Two cases of renal cell carcinoma accompanied with ossification]

We report two cases of renal cell carcinoma accompanied with ossification. Case 1: A 40-year-old male visited a physician with the complaint of epigastric pain. Examination of the stomach revealed compression of the greater curvature. Abdominal radiography and CT scan revealed a left renal mass with calcification, which was a hypovascular tumor on angiography. A transperitoneal left nephrectomy was performed. The resected kidney was 700g in weight and the tumor, which was 12 x 10 x 10 cm in size and located in the upper pole of the kidney, was enveloped with a hard capsule and was extensively necrotized. Histopathological diagnosis was renal cell carcinoma (papillary type, mixed subtype). Case 2: A 69-year-old female was occasionally pointed out to have a left renal mass in ultrasonic examination. It was accompanied with calcification in CT scan and a hypervascular tumor in angiography. A transperitoneal left nephrectomy was performed. The resected kidney was 320 g in weight and the tumor located in the lower pole of the kidney, was 6 x 6 x 6 cm in size and necrotized. Histopathological diagnosis was renal cell carcinoma (alveolar type, clear cell subtype). Microscopically in both cases, ossified tissue existed among the fibrous tissue in the necrotized lesion of the tumor, but not near the cancer cells and, it was accompanied by calcification. During the ossification process, the connective tissue proliferates after the necrosis of the tumor, and metaplasia occurred from its juvenile plastic cells to osteoblastic cells.     

Intrascrotal metastases from renal cell carcinoma

This is an up-to-date report about two patients suffering respectively from testicular and epididymal metastases of a renal adenocarcinoma in the condition following tumour nephrectomy in anamnesis. It is a survey on literature including the number of cases published.     

Two cases of multilocular renal cell carcinoma

Two cases of multilocular cyst of the kidney associated with clear cell carcinoma are described. Only 15 cases of multilocular cystic carcinoma of the kidney have been reported in the English literature including 6 Japanese cases. Their preoperative diagnosis is very difficult and nephrectomy is the only choice of treatment in many cases. The histopathogenesis of the multilocular cyst is reviewed.     

Management of pancreatic metastases from renal cell carcinoma report of five cases

Pancreatic metastases from renal cell carcinoma are rare. In most cases metastases occur many years after nephrectomy. Solitary pancreatic metastases of renal cell cancer can be the only manifestation of tumor dissemination. Between 1995 and 2005 five patients after nephrectomy due to renal cell cancer were suspected of having malignant pancreatic tumor and underwent an operation. The histology revealed metastases of renal cancer. The intervals from primary renal tumor resection to recognition of metastases in the pancreas varied from 6-17 years. The prognosis of metastatic invasion to the pancreas is better than that of primary pancreatic carcinoma. Radical resection of the tumor is the treatment of choice for isolated solitary late metastases of renal cell cancer in the pancreas.     

Isolated pleural metastases from renal cell carcinoma

A 71-year-old female was referred with three right-sided intrathoracic tumours. In 2003, she underwent radical left nephrectomy for renal cell cancer (RCC) clinical stage 1. She was since followed at her local hospital with annual computed tomography (CT)-scans during the first five years and did not present any symptoms until October 2009 when she was admitted with shortness of breath, cough and tiredness. The patient was scheduled for a diagnostic thoracoscopy when it was discovered that her lesions were not located in the lung parenchyma but were protruding nodules from the parietal pleura. Histology demonstrated metastases from RCC which apparently can reach the parietal pleura without lung metastases.     

Isolated testicular metastases from renal cell carcinoma

Testicular metastasis from renal cell carcinoma is very rare. Herein we report a case of left-side renal cell carcinoma initially diagnosed to be clinically stage II, which developed left-side testicular metastases 2 months following radical nephrectomy. High inguinal orchiectomy was carried out. The patient was asymptomatic 2 months later. Although renal vein involvement in renal cell carcinoma is common and its extension into inferior vena cava well documented, tumour invasion of spermatic veins is rare.     

Simultaneous and metachronous pelvic bone metastases from renal cell carcinoma necessitating hemipelvectomy: report of two cases]

Two patients, one with and one without a history of nephrectomy for renal cell carcinoma, presented with lower abdominal pain. One of them, a 49-year-old man, had tumors in the right kidney and the right ischiadic bone. He underwent nephrectomy and pathologic findings showed renal cell carcinoma (tubular type, granular cell subtype, INF-gamma, G2). The other patient, a 33-year-old man with a previous history of left nephrectomy for renal cell carcinoma (tubular type, granular cell subtype, INF-alpha, G2), was found to have a large tumor in the pelvis, extending from the pubic and iliac bones to the hip joint. Both patients underwent embolization of the hypervascular mass using a vascular coil followed by hemipelvectomy under general anesthesia. The pathology reports confirmed bone metastases from renal cell carcinoma. Both patients survived surgery and their postoperative courses were uneventful without urinary or bowel incontinence. However, impaired potency was noted in the latter case. Immunotherapy with INF-alpha was resumed immediately after surgery.     

