Metastasis Of Clear Cell Renal Carcinoma Research Articles

Clear cell renal cancer metastasis - A case of delayed diagnosis.

Renal cell carcinoma represents about 90% of all primary renal neoplasms. Clear cell renal cell carcinoma is the most common histological type, characterized by an aggressive clinical course due to its tendency to metastasize. Metastases are typically diagnosed on average 5 years after oncological surgery. Compared to metastasis to other organs, pancreatic metastases are rare. We present a case of clear cell renal carcinoma metastasis to the pancreas and liver, diagnosed 23 years after nephrectomy during the investigation of portal hypertension findings. Evaluating the late recurrence of clear cell renal carcinoma is crucial. There are no guidelines regarding the appropriate follow-up period after nephrectomy, and prospective studies may be useful in the future.

Knockdown of PIK3R6 impedes the onset and advancement of clear cell renal cell carcinoma

ABSTRACT In this research, we investigated the role of PIK3R6, a regulatory subunit of PI3Kγ, known for its tumor-promoting properties, in clear cell renal cell carcinoma (CCRCC). Utilizing the UALCAN website, we found PIK3R6 upregulated in CCRCC, correlating with lower survival rates. We compared PIK3R6 expression in CCRCC tumor tissues and adjacent normal tissues using immunohistochemistry. Post RNA interference-induced knockdown of PIK3R6 in 786-O and ACHN cell lines, we performed CCK-8, colony formation, Edu staining, flow cytometry, wound healing, and transwell assays. Results showed that PIK3R6 silencing reduced cell proliferation, migration, and invasion, and induced G0/G1 phase arrest and apoptosis. Molecular analysis revealed decreased CDK4, Cyclin D1, N-cadherin, Vimentin, Bcl-2, p-PI3K and p-AKT, with increased cleaved caspase-3, Bax, and E-cadherin levels in CCRCC cells. Moreover, inhibiting PIK3R6 hindered tumor growth. These findings suggest a significant role for PIK3R6 in CCRCC cell proliferation and metastasis, presenting it as a potential therapeutic target.

Pituitary Metastasis of Clear Cell Renal Carcinoma Mimicking Pituitary Macroadenoma – Case Report

Abstract Introduction Pituitary tumors account for 25% of all primary brain tumors and for 15% of overall intracranial expansive masses. Pituitary metastases, in contrast, are a rare condition, estimated as 1.8% of all resected sellar lesions. We present here a rare case of clear cell renal carcinoma metastasis to the pituitary gland. Case Report A 65-year-old patient with holocranial headache and diplopia, whose physical examination showed right eye abduction palsy and ipsilateral anisocoria. Magnetic resonance imaging (MRI) of the pituitary revealed a heterogeneous mass in T1 weighted imaging with mild peripheral contrast enhancement and considerable growth during follow-up. Prolactin levels were high and dropped to normal after use of cabergoline, but remained normal even after the medication was halted. Biopsy was compatible with clear cell renal carcinoma. After surgery, the patient underwent radiotherapy, which was effective in reducing the volume of the lesion. Discussion Only 25 cases of pituitary metastasis arising from the kidney were reported in the literature between the years of 1957 and 2018. Metastases can reach the pituitary through hematogenous spread, cerebrospinal fluid, and contiguous bony lesions. Clinical presentation varies from vague complaints such as fatigue or headache to more specific signs like polyuria and polydipsia, and ∼ 60% of cases have clinical manifestations. Conclusion Case reports of pituitary metastases are low worldwide, with only 25 case reports of kidney metastases in over a 60-year period. The rarity of the lesions and hormonal alterations due to pituitary stalk compression can mislead diagnosis, and some patients may even never be diagnosed regarding their lower life span. In this report, radiotherapy was effective postresection, and accounts for a treatment option. All these issues account for the relevance of these case reports.

