Metastatic Renal Cell Carcinoma Presenting Research Articles

Metastatic Renal Cell Carcinoma Presenting as an Intracardiac Tumour Without Involving the Inferior Vena Cava

Metastatic Renal Cell Carcinoma Presenting as an Intracardiac Tumour Without Involving the Inferior Vena Cava

Renal-Limited Thrombotic Microangiopathy due to Anti-VEGF/ Tyrosine Kinase Inhibitor (TKI) Immunotherapy for Metastatic Renal Cell Carcinoma Presenting as Nephrotic Syndrome

Renal-Limited Thrombotic Microangiopathy due to Anti-VEGF/ Tyrosine Kinase Inhibitor (TKI) Immunotherapy for Metastatic Renal Cell Carcinoma Presenting as Nephrotic Syndrome

Metastatic renal cell carcinoma presenting as gastric ulceration: Case series & literature review

Renal Cell Carcinoma (RCC) accounts for approximately 3% of all adult malignancies. RCC has a propensity to metastasize along the hematogenous route

Choroidal Metastasis as First Presenting Sign of Renal Cell Carcinoma without Evidence of Primary Tumour - A Case Report

Renal cell carcinoma (RCC) is a rare malignancy characterized by a variety of clinical features. It represents approximately 3 % of all adult malignancies and ranks 13th in frequency of all carcinomas.[1,2] RCC has been documented to metastasize to every organ in the body although metastasis to the eye and orbit is uncommon. Metastases may present decades after the removal of the primary disease. However, it is uncommon for patients who present with ocular metastasis before primary RCC is identified. We report a rare and unique case of metastatic renal cell carcinoma presenting as a choroidal mass despite no evidence of a primary tumour.
 We present a case of a 65-year-old Chinese man who had sought treatment for a right-sided painful blind eye for 2 years which progressively worsened over time. His vision was poor since the age of 15 years and he was unsure of the cause. Initially, he was treated for the painful blind eye secondary to glaucoma and went for evisceration. Intraoperatively, we noticed that his vitreous cavity was filled with hard fibrotic mass. Histopathological examination was reported as right eye metastatic renal cell carcinoma with clear cell variant. Further investigation was done and he underwent exenteration in view of right optic nerve bulkiness which was also related to renal cell carcinoma. Interestingly, no tumour marker was positive and computed tomography (CT) thorax, abdomen and pelvis did not reveal any primary tumour. He did not complain of any adverse urinary symptoms and there were no signs and symptoms to suggest a concurrent renal pathology.
 We report a rare and unique case of metastatic renal cell carcinoma presenting as a choroidal mass as the first presenting sign without evidence of primary tumour. Differential diagnosis of metastases must be considered in patients who present with an ocular mass, despite being asymptomatic of any primary malignancy. This is to ensure that this condition is promptly identified and treatment initiated as soon as possible. By highlighting this case, we seek to bring awareness to this condition and hopefully improve on its current dismal prognosis by early diagnosis.

S3136 Metastatic Renal Cell Carcinoma Presenting as a Gastric Polyp – A Case Report