Evaluation of bone metastases from renal cell carcinoma

Forty-two cases of bone metastasis from renal cell carcinoma were examined. Thirty of the cases had bone metastases at the time of renal cell carcinoma. Bone metastasis appeared after treatment of the primary site in 12 cases. Fifteen cases had only bone metastasis and another 27 had metastasis in multiple organs. The total cause-specific survival curve of these patients was 10% at 5 years. All patients with bone metastases died of cancer within 5 years after the bone metastases had developed. There was no significant difference in the survival rate between patients with bone metastases and patients with lung metastases. We investigated the prognostic value of laboratory studies in bone metastases of renal cell carcinoma. However, no significant markers were detected for bone metastases. The 6 patients were treated with decompressed laminectomy (2), wide resection (3) and excision of the metastatic lesions (3). The quality of life was improved in all the patients although they died of cancer.     

Evaluation of bone metastases from renal cell carcinoma

Twenty-nine cases of bone metastases from renal cell carcinoma were examined. Eight had metastatic bone pain as the initial symptom and were diagnosed that the primary lesion was in a kidney. In eight cases bone metastases appeared after treatment of the primary site. Seven had only bone metastases and another 22 cases had multiple metastases in organs such as the lung and lymph node when the bone metastasis was found. Curable surgical treatment was performed in only 2 cases. The survival curve of these patients were: 1 year; 41 per cent, 2 year; 30 per cent and 3 year; 15 per cent. Bone scan used for detection of bone metastases of carcinoma frequently ends with false positive results. CT scan and angiography are available for differential diagnosis of bone metastasis. We examined 6 cases (9 lesions) of bone metastases from renal cell carcinoma (3 pelvic bones, 2 lumbar bones, 2 femurs and 2 humerus). All lesions were hypervascular by angiography and were easily diagnosed as bone metastases. For early detection of bone metastases from renal cell carcinoma, angiography is useful because hypervascularity and tumor stain are easily detected even in such small lesions as 2 cm. Angiography was also useful for chemoembolization.     

Surgical treatment of brain metastases from renal cell carcinoma

Between January 1976 and December 1986, 22 patients with renal cell carcinoma underwent surgical resection of brain metastases at Memorial Sloan-Kettering Cancer Center. Ten of the patients had metastases limited to the brain and 12 also had extracranial metastases. Twenty patients received external radiotherapy. Five had craniotomy after failing radiation therapy and 15 had adjuvant radiotherapy. Two patients died within thirty days following craniotomy; the median survival of the remaining 20 patients was 20.9 +/- 6.8 months calculated according to a Weibull survival model. Variables examined in relation to survival included absence or presence of extracranial metastases at time of craniotomy, time interval between nephrectomy and diagnosis of cerebral metastases, neurologic status prior to craniotomy, location of the brain tumor, and patient age. None of the variables was significant at the 10 percent level by the Weibull analysis. However, three favorable prognostic factors, namely metachronous brain metastasis more than one year after nephrectomy, minimal or no neurologic deficit at time of craniotomy, and infratentorial lesions show a trend toward improved survival with p less than 0.20. The data suggest that surgical resection of a single and occasionally multiple brain metastases is warranted in selected patients with renal cell carcinoma.     

Spontaneous regression of pulmonary metastases from renal cell carcinoma

One year after nephrectomy for renal cell carcinoma in a seventy-year-old man pulmonary nodules developed which proved to be metastases by needle biopsy. Chest radiographs thirteen and eighteen months later revealed complete spontaneous regression of the nodules without therapy.     

Surgical removal of pulmonary metastases from renal cell carcinoma

Thirty-three patients operated on for pulmonary metastases from renal cancer were followed up for a minimum of 5 years or to death. The 5-year survival was 21%. There was a tendency to better survival in patients operated by lobectomy rather than limited resection. Extended operations carried a grave prognosis. Manifest metastatic disease within one year after the primary operation showed shortened survival. Repeated operations were possible, with good results. It is concluded that operations for pulmonary metastases can be performed with good results. However, the effect is a palliative one as the ultimate cause of death in all instances was the spread of the cancer disease.     

Cutaneous metastases of renal cell carcinoma

Renal cell carcinoma has an unknown evolution. We report a case of a man with a skin metastases from renal cell carcinoma and an unfortunate result, five years after its radical surgical treatment. We review the literature and emphasize the need of a long and exhaustive surveillance in these patients.     

Gamma surgery for intracranial metastases from renal cell carcinoma

OBJECT: The goal of this study was to evaluate the effectiveness and limitations of gamma surgery (GS) in the treatment of renal cell carcinoma that has metastasized to the brain. METHODS: The authors performed a retrospective analysis of a consecutive series of 21 patients with 37 metastatic brain deposits from renal cell carcinoma who were treated with GS at the University of Virginia from 1990 to 1999. Clinical data were available in all patients. No patient died of progression of intracranial disease or deteriorated neurologically following GS. Eight patients clinically improved. Follow-up imaging studies were available for 23 tumors in 12 patients. Nine patients did not undergo follow-up imaging. One patient lived 17 months and succumbed to systemic disease: no brain imaging was performed in this case. Another patient refused further imaging and lived 7 months. Seven patients lived up to 4 months after the procedure; however, their physicians did not require these patients to undergo follow-up imaging examinations because of their general conditions-all had systemic progression of disease. Of the 23 tumors that were observed posttreatment, one remained unchanged in volume, 16 decreased in volume, and six disappeared. No tumor progressed at any time, and there were no radiation-induced changes on follow-up imaging an average of 21 months after GS (range 3-63 months). CONCLUSIONS: Gamma surgery provides an alternative to surgical resection of metastatic brain deposits from renal cell carcinoma. Neurological side effects were seen in only one case; freedom from progression of disease was achieved in all cases.