarity may be related to the difficulty of differential diagnosis between metastatic renal cell carcinoma to the ovary and primary ovarian clear cell carcinoma. Elaborate analysis of microscopic features and immunohistochemical profiles may help in the distinction of this metastatic lesion.     

Metastatic renal cell carcinoma to stomach

Metastatic tumors to the stomach are distinctly unusual. Rarer still is renal cell carcinoma metastatic to the stomach following radical excision of the primary tumor several years previously. During evaluation for an upper gastrointestinal hemorrhage, a patient was found to have a large antral mass. Endoscopic biopsy revealed renal cell carcinoma. At celiotomy the tumor was found to have penetrated through to the liver capsule. An antrectomy and wedge resection of the left lobe of the liver was performed. There was no evidence of further metastatic disease. This is the first report of such a patient resected for cure, and emphasizes the unique biology of this tumor in its potential for late, solitary metastasis and surgical resectability.     

Bladder metastasis of renal cell carcinoma : report of a case

A 65-year-old man presented with gross hematuria in 2004. Computed tomography (CT) showed a left renal mass, and he underwent laparoscopic radical nephrectomy. Pathological diagnosis was clear cell carcinoma (pT2N0M0, G2＞G3). Four years later, a right adrenal tumor was disclosed by follow-up CT. Then laparoscopic adrenectomy was performed. Histology showed metastasis of the renal clear cell carcinoma. In 2009, he noticed gross hematuria, and cystoscopy revealed a 2cm solitary, non-papillary tumor at the anterior wall of the bladder. At the same time, small solitary liver metastasis (6 mm) was observed on abdominal CT. Transurethral resection of the bladder tumor and resection of liver tumor was performed, and pathological diagnosis was clear cell carcinoma both in vesical and hepatic masses. Nine months after the last surgery, he is living with no obvious tumor recurrence. To our knowledge this case is the 34th case of bladder metastasis from renal cell carcinoma in the Japanese literature. We reviewed literature and discuss the clinical features of bladder metastasis of renal cell carcinoma.     

Periosteal Chondroma of the Rib: Report of Two Cases

We report two cases of periosteal chondroma of the rib, an extremely rare entity. The first case involved a 5-year-old boy who was admitted with pain and swelling around his left fifth rib. Surgery was performed in May 1999, and an 8 × 6 × 5 mm tumor was resected with the fifth rib. The second case involved a 39-year-old man with a 2-month history of cough who was referred to our department after a coin lesion had been detected on a chest roentgenogram. Physical examination on admission did not reveal any pain or tenderness. The rib tumor was resected along with the fourth rib by video-assisted thoracoscopic surgery and mini-thoracotomy in February 2000. The tumor was well encapsulated and consisted of an elastic hard mass measuring 22 × 15 × 13 mm. Both patients had an uneventful postoperative course and have remained well with no evidence of recurrence. Our review of the literature revealed only six previously documented cases of periosteal chondroma of the rib. Received: December 20, 2000 / Accepted: July 17, 2001     

Preoperative induction with sorafenib pathologically downstaged advanced renal cell carcinoma: A case report

We present the case of a patient with renal cell carcinoma treated preoperatively with sorafenib. Complete resection of the left renal mass measuring 7.2 × 6.6 cm seemed to be difficult at diagnosis because of large renal hilar lymph nodes. With a short period of sorafenib administration, marked shrinkage of the renal mass and lymphadenopathy was observed after the patient experienced fulminant hepatic failure and a severe hand–foot skin reaction. Two‐dimensional computed tomography revealed 60%, 78% and 84% reduction in the primary renal tumor, lung metastatic nodules and lymph nodes, respectively. Tumor shrinkage allowed for complete resection of the left kidney and the lymphadenopathy. Pathological findings revealed that over 90% of the renal tumor was substituted by necrotic fibrotic tissue and that the residual neoplastic component was diagnosed as clear cell carcinoma. The lymph nodes that were resected were negative for malignancy. At 6 months after radical nephrectomy, a new computed tomography scan revealed no evidence of disease with the disappearance of lung nodules.     

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.