Introduction: Patients with renal cell carcinoma are metastatic in 1/3rd of the cases, however, metastasis to gastrointestinal tract is uncommon. We present a case of rare finding of metastatic renal cell carcinoma presenting as gastric polyp in a patient who presented with gastrointestinal bleeding. Case Description/Methods: A 70-year-old man with history of clear cell renal cell carcinoma (ccRCC) with metastatic mediastinal lymphadenopathy presented with melena and anemia. The patient had received Nivolumab and Ipilimumab in the past and was currently on Cabozatinib for the past fourteen months. Patient denied any use of non-steroidal anti-inflammatory drugs. Laboratory data was significant for a hemoglobin of 6.8 g/dL. An esophagogastroduodenoscopy showed two friable gastric polyps ranging from 8-10 mm in the body. Polyps were removed using a cold snare and endoclips were placed. Histopathological analysis demonstrated portions of gastric mucosa with central area of fibrinoid necrosis covering clusters of epithelial cells with pale to clear cytoplasm, with immunostains Pax2/8 consistent with metastatic renal cell carcinoma. Discussion: Metastasis of RCC to stomach presenting as gastric polyps is exceedingly rare. The gross appearance of these polyps appears to have a smooth surface and can be friable to contact. The size of the polyp can be variable. Clinical presentation includes gastrointestinal bleeding and abdominal pain as was the case in our patient. Small gastric polyps are often not biopsied, however, our case highlights that in patients with RCC, gastric polyps should be biopsied to rule out metastasis.Figure 1.: CT Abdomen: A, B revealed 2.9cm gastric ulcer in lesser curvature, fused distal body and tail of pancreas with stomach. Endoscopy: C, normal esophagus. D-H, ischemic ulceration with nodularity, blackened mucosa, non-obstructing, clean-based gastric ulcers in the entire stomach. I, normal duodenum. J Gastric lymphoma pathology, Lymphoma cells diffusely infiltrate between the gastric glands. Separation of gastric cells with architectural disruption. Round, oval, and irregular nuclei are present with scant cytoplasm. K. Concomitant component of low-grade marginal zone lymphoma (seen in 1/3 of cases). These cells arise from large cell transformation.

INCIDENTAL SOLE CONTRALATERAL PLEURAL METASTASIS FROM RENAL CELL CARCINOMA SEVEN YEARS POST NEPHRECTOMY

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Renal cell carcinoma (RCC) accounts for 3% of all adult male cancers, and half of them are incidental findings on imaging [1]. 18% of patients have synchronous metastasis at RCC diagnosis, and 85% have metachronous metastasis within five years after surgery. A better prognosis is seen with a metachronous metastasis occurring after a long disease-free interval [2] CASE PRESENTATION: A 68-year-old male presented to an outside emergency department with generalized weakness, fatigue, and loss of appetite for a week's duration with no respiratory complaints. He was a former smoker who quit 40 years back. He had significant asbestos exposure as a sandblaster and changing railroad brake shoes. His initial blood work revealed an acute kidney injury with a serum creatinine of 14.8 mg/dL with no leukocytosis. Computed tomography (CT) abdomen revealed an obstructive right ureteropelvic junction stone (1.4 x 1 cm) with moderate hydronephrosis. Chest x-ray and CT revealed multiple right pleural soft tissue masses (largest measuring 7.7 x 3.1 x 3.5 cm) with no effusion concerning for malignancy (Figure A). Past medical history was significant for left clear cell RCC grade 3/4 with no invasion (T1bNxMx) treated by left radical nephrectomy seven years ago. His obstruction was relieved by urological intervention. A nuclear positron emission tomography showed hypermetabolic right pleural masses and a right paratracheal lymph node (Figure B). A CT-guided biopsy returned positive for metastatic RCC (Figure C1-C2). His creatinine improved, and he was discharged with an oncology follow-up DISCUSSION: The risk of RCC metastasis via hematogenous or lymphatic spread increases if it is locally advanced (stage 3-4), higher nuclear grade, and clear cell histology [2]. The lung is the frequent site of metastasis (45%), and pleural lesions occur in 12% along with lung spread [3]. Isolated pleural spread without an effusion is rare. Dormant metastasis uses Batson's venous plexus draining into thoracic veins (bronchial and intercostal) and reaches the pleura rather than by lung parenchyma direct extension [2]. Most reported cases of solitary pleural spread are symptomatic with effusion. Our patient was asymptomatic with incidental contralateral pleural metastasis without pleural effusion seven years postresection with a rare combination of pleural and paratracheal lymph node spread. 5-15% of patients recur with a distant spread questioning the current five-year surveillance strategy [4] CONCLUSIONS: Metastatic RCC to the pleura is a rare finding. This diagnosis should be considered in patients with RCC history, even if the presentation is many years after initial diagnosis and treatment. Postnephrectomy, the surveillance should be based on an individual's RCC risk factors REFERENCE #1: Ohnishi H, Abe M, Hamada H, et al. Metastatic renal cell carcinoma presenting as multiple pleural tumours. Respirology. 2005;10(1):128-31 REFERENCE #2: Brufau BP, Cerqueda CS, Villalba LB, Izquierdo RS, González BM, Molina CN. Metastatic renal cell carcinoma: radiologic findings and assessment of response to targeted antiangiogenic therapy by using multidetector CT. Radiographics. 2013;33(6):1691-716 REFERENCE #3: Saitoh H. Distant metastasis of renal adenocarcinoma. Cancer. 1981;48(6):1487-91 DISCLOSURES: No relevant relationships by Mohammed Alnijoumi, source=Web Response No relevant relationships by Cliff Chen, source=Web Response No relevant relationships by Tarang Patel, source=Web Response No relevant relationships by SACHIN PATIL, source=Web Response

