Two cases of metastatic renal tumor

Two cases of metastatic renal tumor are reported, one in a 78-year-old male who had undergone total gastrectomy for gastric carcinoma, and the other in a 45-year-old female who had undergone hysterectomy for cervical carcinoma of the uterus. The chief complaint was flank pain and nephrectomy was performed in both cases. Histopathological examination of the removed specimen revealed metastatic renal tumor the primary site of which was probably the stomach in the first case and cervix uteri in the second case. The literature on metastatic renal tumors in Japan is reviewed.     

Renal cell carcinoma presenting as a cervical mass

The authors report a case of a 60-year-old woman presenting with a renal cell carcinoma in which the first sign leading to its diagnosis was a cervical metastasis, an uncommon site of distant disease in renal neoplasms. The patient had an 18-month history of a progressively enlarging cervical mass at the anterior aspect of the neck. After laboratory and radiological evaluation, the cervical mass was excised, and the microscopic and immunohistochemical patterns suggested the possibility of a metastatic renal cell carcinoma. Computerized tomography of the abdomen showed a solid, 4 cm left renal mass. A radical left nephrectomy was performed, and the histology confirmed the suspected diagnosis. The patient received immunotherapy, and in a follow-up period of 9 months, there was no evidence of recurrent disease. It seems that head and neck metastasis of renal cell carcinoma should preferentially be treated with surgical excision because of the associated morbidity and quality-of-life issues.     

Benign hepatic masses mimicking metastatic renal cell carcinoma

Making the distinction between a benign hepatic mass and renal cell carcinoma metastatic to the liver is crucial in evaluating a patient with renal cell carcinoma. The erroneous diagnosis of metastatic renal cell carcinoma may deter the surgeon from performing a potentially curative nephrectomy. In this report, we present 1 patient with cavernous hemangiomas and another patient with focal nodular hyperplasia of the liver. In each case the benign liver lesion was incorrectly diagnosed initially as metastatic renal cell carcinoma. The radiographic appearance of these lesions is discussed in detail.     

Metastatic renal cell carcinoma presenting as an intrasellar mass on computerized tomography

We report a case of renal cell carcinoma metastatic to the pituitary gland. A review of the literature indicated breast carcinoma to be the most frequent primary tumor metastatic to this site, while renal cell carcinoma metastasis has not been reported previously. This case emphasizes the capricious nature of renal cell carcinoma, particularly in a patient presenting with no evidence of disseminated disease.     

Collision tumor of the thyroid: a case report of metastatic liposarcoma plus papillary thyroid carcinoma

BACKGROUND: The term collision tumor represents the proximal coexistence of two histologically distinct tumors. Collision tumors within the thyroid are extremely rare, and reported cases are usually of mixed histologies of papillary and medullary carcinomas. Metastatic disease to the thyroid is also an uncommon scenario but may develop after long disease-free intervals. Carcinomas, most commonly renal cell carcinoma, are the likeliest group of neoplasms to metastasize to the thyroid. Soft tissue sarcomas metastasize to the thyroid with a much lower frequency. METHODS: We are reporting this highly unusual case of metastatic liposarcoma from the thigh to thyroid, which harbored a collision tumor of papillary thyroid carcinoma. This 86-year-old woman had undergone an initial resection for liposarcoma of the thigh two decades before being seen with a thyroid mass. RESULTS: Histologically, the thyroid mass was a metastatic myxoid liposarcoma, identical to the primary neoplasm. Papillary thyroid carcinoma was present within this metastasis and in the adjacent thyroid. CONCLUSION.: For any patient seen with a thyroid mass with a history of prior malignancy, no matter how remote, metastatic disease should be considered in the differential diagnosis.     

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.     

Metastatic cervical carcinoma masquerading as bilateral renal abscesses

A case is presented of a thirty-seven-year-old woman with bilateral renal masses interpreted as abscesses on computerized tomography (CT) scan. Subsequent renal exploration revealed metastatic cervical carcinoma, which is a relatively rare entity.     

Axillary skin metastasis of renal cell carcinoma—Case report

IntroductionMetastatic diseases are seen in approximately 25% of all cases with renal cell carcinoma and sometimes they can appear in unusual sites.Case presentationWe present a 35-year old patient with a painful left axillary mass which causes the functional impairment of the left arm. The axillary mass appeared 2 years after the nephrectomy performed for a left renal cell carcinoma. Numerous metastases have been identified through CT scans during the postoperative evolution of the disease for which the patient underwent adjuvant therapy with tyrosine-kinase inhibitors.DiscussionsParticular to our case is not just the rare metastatic site but also the fact that the tumor appeared despite the adjuvant therapy with tyrosine-kinase inhibitors. Unfortunately, the prognosis of metastatic RCC with skin metastasis is in most cases unfavorable.ConclusionsWe believe that our case could add more information to subsequent measures, complete the frame of rare oncologic cases and consolidate the data published on the topic so far.     