SAMHD1-induced endosomal FAK signaling promotes human renal clear cell carcinoma metastasis through activating Rac1-mediated lamellipodia protrusion.

e16523 Background: Human sterile α motif and HD domain-containing protein 1 (SAMHD1) has deoxyribonucleoside triphosphohydrolase (dNTPase) activity that allows it to defend against human immunodeficiency virus type I (HIV-1) infections and regulate the cell cycle. Although SAMHD1 mutations have been identified in various cancer types, their role in cancer is unclear. Here, we aimed to investigate the oncogenic role of SAMHD1 in human clear cell renal cell carcinoma (ccRCC), particularly as a core molecule promoting cancer cell migration. Methods: HK-2 (#22190, a normal kidney cell line), Caki-1 (#30046), Caki-2 (#30047), SN12C (#80025), and ACHN (#21611) cells were obtained from the Korean Cell Line Bank (Seoul, Korea). SN12C and ACHN cells were transfected with siRNA targeting SAMHD1. From the Broad GDAC Firehose database ( https://gdac.broadinstitute.org/ ), we downloaded RNA-sequencing (RNA-seq) and clinical data from the pankidney cohort (KIPAN), clear cell renal cell carcinoma (KIRC, ccRCC in the present study), renal papillary cell carcinoma (KIRP, PRCC in the present study), and kidney chromophobe (KICH, chRCC in the present study) datasets. We analyzed 20 pairs of human tissues (tumor and normal specimens) from Dongsan Hospital. The results are expressed as the mean ± SD or SEM. We used a two-tailed Student’s t test for single comparisons or two-way ANOVA for multiple comparisons. Results: We found that SAMHD1 participated in endocytosis and lamellipodia formation. Mechanistically, SAMHD1 contributed to the formation of the endosomal complex by binding to cortactin. Thereafter, SAMHD1-stimulated endosomal focal adhesion kinase (FAK) signaling activated Rac1, which promoted lamellipodia formation on the plasma membrane and enhanced the motility of ccRCC cells. Finally, we observed a strong correlation between SAMHD1 expression and the activation of FAK and cortactin in tumor tissues obtained from patients with ccRCC. Conclusions: In brief, these findings reveal that SAMHD1 is an oncogene that plays a pivotal role in ccRCC cell migration through the endosomal FAK-Rac1 signaling pathway.

SAMHD1-induced endosomal FAK signaling promotes human renal clear cell carcinoma metastasis by activating Rac1-mediated lamellipodia protrusion

Human sterile α motif and HD domain-containing protein 1 (SAMHD1) has deoxyribonucleoside triphosphohydrolase (dNTPase) activity that allows it to defend against human immunodeficiency virus type I (HIV-1) infections and regulate the cell cycle. Although SAMHD1 mutations have been identified in various cancer types, their role in cancer is unclear. Here, we aimed to investigate the oncogenic role of SAMHD1 in human clear cell renal cell carcinoma (ccRCC), particularly as a core molecule promoting cancer cell migration. We found that SAMHD1 participated in endocytosis and lamellipodia formation. Mechanistically, SAMHD1 contributed to the formation of the endosomal complex by binding to cortactin. Thereafter, SAMHD1-stimulated endosomal focal adhesion kinase (FAK) signaling activated Rac1, which promoted lamellipodia formation on the plasma membrane and enhanced the motility of ccRCC cells. Finally, we observed a strong correlation between SAMHD1 expression and the activation of FAK and cortactin in tumor tissues obtained from patients with ccRCC. In brief, these findings reveal that SAMHD1 is an oncogene that plays a pivotal role in ccRCC cell migration through the endosomal FAK-Rac1 signaling pathway.

Synchronous clear cell renal carcinoma metastasis presenting as an upper gastro-intestinal obstruction

Background: Clear cell renal carcinomas (CCRC) represent more than 60% of all renal cell cancers. It is common to find metastasis during presentation, after the initial treatment and follow up visits and in most cases the normal metastatic patterns can be unpredictable. A major characteristic of this type of cancer is its tendency to metastasize before the appearance of any signs or symptoms. This dissemination process follows a number of organ sites such as pulmonary, hepatic, osteo-articular and central nervous system and some cases exhibit rare metastatic sites such as the gallbladder, breast and pancreas.

