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Pulmonary Lymphangitic Carcinomatosis due to Renal Cell Carcinoma.

Guddati AK, Marak CP - Case Rep Oncol (2012)

Bottom Line: In this case report, we describe the presentation and clinical course of renal cell carcinoma in a patient which manifested as lymphangitis carcinomatosa of the lungs.Immunohistochemistry of the tissue obtained by the biopsy confirmed the diagnosis which was subsequently corroborated during his autopsy.This case illustrates the necessity of an urgent follow-up of chemotherapy and immunotherapy in such patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, St. Vincent's Hospital, Bridgeport, Conn., and New York, N.Y., USA.

ABSTRACT
Renal cell carcinoma is an aggressive disease with a high rate of mortality. It is known to metastasize to the lung, liver, bone and brain. However, manifestation through lymphatic spread to the lungs is rare. Lymphangitic carcinomatosis is commonly observed in malignancies of the breast, lung, pancreas, colon and cervix. It is unusual to observe lymphangitic carcinomatosis of the lungs due to renal cell carcinoma. Lymphangitic carcinomatosis of the lungs may result in severe respiratory distress and may be the direct cause of death. Currently, there are no known modalities of preventing or slowing lymphangitic carcinomatosis besides treating the primary tumor. However, early detection may change the course of the disease and may prolong survival. This is compounded by the difficulty involved in diagnosing lymphangitic carcinomatosis of the lung which frequently involves lung biopsy. Immunohistochemical studies are often used in conjunction with regular histochemistry in ascertaining the primary tumor and in differentiating it from pulmonary metastasis. In this case report, we describe the presentation and clinical course of renal cell carcinoma in a patient which manifested as lymphangitis carcinomatosa of the lungs. The patient underwent surgical resection of the primary tumor with lymph node resection but presented with a fulminant lymphangitic carcinomatosis of the lungs within two weeks. Immunohistochemistry of the tissue obtained by the biopsy confirmed the diagnosis which was subsequently corroborated during his autopsy. This case illustrates the necessity of an urgent follow-up of chemotherapy and immunotherapy in such patients.

No MeSH data available.


Related in: MedlinePlus

Hematoxylin and eosin staining of tumor sample. a High-grade spindle cells in sarcomatoid focus. b Rhabdoid cells with large eccentric nuclei and abundant eosinophilic cytoplasm.
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Figure 1: Hematoxylin and eosin staining of tumor sample. a High-grade spindle cells in sarcomatoid focus. b Rhabdoid cells with large eccentric nuclei and abundant eosinophilic cytoplasm.

Mentions: A 49-year-old man with hypertension presented with left flank pain. He denied night sweats and weight loss, and was a lifelong non-smoker. MRI showed a left renal mass with extensive retroperitoneal lymph node involvement. He underwent radical nephrectomy with retroperitoneal lymph node dissection. Hilar lymph nodes (3/3), para-aortic lymph nodes (8/8) and interaortocaval lymph nodes (7/7) tested positive for tumor involvement. The left kidney was found to have a 9.8-cm mass at the lower pole and biopsy showed clear cell type renal cell carcinoma with focal sarcomatoid and rhabdoid cells. Fig. 1a shows high-grade spindle cells in the sarcomatoid focus and fig. 1b shows rhabdoid cells with large eccentric nuclei and abundant cytoplasm. The adrenal gland was also found to be infiltrated with tumor.


Pulmonary Lymphangitic Carcinomatosis due to Renal Cell Carcinoma.

Guddati AK, Marak CP - Case Rep Oncol (2012)

Hematoxylin and eosin staining of tumor sample. a High-grade spindle cells in sarcomatoid focus. b Rhabdoid cells with large eccentric nuclei and abundant eosinophilic cytoplasm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3369259&req=5

Figure 1: Hematoxylin and eosin staining of tumor sample. a High-grade spindle cells in sarcomatoid focus. b Rhabdoid cells with large eccentric nuclei and abundant eosinophilic cytoplasm.
Mentions: A 49-year-old man with hypertension presented with left flank pain. He denied night sweats and weight loss, and was a lifelong non-smoker. MRI showed a left renal mass with extensive retroperitoneal lymph node involvement. He underwent radical nephrectomy with retroperitoneal lymph node dissection. Hilar lymph nodes (3/3), para-aortic lymph nodes (8/8) and interaortocaval lymph nodes (7/7) tested positive for tumor involvement. The left kidney was found to have a 9.8-cm mass at the lower pole and biopsy showed clear cell type renal cell carcinoma with focal sarcomatoid and rhabdoid cells. Fig. 1a shows high-grade spindle cells in the sarcomatoid focus and fig. 1b shows rhabdoid cells with large eccentric nuclei and abundant cytoplasm. The adrenal gland was also found to be infiltrated with tumor.

Bottom Line: In this case report, we describe the presentation and clinical course of renal cell carcinoma in a patient which manifested as lymphangitis carcinomatosa of the lungs.Immunohistochemistry of the tissue obtained by the biopsy confirmed the diagnosis which was subsequently corroborated during his autopsy.This case illustrates the necessity of an urgent follow-up of chemotherapy and immunotherapy in such patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, St. Vincent's Hospital, Bridgeport, Conn., and New York, N.Y., USA.

ABSTRACT
Renal cell carcinoma is an aggressive disease with a high rate of mortality. It is known to metastasize to the lung, liver, bone and brain. However, manifestation through lymphatic spread to the lungs is rare. Lymphangitic carcinomatosis is commonly observed in malignancies of the breast, lung, pancreas, colon and cervix. It is unusual to observe lymphangitic carcinomatosis of the lungs due to renal cell carcinoma. Lymphangitic carcinomatosis of the lungs may result in severe respiratory distress and may be the direct cause of death. Currently, there are no known modalities of preventing or slowing lymphangitic carcinomatosis besides treating the primary tumor. However, early detection may change the course of the disease and may prolong survival. This is compounded by the difficulty involved in diagnosing lymphangitic carcinomatosis of the lung which frequently involves lung biopsy. Immunohistochemical studies are often used in conjunction with regular histochemistry in ascertaining the primary tumor and in differentiating it from pulmonary metastasis. In this case report, we describe the presentation and clinical course of renal cell carcinoma in a patient which manifested as lymphangitis carcinomatosa of the lungs. The patient underwent surgical resection of the primary tumor with lymph node resection but presented with a fulminant lymphangitic carcinomatosis of the lungs within two weeks. Immunohistochemistry of the tissue obtained by the biopsy confirmed the diagnosis which was subsequently corroborated during his autopsy. This case illustrates the necessity of an urgent follow-up of chemotherapy and immunotherapy in such patients.

No MeSH data available.


Related in: MedlinePlus