A rare form of metastasis of renal cell cancer. A case report of intra-oral soft tissue metastasis

Metastatic lesions represent 1%-8% of all malignant tumours of the mouth and jaws, which are regarded as rare sites of metastases from different primary tumours. The vast majority of these lesions (90%) have been observed in the mandibula, and 5%-20% in the maxilla. Metastatic tumours in the oral soft tissue are very rare. The primary tumour that most commonly metastasizes to the mouth and jaws seems to be carcinoma of the lung, followed by breast cancer and renal cell carcinoma. The case of a 47-year-old woman with renal cell carcinoma and an intraoral soft tissue metastatic lesion is presented.     

Metastatic renal cell carcinoma to the thyroid gland: report of seven cases and review of the literature

PURPOSE: The aim of this study was to retrospectively report clinical manifestations, type of treatment, survival rate of thyroid metastases from renal carcinoma. PATIENTS AND METHODS: Seven patients were retrospectively collected from files of different Burgundy's hospitals. All renal and thyroid gland specimens were controlled by the anatomopathologist. RESULTS: Tumors occurred in four women and three men (mean age: 66 years). Symptoms were generally a solitary mass. The metastatic tumor to the thyroid gland was the initial presentation of renal carcinoma in one case. In the other cases, patients had documented previous evidence of renal carcinoma as remotely 8.1 years before the thyroid metastases. Thyroglobulin immunohistochemistry was always negative in the foci of metastatic renal carcinoma. All patients had surgical resection of there metastasis. The majority of patients died with disseminated malignancies (mean: 38.1 months after there thyroid resection). Three patients are still alive, one after a complementary pancreatic resection for a secondary pancreatic metastasis and one other with cervical and mediastinal lymph node recurrence. CONCLUSIONS: Surgical treatment of the metastatic disease is suggested, as this may prolonged patient survival.     

Metastatic renal tumors: clinical report of three cases and review of 136 cases including 38 cases from the Japanese literature

Three cases of metastatic renal tumor are reported. The first case was of a 61-year-old man, who had a Miles' operation for rectal adenocarcinoma 30 months before, and suffered from high fever and right flank pain. Right nephrectomy was carried out and the kidney was found to contain an adenocarcinoma identical to the one previously removed from the rectum. He died 1 year after nephrectomy. The second case was of a 35-year-old man, who had undergone left pneumonectomy for a squamous cell carcinoma of the bronchus. One month later, he was readmitted with cloudiness of consciousness and high fever. Investigations revealed right kidney, adrenal gland and brain malignancies, and which were ectomized totally. On pathological examination all ectomized tissues were metastatic squamous cell carcinoma. He died 1 month after the second operation. The third case was of a 48-year-old man, who had undergone left pneumonectomy for a squamous cell carcinoma of the bronchus. One year after pneumonectomy, abdominal CT showed a left renal tumor. Right nephrectomy was performed and pathological examination revealed a metastatic squamous cell carcinoma. He is now alive 4 months after nephrectomy without any sign of recurrence. A total of 136 cases of metastatic renal tumors including 38 cases from the Japanese literature, are reviewed.     

Expression of OCT3/4 in renal medullary carcinoma represents a potential diagnostic pitfall

Renal medullary carcinoma (RMC) is a rare aggressive renal tumor that classically afflicts young black patients with sickle cell trait. The tumor shows overlapping pathologic and clinical characteristics with collecting duct carcinoma and urothelial carcinoma, which often results in a diagnostic conundrum. When the tumor presents in a metastatic site in the absence of a history of renal tumor, germ-cell tumor is often a primary diagnostic consideration, given the young age of most patients. OCT3/4 is an immunohistochemical marker that is routinely used in clinical practice and is widely considered to be a specific marker for germ-cell tumor. We studied the pathologic and immunohistochemical characteristics of 14 cases of RMC. Immunohistochemical staining for OCT3/4 staining was noted in 10/14 RMCs with strong nuclear staining in 8 cases and was absent in all cases of collecting duct carcinoma and urothelial carcinoma. OCT3/4 expression is not specific to germ-cell tumor and is seen in the majority of RMC cases. Caution must be exercised in interpreting the presence of OCT3/4 staining in a poorly differentiated neoplasm, especially at a metastatic site as a germ-cell tumor, as this may represent a potential diagnostic pitfall.     