Retroperitoneoscopic single-site 3D adrenalectomy for left adrenal renal cell carcinoma metastasis 20 years after left laparotomic radical nephrectomy

The aim of the paper is to demonstrate the practicability of retroperitoneoscopic single-site 3D left adrenalectomy after previous homolateral laparotomic renal surgery. We present a case report of a 70-year-old male who underwent radical nephrectomy in 1999. Twenty years after radical nephrectomy, the patient underwent a computed tomography scan for B-cell lymphoma follow-up, which revealed a 30 mm left adrenal mass suspicious for a delayed renal-cell carcinoma metastasis. After multidisciplinary discussion, surgery was chosen as first option. To minimize surgical morbidity as much as possible, a 3D laparoscopic single-site retroperitoneal approach was chosen. The patient had no peri- or intra-operative complications and was discharged on Postoperative Day 3. The final histological report revealed an adrenal clear cell renal-cell carcinoma metastasis. This experience shows that single-site retroperitoneal laparoscopic adrenalectomy is possible in patients who underwent previous abdominal cancer surgery and is an option to consider when determining optimal approaches for adrenal surgery.

MULTIPLE LUNG NODULES AND AN UNCOMMON FINDING: TWO DISTINCT PULMONARY METASTASIS

TOPIC: Lung Cancer TYPE: Global Case Reports INTRODUCTION: The solitary lung nodule is a classical entity usually described under solid guidelines and strong scientific evidence, with well-known management and follow-up. However, dual or multiple pulmonary nodules might be a propedeutic challenge, although they are usually linked to a single nosological agent and when related to a tumoral origin are habitually provenient from breast, colorectal, renal cell, head and neck cancer. More uncommon primary tumors with frequent lung metastasis are pancreatic, testicular and thyroid cancer followed by osteosarcoma. This case report demonstrates the management of a patient with double main pulmonary nodules with distinct causes. CASE PRESENTATION: A 69 year old, non-smoker male patient from Rio de Janeiro, Brazil presented on a scheduled follow-up for a nephrectomy in 2009 caused by a renal clear cell carcinoma with a chest tomography with two lung nodules in lingula, both measuring about 1,5 cm and clinically asymptomatic. Further investigation revealed nodule enlargement but low avidity on PET-CT 2 months later. Patient underwent exploratory thoracotomy and lobectomy which revealed both nodules to be a clear renal cell carcinoma metastasis, but surprisingly, a third nodule of 1,5 mm was found on the procedure and consisted of a papillary thyroid carcinoma. On sequence, in 2021 his thyroid was surgically removed, revealing a malignant nodule, corroborating the previous diagnosis. DISCUSSION: Thyroid cancer is the most common subsequent tumor related to a previous renal cell carcinoma and some scientific research proposes a BRAF mutation being linked to this finding. That being said, renal cell carcinoma has as risk factor a history of thyroid carcinoma. Being both tumors with slow onset and poor clinical presentation and low metabolic profile, they are usually difficult to diagnose at early stages. CONCLUSIONS: This case demonstrates that a high suspicion level and thorough management can achieve reasonable levels of diagnosis and high survival rates even when two rare entities are bound in the same case. REFERENCE #1: Immunotargets Ther . 2013; 2: 73 90. Jul 22 REFERENCE #2: Thyroid cancer : Coexisting papillary thyroid carcinoma and renal cell carcinoma: 4 cases ( Mehmet Celik1, Semra Ayturk1, Buket Yilmaz Bulbul1, Nuray Can2, Ebru Tastekin2, Atakan Sezer3, Funda Ustun4 & Sibel Guldiken1) : Endocrine Abstracts (2016) 41 EP1146 DISCLOSURES: no disclosure on file for Barbara Bracarense; No relevant relationships by Michelle Cailleaux-Cezar, source=Web Response No relevant relationships by Fábio Kunita, source=Web Response

Clear cell renal carcinoma metastases to the pancreas.