S1603 Ampullary Mass from Metastatic Renal Cell Carcinoma Presenting as Acute Pancreatitis

INTRODUCTION: Renal cell carcinoma (RCC) is a heterogenous group of cancers that originate from renal tubular epithelial cells. Metastatic disease most commonly affects the lungs or bone. In rare cases, there may be metastasis to the ampulla of Vater, which can result in acute pancreatitis. Although there have been few case reports of recurrent RCC presenting as a periampullary mass, none have presented with acute pancreatitis. CASE DESCRIPTION/METHODS: A 61-year old male presented with a 1-day history of periumbilical and epigastric pain radiating to the back, nausea, and vomiting. Past medical history was notable for clear cell carcinoma of the left kidney with pulmonary metastasis. Physical examination revealed tenderness in periumbilical and epigastric regions without rebound or guarding. Liver function tests were significant for a bilirubin of 3.2 mg/dL, alkaline phosphatase of 777 U/L, and an ALT of 659 U/L. Serum lipase was 5,862 U/L. Gallbladder ultrasound revealed sludge and common bile duct dilation to 12 mm. An abdominal CT scan showed pancreatic tail edema and peripancreatic fat infiltration. Endoscopic retrograde cholangiopancreatography (ERCP) showed ulceration of the major papilla and a large, periampullary mass. A stricture of distal common bile duct at the ampulla was also present. A sphincterotomy was performed and a temporary, plastic biliary stent was placed. The lower one-third of the common bile duct and ampulla were biopsied and cytology was consistent with metastatic renal cell carcinoma. DISCUSSION: Although RCC appears to have a predilection for certain organs, metastatic disease can present in many places. Metastasis to the ampulla of Vater is rare, and there are very few reported cases. Despite limited data, it is believed that renal cell carcinoma with metastasis to the ampulla of Vater has a more favorable prognosis compared to other sites. Of the reported cases, symptoms of biliary obstruction such as nausea, vomiting, abdominal pain, and jaundice were the most common presentations. To our knowledge, this is the first reported case of an ampullary mass from renal cell carcinoma resulting in acute pancreatitis. Treatment of these patients should focus on fluid resuscitation and pain control, ERCP with sphincterotomy and stent placement, and coordination with oncology services. It is difficult to provide absolute estimates of patient prognosis, although relative ones can be made when comparing to other sites of RCC metastasis.Figure 1.: H&E (×400): At high magnification, the atypical cells have round to oval nuclei with prominent nucleoli and voluminous clear cytoplasm. They are separated by delicate blood vessels with associated extravasated red cells and inflammatory cells.

Corrigendum to "Metastatic Renal Cell Carcinoma Presenting as Prolonged Pyrexia and Stauffer's Syndrome: Can a Routine Ultrasound Scan Fail to Detect a Renal Cell Carcinoma?"

[This corrects the article DOI: 10.1155/2018/4215041.].

Metastatic Renal Cell Carcinoma Presenting as a Solitary Gastric Polyp

Metastatic Renal Cell Carcinoma Presenting as a Solitary Gastric Polyp

Metastatic Renal Cell Carcinoma Presenting as a Cerebellopontine Angle and Internal Auditory Canal Mass.

Metastatic Renal Cell Carcinoma Presenting as a Cerebellopontine Angle and Internal Auditory Canal Mass.

