Clinical features of renal cell carcinoma (RCC) found in 110 nephrectomized Japanese, of which 24 (22%) RCC cases showed 31 double or triple cancers

Abstract

The causes of renal cell carcinoma (RCC) were investigated in 115 nephrectomized Japanese. Among them, 110 nephrectomized Japanese had RCC as follows: 86 clear cell RCC, 8 papillary RCC, 8 chromophobe RCC, 7 dialytic–multicystic RCC, and 1 liposarcoma, while 5 nephrectomized Japanese had benign renal tumors of oncocytoma (1), angiomyolipoma (2), and hemangioma (2). In the eight chromophobe RCC, three cases that resulted in death involved medullary RCC showing extensive oncogenic features. Double or triple cancers were found in 17 clear cell RCC, 5 papillary RCC, 1 chromophobe RCC, and 1 dialytic–multicystic RCC. Among 31 non-RCC found in 24 RCC cases, 23(74%) non-RCC were removed prenephrectomy. Prenephrectomy adenocarcinoma and postnephrectomy squamous cell carcinoma were their characteristic findings. Compared with those of clear cell RCC, double (triple) cancers of papillary RCC showed more aggressive malignancy. One clear cell RCC had triple cancer of thymoma and rectum cancer. One chromophobe RCC developed thymoma, while one oncocytoma had insulinoma >10 years before. A patient in his sixties with clear cell RCC, who had a past history of pneumothorax, had developed adenocarcinoma of colon polyps and liver adenocarcinoma almost at the same time as triple cancer. His lactate dehydrogenase (LDH) levels were under 300 IU/l. He was suspected of having Birt–Hogg–Dube syndrome. One patient with papillary RCC of Paget’s disease of the bone developed colon polyp adenocarcinoma, osteosarcoma, and additionally exhibited p97/valosin-containing protein downregulation in his sixties. His LHD was increased to 4,289 IU/l with cell lysis reactions. His radical nephrectomy accompanied by adrenalectomy reinforced clinical manifestations of p97 downregulation. For p97 functions, the kidney and adrenal gland had important roles. It was concluded that oxygen stress was stronger in RCC, especially in papillary RCC. Nonsense mutations of protein tyrosine phosphatase receptor delta might be one cause of double (triple) cancers in RCC.