To date, clear cell renal carcinoma (Grawitz tumour) remains the most frequent malignant tumour of the kidney in adults. It metastasises in more than 25% of cases, most frequently to the bones (osteolytic metastases), lungs, brain, liver, adrenal glands and the contralateral kidney. Metastases to the pancreas are rare and represent 1-4% of all malignant tumours of the pancreas. This is aretrospective analysis of patients who were operated at the Department of Surgery in Pilsen between 2010 and 2018 for histologi-cally verified metastasis of clear cell carcinoma (Grawitz tumour) to the pancreas. We operated 12 patients (8 men and 4 women). The metastases appeared on average 8 years and 8 months following the primary urolo-gical surgery. The mean age of the male patients was 66.5 years and that of the female patients was 67.4 years. In our sample, the diagnostic specificity of the CT scan was 50%, the diagnostic specificity of endoscopic ultrasound (EUS) was 75% and subsequent EUS-guided fine needle aspiration biopsy performed in 100% of cases yielded aspecificity of 75%. Resectability was 92%. The average length of hospitalisation was 11.5 days. Post-operative complications according to Clavien-Dindo were grade 1 in 66%, grade 2 in 1.25% and grade 5 in 8.3% of the cases. The 30-day post-operative mortality was 8.3% (one patient). Conclusion: Clear cell renal carcinoma metastases to the pancreas are very rare. However, if radically removed, the patient has agood prognosis with regards to long-term survival.

Renal Cell Carcinoma (RCC) Stain Negative Metastatic Clear Cell Renal Cell Carcinoma Masquerading as a Pyogenic Granuloma on the Scalp

Metastasis occurs in 25-50% of patients diagnosed with primary renal cell carcinoma (RCC), although only 6% of RCC metastases manifest on the skin. We present a unique case of a slowly growing clear cell RCC metastasis of the scalp in a middle-aged male that was RCC stain negative. The lesion clinically appeared to be a benign pyogenic granuloma, however, the diagnosis of metastatic clear cell renal cell carcinoma was made based on histology. Because cutaneous metastases may masquerade as other more benign tumors, the physician must be clinically suspicious of vascular appearing lesions on the scalp.

METASTATIC RENAL CLEAR-CELL CARCINOMA PRESENTING AS A PYOGENIC GRANULOMA

Metastatic tumors of the oral mucosa are infrequent and represent approximately 1% of all oral neoplasms. Renal clear-cell carcinoma (RCCC) is the third most common metastatic tumor in the mouth and it can mimic a pyogenic granuloma. A 51-year-old man was referred due to an oral lesion involving the vestibular gingival region of teeth 23 to 22, with clinical diagnosis of pyogenic granuloma. An excisional biopsy was made, histopathologic features revealed a malignant neoplasm of clear cells. Immunohistochemical analysis was carried out in order to discard metastasis of RCCC. The neoplastic cells were positive for CD10, AE1/AE3, EMA, vimentin, and Ki-67. In addition, a coexpression between CD10, AE1/AE3, and vimentin antibodies was observed. With these findings, the diagnosis of metastatic RCCC was established and the patient was sent to an oncology hospital. The diagnosis of an oral metastasis is associated with poor prognosis due to the multiple organ involvement.

GATA3 suppresses human fibroblasts-induced metastasis of clear cell renal cell carcinoma via an anti-IL6/STAT3 mechanism

Tumorigenesis and metastasis depend on intricate interactions between genetically altered tumor cells and their surrounding microenvironment. It is, however, unclear regarding the molecular mechanisms underlying the progress and metastasis of human clear-cell renal cell carcinoma in the microenvironment with fibroblasts. In this work, we investigated the effect of normal fibroblasts on the metastasis of renal cancer and the relevant signaling pathways. We isolated normal fibroblasts from normal renal tissues and used normal fibroblast-conditioned medium culture renal cancer cells. The CCK-8 and transwell assays showed that normal fibroblasts conditioned medium significantly enhanced ccRCC cell migration. IL6 mediated the cross talk between normal fibroblasts and the cancer cells, and promoted tumor cell migration through the STAT3 pathway. In contrast, GATA3 was downregulated at both mRNA and protein levels in the normal fibroblast-conditioned medium treated with renal cancer cells, but upregulated in adjacent normal tissues. GATA3 overexpression significantly reduced STAT3 phosphorylation and attenuated the migration in both renal cancer cell and IL6-stimulated renal cancer cell. Taken together, our findings suggest that the IL6/STAT3 pathway plays a crucial role in the normal fibroblast-enhanced clear-cell renal cell carcinoma metastasis, while GATA3 may mitigate this effect by inhibiting IL6/STAT3 signaling.

