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'Prechronous' metastasis in clear cell renal cell carcinoma: a case report.

Poon E, Ong SJ, Chuang XE, Lim WT, Mohd Zam NA, Chong TW, Al Jajeh I, Mancer K, Tan MH - J Med Case Rep (2011)

Bottom Line: Computed tomography scanning revealed a 10 cm right renal mass, with renal vein and inferior vena cava invasion, as well as recurrent disease in the right thorax.This is the first reported case of prechronous metastasis of renal cell carcinoma, with metastatic disease manifesting prior to the development of the primary lesion.The underlying mechanism is uncertain, but our patient's case provides anecdotal support for the early dissemination model of metastasis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medical Oncology, National Cancer Centre Singapore. minhan.tan@gmail.com.

ABSTRACT

Introduction: Although metastatic carcinoma in the presence of an occult primary tumor is well recognized, underlying reasons for the failure of the primary tumor to manifest are uncertain. Explanations for this phenomenon have ranged from spontaneous regression of the primary tumor to early metastasis of the primary tumor before manifestation of a less aggressive primary tumor. We report a case of 'prechronous' metastasis arising from clear cell renal cell carcinoma, where metastatic disease initially manifested in the absence of a primary renal tumor, followed by aggressive growth of the primary renal lesion.

Case presentation: A 43-year-old Malay man initially presented to our facility with fever and cough. He subsequently underwent surgical resection of a 9 cm right-sided lung mass found on radiological examination. Histology showed a high-grade clear cell tumor with sarcomatoid differentiation, suggestive of a metastasis from clear cell renal cell carcinoma. However, no concurrent renal lesions were noted on computed tomographic evaluation at that time. Then, four months after lung resection, he presented with a subcutaneous mass in the left loin, as well as right loin discomfort. Computed tomography scanning revealed a 10 cm right renal mass, with renal vein and inferior vena cava invasion, as well as recurrent disease in the right thorax. Histological examination of the excised subcutaneous mass revealed a high-grade carcinoma consistent with clear cell renal cell carcinoma.

Conclusions: This is the first reported case of prechronous metastasis of renal cell carcinoma, with metastatic disease manifesting prior to the development of the primary lesion. The underlying mechanism is uncertain, but our patient's case provides anecdotal support for the early dissemination model of metastasis.

No MeSH data available.


Related in: MedlinePlus

Computed tomography (CT) coronal view of our patient's thorax and abdomen, showing a large right lower lobe lesion (arrow). As shown here, the kidneys were free of any lesions.
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Figure 1: Computed tomography (CT) coronal view of our patient's thorax and abdomen, showing a large right lower lobe lesion (arrow). As shown here, the kidneys were free of any lesions.

Mentions: A 43-year-old Malay man presented to our facility with a three-month history of fever, non-productive cough and weight loss. He was a chronic smoker and had no significant medical history. Results of a physical examination were unremarkable. A chest radiograph revealed a large right lower zone lung lesion, and a subsequent computed tomography (CT) scan of the thorax and abdomen revealed a large heterogeneously enhancing soft tissue mass in the right lower lobe of the lung with intra-cavitary extension into the left atrium via the right inferior pulmonary vein (Figure 1). Transthoracic needle aspiration of this mass was suggestive of carcinoma. Surgery was performed for the resection of this mass; a right posterior lateral thoracotomy was performed, followed by a right lower lobectomy. The left atrium was opened at the inferior part of the superior pulmonary vein and the tumor resected with a small cuff of left atrium. The entire tumor and right lower lobe was delivered en bloc, and the left atrial defect subsequently patched. Histology demonstrated a high-grade clear cell sarcomatoid tumor, suggestive of metastatic clear cell renal cell carcinoma, a diagnosis specifically considered by the pathologist. On immunohistochemistry, the lesion was focally positive for epithelial membrane antigen (EMA), CD10 and vimentin, but negative for anticytokeratin CAM5.2, thyroid transcription factor-1 (TTF-1), smooth muscle actin (SMA), S100, HMB-45, Melan-A, Hepar and synaptophysin. However, as no renal lesion was evident on the CT scan (Figure 1), a diagnosis of alveolar soft part sarcoma was considered. An additional extensive investigation did not reveal a primary lesion or any other metastatic lesions.