Metastatic renal cell carcinoma presenting with melena.

Key Clinical MessageRenal cell carcinoma is a highly malignant neoplasm. Metastasis to the pancreas and gastrointestinal tract is rare. In this case report, we show images of metastatic renal cell carcinoma to the upper gastrointestinal tract in a patient who presented with melena.

Metastatic Renal Cell Carcinoma Presenting as Rapid Onset Iron Deficiency Anemia

Iron deficiency anemia is a common referral to GI practice. This is a case of rapid onset iron deficiency anemia found to be secondary to metastatic renal cell carcinoma. A 54 year old woman presented with 3 weeks of fatigue, muscle weakness, palpitations, and SOB to her PCP. She had no abdominal pain or gross GI bleed. Last colonoscopy 4 years ago showed chronic internal hemorrhoids. Labs showed hemoglobin decreased from 15.2 to 7.2 (MCV 86.2, MCH 26.2) in a span of 8 months. She was also found to be iron deficient (Fe 18 ug/dL, TIBC 352 ug/dL, iron % saturation 5, ferritin 27 ng/mL). A hematologist started IV iron and referred to GI. EGD found a 4-5cm firm, friable mass in the descending duodenum. Cold forceps biopsy revealed metastatic high grade clear cell carcinoma. Staging CT showed a large Left renal mass, wall thickening of the duodenum, multiple sub-centimeter pulmonary nodules, and two areas of enhancement in the pancreas. She was started on systemic therapy sunitinib and oral iron. Her anemia resolved after 2 cycles of sunitinib. Cytoreductive Left laparoscopic nephrectomy confirmed grade 4 clear cell carcinoma. Renal cell carcinoma (RCC) rarely presents as the classic triad of flank pain, hematuria, and palpable abdominal mass. Several case reports describe patients presenting with melena from a bleeding duodenal mass, found to be invasive renal cell cancer (1,2). However, there are also case reports of RCC with IDA, and no abnormalities found on endoscopic exam (3,4). The proposed mechanism is increased tumor cell storage of iron via an apoferritin-like substance (3). The inadequate transfer of stored iron to plasma transferrin likely accounts for the iron-deficiency anemia. In the presentation of rapid onset iron-deficiency anemia without gross GI bleed, aggressive endoscopic evaluation, and CT scan in cases of negative endoscopic workup, may be necessary to diagnose occult metastatic RCC.Figure: Bleeding duodenal mass.Figure: Sagittal CT view of advanced Left renal cell carcinoma.

Metastatic Renal Cell Carcinoma Presenting as a Bleeding Gastric Polyp

Metastatic Renal Cell Carcinoma Presenting as a Bleeding Gastric Polyp

Metastatic renal cell carcinoma with undetectable renal mass presenting as lymphadenopathy.

Renal cell carcinoma has the ability to metastasize to any organ; about 16% of affected patients present initially with metastasis. However, it is rare for this tumor to present with metastasis from an unidentified primary. The current use of immunohistochemistry and molecular genetics has enabled clinicians to reach a precise diagnosis. It has been hypothesized that the treatment protocol for metastatic renal cell carcinoma can be applied to cases with undetectable primary. In this paper, a novel case of metastatic renal cell carcinoma presenting with lymphadenopathy with no evidence of a primary renal lesion is reported from Kuwait cancer center.