Amaurosis fugax as initial symptom of metastatic clear cell renal carcinoma

Background: In this case we describe the rare presentation of orbital metastasis of a clear cell renal carcinoma. Case Report: We present a case of a 57-year-old male with suddenly lost the vision in his left eye and homolateral abducens palsy. The magnetic resonance imaging of the skull revealed a left intraorbital tumor with center-lateral displacement measuring 21.8 x 19.6 mm, compressing the optic nerve and the homolateral lateral rectus muscle. The patient underwent surgical removal of the lesion. The histologic diagnosis indicated clear cell renal carcinoma metastasis confirmed by the abdominal computed tomography (CT), which showed a neoplasia in the upper third of the left kidney measuring 3.5 x 3.4 cm with heterogeneous reinforcement after intravenous contrast administration. Conclusion: This case described the rare presentation of a clear cell renal carcinoma metastasis in orbit. The initial presentation of patient was amarosis fugax and homolateral abducens palsy. Orbital metastasis of clear cell renal carcinoma are rare, however, the histologic exam conclude the diagnosis.

Central pancreatectomy in portal annular pancreas for metastatic renal cell carcinoma: a case report

BackgroundPortal annular pancreas (PAP) is a rare congenital anatomical abnormality of the pancreas in which the portal vein is encircled by aberrant parenchyma, and special attention is needed for pancreatic resections. This is the first report of central pancreatectomy (CP) in a PAP for metastatic renal cell carcinoma (RCC).Case presentationA 76-year-old man who had a history of left nephrectomy for renal cancer not otherwise specified 36 years earlier and radical cystectomy for bladder cancer 4 years earlier was incidentally found to have a pancreatic tumor and a liver tumor. The pancreatic tumor was diagnosed as metastasis of clear cell RCC, and the liver tumor was diagnosed as moderately differentiated hepatocellular carcinoma (HCC) on preoperative histological evaluation. Preoperative computed tomography imaging showed a type 3A PAP, in which the main pancreatic duct (MPD) ran ventral to the portal vein (anteportal type), and the aberrant parenchyma was located cranial to the confluence of the portal vein and splenic vein (suprasplenic type). After adhesiotomy and partial liver resection, CP was performed. With intraoperative ultrasound guidance, the aberrant parenchyma of the PAP could be preserved, avoiding additional resection. Thus, two pancreatic transections were performed, creating a single-cut margin that contained the MPD in the distal pancreas. Oncologically safe margins were confirmed by intraoperative pathological diagnosis. The distal pancreas was reconstructed by pancreatojejunostomy in the routine procedures. The pathological diagnosis of the surgical specimens was identical to the preoperative diagnosis. A postoperative pancreatic fistula (POPF) developed from the proximal stump of the head of the pancreas, necessitating no specific treatment other than drainage. The patient showed no signs or symptoms of recurrent RCC or abnormal pancreatic function for 2 years after the operation, although a histologically proven new HCC lesion developed distant from the initial site 8 months after the operation.ConclusionsPrecise preoperative evaluation of the tumor features and PAP allowed adequate surgical strategies to be planned. Intraoperative ultrasound was useful to minimize parenchymal resections of the PAP. CP is still a challenging procedure in terms of the development of POPF.

Sternal resection of a solitary renal cell carcinoma metastasis: a case report and a literature review.

Renal cell carcinoma (RCC) may be metastatic, although solitary sternal metastasis of RCC is a rare medical condition. Here we report an unusual case of a 63-year-old male with a solitary sternal metastasis as an initial presentation of clear-cell renal cell carcinoma. A 63-year-old male presented with a small sternal mass. Chest computer tomography (CT) and a biopsy from the sternal tumour were performed. Histopathological examination revealed the diagnosis of renal clear cell carcinoma metastasis to the sternal bone. On the basis of a subsequently performed abdominal CT the patient was confirmed with a suspicion of a left renal lower pole tumour. Treatment with sunitinib was initiated. Due to the limited response and a growing sternal mass, the patient was admitted to the National Cancer Institute after two cycles of sunitinib therapy. Open left partial nephrectomy was performed followed by the resection of the sternal metastasis two months later. The chest wall was reconstructed with polypropylene mesh combined with transversal rectus abdominis musculocutaneous flap. The postoperative course after the partial nephrectomy was uneventful. The postoperative course of metastasectomy complicated with the right pneumothorax which was successfully treated by insertion of a chest tube. Bleeding from the upper digestive tract also occurred on the seventh postoperative day but was successfully controlled by haemostasis with three 20 ml endoscopic injections of 1:10,000 solution of epinephrine. The patient had been followed up after the surgery for 30 months with biannual chest and abdominal CT scans that showed neither local nor distant recurrence of the disease. Radical surgical treatment of a solitary renal clear cell carcinoma metastasis may offer the best cancer-specific outcomes and improve the quality of life in some patients.