'Prechronous' metastasis in clear cell renal cell carcinoma: a case report.

Poon E, Ong SJ, Chuang XE, Lim WT, Mohd Zam NA, Chong TW, Al Jajeh I, Mancer K, Tan MH - J Med Case Rep (2011)

Computed tomography (CT) coronal view of our patient's thorax and abdomen, showing a large right lower lobe lesion (arrow). As shown here, the kidneys were free of any lesions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108321&req=5

Figure 1: Computed tomography (CT) coronal view of our patient's thorax and abdomen, showing a large right lower lobe lesion (arrow). As shown here, the kidneys were free of any lesions.
Mentions: A 43-year-old Malay man presented to our facility with a three-month history of fever, non-productive cough and weight loss. He was a chronic smoker and had no significant medical history. Results of a physical examination were unremarkable. A chest radiograph revealed a large right lower zone lung lesion, and a subsequent computed tomography (CT) scan of the thorax and abdomen revealed a large heterogeneously enhancing soft tissue mass in the right lower lobe of the lung with intra-cavitary extension into the left atrium via the right inferior pulmonary vein (Figure 1). Transthoracic needle aspiration of this mass was suggestive of carcinoma. Surgery was performed for the resection of this mass; a right posterior lateral thoracotomy was performed, followed by a right lower lobectomy. The left atrium was opened at the inferior part of the superior pulmonary vein and the tumor resected with a small cuff of left atrium. The entire tumor and right lower lobe was delivered en bloc, and the left atrial defect subsequently patched. Histology demonstrated a high-grade clear cell sarcomatoid tumor, suggestive of metastatic clear cell renal cell carcinoma, a diagnosis specifically considered by the pathologist. On immunohistochemistry, the lesion was focally positive for epithelial membrane antigen (EMA), CD10 and vimentin, but negative for anticytokeratin CAM5.2, thyroid transcription factor-1 (TTF-1), smooth muscle actin (SMA), S100, HMB-45, Melan-A, Hepar and synaptophysin. However, as no renal lesion was evident on the CT scan (Figure 1), a diagnosis of alveolar soft part sarcoma was considered. An additional extensive investigation did not reveal a primary lesion or any other metastatic lesions.

Bottom Line: Computed tomography scanning revealed a 10 cm right renal mass, with renal vein and inferior vena cava invasion, as well as recurrent disease in the right thorax.This is the first reported case of prechronous metastasis of renal cell carcinoma, with metastatic disease manifesting prior to the development of the primary lesion.The underlying mechanism is uncertain, but our patient's case provides anecdotal support for the early dissemination model of metastasis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medical Oncology, National Cancer Centre Singapore. minhan.tan@gmail.com.

ABSTRACT

Introduction: Although metastatic carcinoma in the presence of an occult primary tumor is well recognized, underlying reasons for the failure of the primary tumor to manifest are uncertain. Explanations for this phenomenon have ranged from spontaneous regression of the primary tumor to early metastasis of the primary tumor before manifestation of a less aggressive primary tumor. We report a case of 'prechronous' metastasis arising from clear cell renal cell carcinoma, where metastatic disease initially manifested in the absence of a primary renal tumor, followed by aggressive growth of the primary renal lesion.

Case presentation: A 43-year-old Malay man initially presented to our facility with fever and cough. He subsequently underwent surgical resection of a 9 cm right-sided lung mass found on radiological examination. Histology showed a high-grade clear cell tumor with sarcomatoid differentiation, suggestive of a metastasis from clear cell renal cell carcinoma. However, no concurrent renal lesions were noted on computed tomographic evaluation at that time. Then, four months after lung resection, he presented with a subcutaneous mass in the left loin, as well as right loin discomfort. Computed tomography scanning revealed a 10 cm right renal mass, with renal vein and inferior vena cava invasion, as well as recurrent disease in the right thorax. Histological examination of the excised subcutaneous mass revealed a high-grade carcinoma consistent with clear cell renal cell carcinoma.

Conclusions: This is the first reported case of prechronous metastasis of renal cell carcinoma, with metastatic disease manifesting prior to the development of the primary lesion. The underlying mechanism is uncertain, but our patient's case provides anecdotal support for the early dissemination model of metastasis.

No MeSH data available.


Related in: MedlinePlus