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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

Histology of the lung tumor showing a clear cell malignancy at (a) 20 × magnification and (b) 40 × magnification.
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Figure 3: Histology of the lung tumor showing a clear cell malignancy at (a) 20 × magnification and (b) 40 × magnification.

Mentions: Then, four months later, our patient developed a subcutaneous mass in his left loin. A CT scan of the abdomen confirmed a large 11 cm tumor occupying nearly the entire right kidney with involvement of the pelvicalyceal system and proximal ureter (Figure 2). The tumor also extended into the right renal vein and the inferior vena cava, with a 2 cm soft tissue nodule was seen in the subcutaneous layer of the left flank. Further imaging of the thorax demonstrated multiple lung nodules, a large right pleural-based mass and an enlarged subcarinal lymph node. A bone scan was performed, and suggested involvement of the right humeral head and multiple thoracic vertebrae. Excision biopsy of the subcutaneous nodule was performed, and histology demonstrated a tumor morphologically similar to the initially resected lung lesion, suggestive of a high-grade clear cell renal cell carcinoma with sarcomatoid differentiation (Figure 3). On immunohistochemistry, the tumor was strongly positive for vimentin, CD10, focally positive for epithelial membrane antigen, melan-A and negative for TTF-1, S100, inhibin and synaptophysin (Figure 4) The positive vimentin and negative inhibin results weighed against the likelihood of an adrenocortical tumor.


'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)

Histology of the lung tumor showing a clear cell malignancy at (a) 20 × magnification and (b) 40 × magnification.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Histology of the lung tumor showing a clear cell malignancy at (a) 20 × magnification and (b) 40 × magnification.
Mentions: Then, four months later, our patient developed a subcutaneous mass in his left loin. A CT scan of the abdomen confirmed a large 11 cm tumor occupying nearly the entire right kidney with involvement of the pelvicalyceal system and proximal ureter (Figure 2). The tumor also extended into the right renal vein and the inferior vena cava, with a 2 cm soft tissue nodule was seen in the subcutaneous layer of the left flank. Further imaging of the thorax demonstrated multiple lung nodules, a large right pleural-based mass and an enlarged subcarinal lymph node. A bone scan was performed, and suggested involvement of the right humeral head and multiple thoracic vertebrae. Excision biopsy of the subcutaneous nodule was performed, and histology demonstrated a tumor morphologically similar to the initially resected lung lesion, suggestive of a high-grade clear cell renal cell carcinoma with sarcomatoid differentiation (Figure 3). On immunohistochemistry, the tumor was strongly positive for vimentin, CD10, focally positive for epithelial membrane antigen, melan-A and negative for TTF-1, S100, inhibin and synaptophysin (Figure 4) The positive vimentin and negative inhibin results weighed against the likelihood of an adrenocortical tumor.

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