Renal clear cell carcinoma metastasis to the breast ten years after nephrectomy: a case report and literature review

BackgroundRenal cell carcinoma most commonly metastasizes to the lungs, skeleton or liver. Metastatic renal cell carcinoma to the breast is very rare, especially for clear cell carcinoma, and few cases regarding this condition have been reported.Case PresentationThe case we presented was a 68-year-old Chinese female with metastatic renal clear cell carcinoma of the left breast 10 years after a nephrectomy. Identification of the metastatic renal clear cell carcinoma in the breast required multiple breast imaging modalities. Imaging showed a single, ovary-shaped, well-defined hypo-echoic mass, with abundant blood flow on ultrasound images. The mass was enhanced early on MRI, and it was hypointense on a T1-weighted image and hyperintense on a fat-saturated T2-weighted image. Following surgical excision of the tumor, a routine immunohistochemistry antibody panel on the tumor cells revealed negative staining for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (Her-2). Strong positive staining for the cluster of differentiation 10 (CD10) and vimentin was present.ConclusionThis case is unusual because of the site of metastatic progression. It is important for physicians to be aware of this progression so early diagnoses can be made, and appropriate therapeutic planning can be initiated.

Utility of MRI to Differentiate Clear Cell Renal Cell Carcinoma Adrenal Metastases From Adrenal Adenomas.

The purpose of this study is to compare MRI features of clear cell renal cell carcinoma (RCC) adrenal metastases and adenomas. Fifteen clear cell RCC adrenal metastases imaged with MRI were compared to 29 consecutive adenomas between 2006 and 2015. Two blinded radiologists assessed homogeneity (homogeneous vs heterogeneous), signal intensity (SI) decrease on chemical-shift MRI, and T2-weighted SI (isointense, mildly hyperintense, or markedly hyperintense) relative to muscle. A third blinded radiologist measured the chemical-shift SI index, adrenal-to-spleen SI ratio, T2-weighted SI ratio, AUC for contrast-enhanced MRI, and histogram analysis. Analyses were performed using chi-square, linear regression, ROC, and logistic regression modeling. Clear cell RCC metastases were larger than adenomas (mean [± SD], 5.0 ± 4.2 cm [range, 1.1-15 cm] vs 2.0 ± 0.7 cm [range, 1.2-3.7 cm]; p < 0.0001). Subjectively, 33.3% (5/15) of metastases and 68.9% (20/29) of adenomas showed an SI decrease on chemical-shift MRI (p = 0.0421; κ = 0.76). Chemical-shift SI index (mean, 9.2% ± 20.6%; range, -30.0% to 57.9%) and adrenal-to-spleen SI ratio (0.94 ± 0.23 [range, 0.44-1.33]) for metastases differed significantly from those for adenomas (47.3% ± 27.8% [range, -9.4% to 86%] and 0.52 ± 0.28 [range, 0.13-1.11], respectively) (p < 0.0001). Twenty percent (3/15) of metastases had chemical-shift SI index in the adenoma range (> 16.5%). Metastases had higher T2-weighted SI than did adenomas, both quantitatively (5.1 ± 3.0 [range, 1.5-10.6] vs 1.8 ± 0.8 [range, 0.5-3.8]; p < 0.0001) and subjectively (p < 0.0001; κ = 0.89). Metastases had higher entropy than did adenomas (6.76 ± 0.61 vs 6.1 ± 0.74; p = 0.0051) and were subjectively more heterogeneous (p < 0.0001; κ = 0.86). The contrast-enhanced MRI AUC, skewness, and kurtosis did not differ between groups (p > 0.05). The ROC AUCs were 0.91 (95% CI, 0.79-1.0) for T2-weighted SI ratio and 0.85 (95% CI, 0.68-1.0) for entropy. The logistic regression model of T2-weighted SI ratio plus entropy improved accuracy (ROC AUC, 0.97; 95% CI, 0.93-1.0]) compared with either feature alone (p = 0.0215). Increased T2-weighted SI and heterogeneity are features that can differentiate clear cell RCC adrenal metastases from adenomas using quantitative and subjective analysis.