Renal cell carcinoma metastatic to the tongue: a case report

We report a case of renal cell carcinoma (RCC) metastatic to the tongue in a 58-year-old female. The patient had undergone radical nephrectomy for renal cell carcinoma 5 years previously, and experienced multiple metastatic disease in lung, bone, and contralateral kidney, before she noticed yellowish tumor on the left border of the tongue. Microscopic appearances of the biopsied lingual tumor were almost identical to those of the primary kidney tumor, thus the diagnosis of lingual metastasis from renal cell carcinoma was established. This case represents the tenth case of RCC metastatic to the tongue.     

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.     

Localized renal cell carcinoma of an unusually large size: case report

Renal cell carcinoma has a variable clinical course. Size is a prognostic factor correlated with venous invasion, lymph node or distant metastases. These are more often encountered when the size exceeds 10 cm. For 20 years, incidental renal tumours have represented the majority of diagnosed cases, as a result of more common use of imaging techniques. We report a case of renal cell carcinoma of an unusually large size, without metastatic or locally advanced disease. Histology revealed a pT2 clear cell renal cell carcinoma of 31 x 31 x 10 cm, which was totally resected. It is the first case reported of localized conventional renal cell carcinoma reaching such a size.     

Cavernous hepatic hemangioma simulating metastatic renal cell carcinoma

A case of cavernous heinangioma of the liver resembling a metastatic deposit is reported in a patient with renal cell carcinoma. The clinical and angiographic features that distinguish hepatic hemangiomas from metastatic renal cell carcinoma are discussed. The importance of this distinction in patient management is emphasized.     

Metastatic renal cell carcinoma to the nose and paranasal sinuses

BACKGROUND: Renal cell carcinoma represents 3% of all malignant tumors. Metastatic deposits of renal cell carcinoma to the head and neck region are infrequent. The objective of this work is to analyze the clinical presentation, radiologic features, surgical and radiotherapy treatment, and outcome of metastatic renal cell carcinoma to the nose and sinuses. METHODS: Retrospective review of 6 patients diagnosed with renal cell carcinoma who had nasal metastasis develop and were seen at the Christie Hospital in Manchester over the past 8 years. RESULTS: Six patients with renal cell carcinoma were seen with recurrent epistaxis, nasal obstruction, and unpleasant nasal crusting. Three patients had orbital involvement. Examination under general anaesthesia and biopsy was performed in all 6 cases. Histologic studies confirmed metastases of renal cell carcinoma in all 6 patients. All patients underwent local external beam radiotherapy. The most common dose used was 35 Gy in 8 daily fractions. All patients had symptomatic control of local nasal disease with a minimum follow-up of 2 years in 4 patients. Two patients died within 6 months of the radiotherapy treatment as a result of their primary tumor. CONCLUSIONS: Metastatic renal cell carcinoma to the nose and paranasal sinuses is rare but has unpleasant symptoms. Local symptomatic control with radiotherapy is excellent.     

囊性肾癌5例报告并文献复习

目的:探讨囊性肾癌的早期诊断及治疗方法。方法:回顾性分析2008年1月~2012年8月间收治的5例囊性肾癌患者的临床资料,1例术前影像学检查提示双侧肾脏占位病变,一侧为囊性占位病变;4例显示单侧肾脏单发囊性占位病变,左肾3例,右肾1例;其中男3例,女2例;年龄46~68岁,平均56.4岁;肿瘤体积21.84~208ml,平均101.96ml。按照Bosniak分类,Ⅱ类1例,Ⅲ类2例,Ⅳ类2例;T1期2例,T2期2例,T3期1例。3例术前诊断为囊性肾癌,1例为肾脏囊肿,1例为肾嗜酸性细胞瘤合并囊性肾癌。2例行肾癌根治术,2例行肾部分切除术,1例行囊肿去顶减压术后2周行肾癌根治术。并结合相关文献复习进行分析讨论。结果:5例患者术后病理检查报告证实为透明细胞癌2例,乳头状细胞癌1例,多房囊性肾癌1例,嗜酸细胞腺瘤伴囊性变1例。平均随访34.4个月(10~66个月),1例发生骨骼及肺部转移,余4例均无复发转移。结论:囊性肾癌是一种广义上的肾癌分类,有四种分型;与其他类型肾癌相比,大部分恶性程度较低。囊性肾癌的术前诊断主要依赖于影像学检查,对于可疑病例,术中需行快速冷冻病理检查。对此类肿瘤,建议行保留肾单位手术。