Arteriovenous malformation and thyroid metastasis from underlying renal cell carcinoma, an unusual presentation of malignancy: A case report.

Renal Clear Cell Carcinoma (RCC) comprises over 80% of renal malignancies in adults. Thyroid gland metastasis is rare in RCC. Few studies have described cases of RCC mistaken for benign arteriovenous malformation (AVM). To the best of our knowledge, an AVM arising from underlying RCC metastasis to the brain has not yet been reported. The current study presents a case of RCC metastasis to the thyroid gland, with an AVM identified to be a result of metastatic involvement in the brain. A 45-year-old African-American female presented with left-sided weakness, slurred speech, facial droop and seizure. The patient's medical history was notable for a diagnosis of RCC, 2010 American Joint Committee on Cancer Tumor-Node-Metastasis Stage 1B (T1B, N0, M0) grade III status post-right partial nephrectomy. Computed tomography (CT) imaging revealed a soft-tissue mass, suspected to be metastasis, in the left lobe of the thyroid, in addition to a 1.9 cm right intracranial mass in the parietal lobe. Positron emission tomography/computed tomography revealed a hypermetabolic area in the thyroid. Fine needle aspiration of the thyroid, and subsequent histopathological analysis, suggested a diagnosis of RCC metastasis. Subsequent immunohistochemical analysis of the thyroid tumor confirmed RCC metastasis. The patient also underwent a right partial craniotomy with resection of the intra-axial mass. Initial pathology was suggestive of an AVM. After several months, the patient was readmitted with headache, nausea and vomiting. Repeat imaging revealed recurrence of a 3.9 cm mass that was negative for AVM on biopsy; however, the immunostaining markers were positive for RCC. Recent literature suggests a link between AVMs and RCC as each exhibit highly vascular characteristics. RCC is a particularly vascular tumor that has been demonstrated to lead to the abnormal expression of various angiogenesis-promoting growth factors, including vascular endothelial growth factor. These angiogenic factors are vital to the pathophysiological pathway involved in the tumorigenesis and progression of RCC, and may explain the development of AVMs within these neoplasms, as demonstrated in the case presented in the current study.

Genetic mutations associated with metastatic clear cell renal cell carcinoma.

Metastasis is the major cause of death among cancer patients, yet early detection and intervention of metastasis could significantly improve their clinical outcomes. We have sequenced and analyzed RNA (Expression) and DNA (Mutations) from the primary tumor (PT), tumor extension (TE) and lymphatic metastatic (LM) sites of patients with clear cell renal cell carcinoma (CCRCC) before treatment. Here, we report a three-nucleotide deletion near the C-region of Plk5 that is specifically associated with the lymphatic metastasis. This mutation is un-detectable in the PT, becomes detectable in the TE and dominates the LM tissue. So while only a few primary cancer cells carry this mutation, the majority of metastatic cells have this mutation. The increasing frequency of this mutation in metastatic tissue suggests that this Plk5 deletion could be used as an early indicator of CCRCC metastasis, and be identified by low cost PCR assay. A large scale clinical trial could reveal whether a simple PCR assay for this mutation at the time of nephrectomy could identify and stratify high-risk CCRCC patients for treatments.

Thyroid Metastasis from Renal Cell Carcinoma Eight Years after Total Nephrectomy

Introduction: Metastases to the thyroid gland are rare in clinical practice. 12 to 34% of secondary thyroid tumors originate from renal carcinoma. We report a case of late thyroid metastasis, eight year after a nephrectomy for clear cell renal carcinoma. Case: A 70-years-old Caucasian patient followed for a multi-nodular goiter with a history of renal carcinoma, underwent a thyroidectomy. A histological examination revealed clear cell renal carcinoma metastasis to the thyroid. Conclusion: Metastases to the thyroid gland are usually asymptomatic. The diagnosis of secondary malignant thyroid tumor should be taken into account if there is history of neoplasia, renal in particular, even years after the surgery of the primary tumor.