A Case of Metastatic Renal Cell Carcinoma Presenting as a Major Upper GI Bleed

Renal cell carcinoma commonly metastasizes to the lung, liver and bone. It is extremely rare to metastasize to the gastrointestinal tract. In fact, only 0.2-0.7% of cases of renal cell carcinoma will metastasize to the GI tract. We present a case of a patient with hematemesis from an unusual source. A 63-year old man with a history of renal cell carcinoma status-post right nephrectomy 1-year ago presented with intractable hematemesis, fatigue, nausea and dark-colored stools for 1-week. Laboratory data showed a normocytic anemia with Hemoglobin of 9.2 g/dl and Hematocrit of 27.1%. Liver function tests were elevated at AST 70 unit/L and ALT 98 unit/L. Lipase, total bilirubin and alkaline phosphatase were normal. An emergent EGD revealed a 2 cm ulcer with a visible vessel (figure 1). The lesion was injected with 8 cc of epinephrine and the vessel was cauterized and hemoclipped. Biopsy revealed poorly differentiated malignant neoplasm consistent with recurrent renal cell carcinoma. CT imaging showed a 10x5x6 cm right renal bed mass with erosion into the duodenum (figure 2). The tumor was significantly large, involving the poles of the 2nd and 3rd parts of the duodenum and the head of the pancreas. It was therefore deemed unresectable and palliative gastrojejunostomy was performed. RCC accounts for 2% of all adult neoplasm. Among patients recently diagnosed with RCC, 25-30% already have metastasis. To date, surgical resection remains the standard therapy for localized RCC. Unfortunately, RCC metastasis can arise up to 17.5 years later after nephrectomy. Anatomically, right renal masses tend to invade the duodenum more frequently compared to the left. Patients with metastatic disease have a poor 5-year survival rate of 10%. Treatment options for metastatic of RCC involves surgical and interventional therapies. Pancreaticoduodenectomy and excision of solitary disease have been shown to improve survival. In addition, chemotherapy using tyrosine kinase inhibitors such as Sunitinib are commonly used. In conclusion, patients with a history of RCC presenting with new-onset gastrointestinal symptoms require a comprehensive and extensive work-up to rule out a malignant recurrence.Figure 1Figure 2

Metastatic Renal Cell Carcinoma (RCC) Presenting as Gastric Polyploid Masses

Metastatic Renal Cell Carcinoma (RCC) Presenting as Gastric Polyploid Masses

Metastatic renal cell carcinoma presenting with thyroid nodule and Addisonian crisis: Tumour‐to‐tumour metastasis

Metastasis to the thyroid gland is uncommon. More infrequent is metastasis occurring within a primary thyroid carcinoma. We report a rare case presenting as an enlarging primary thyroid tumour, harbouring metastatic renal cell carcinoma within. The primary thyroid tumour was only identified after thyroidectomy. The pathology of metastatic disease into a thyroid neoplasm is demonstrated with a brief review of the literature.

Metastatic Renal Cell Carcinoma Presenting With Hematochezia and Chest Pain

Renal cell carcinoma (RCC) is known to have late recurrence even among patients with early stage disease and surgical resection.Typical sites for metastasis include lungs, bone, liver, and brain, whereas colonic metastasis is rare. A 54 year old man with past medical history significant for coronary artery disease, type II diabetes, hypertension, and stage 1 RCC status post right nephrectomy 3.5 years prior, presented with hematochezia, anemia, and chest pain. Initially, patient was admitted to an outside hospital with anemia, renal failure, and chest pain. He was diagnosed with non-ST elevation myocardial infarction and underwent a left heart catheterization significant for multi-vessel coronary artery disease. After starting dual anti-platelet therapy with aspirin and clopidogrel, he had frank hematochezia and worsening dyspnea, which prompted him to present to our emergency room. The vital signs were within normal limits and physical exam was significant for mild diffuse abdominal tenderness on palpation without rebound tenderness. Laboratory studies revealed hemoglobin of 9.2, mean corpuscular volume of 70.6 μm3, creatinine of 5.23mg/dL, iron 20mcg/dL, iron binding capacity 280mcg/dL, and ferritin 146ng/mL. Stool occult blood testing was negative. An abdominal computed tomography (CT) scan revealed a soft tissue mass in the right nephrectomy surgical bed measuring 3.2 cm x 3.7 cm, innumerable lesions within the left kidney, left adrenal mass, multiple pulmonary nodules and lymphadenopathy consistent with metastatic disease. The colon was noted to be unremarkable. The patient's renal function improved with intravenous fluid hydration. No biopsy was performed given his dual antiplatelet therapy and he was discharged with referral for follow-up with oncology and gastroenterology. He was re-admitted 1 month later with chest pain and dyspnea where cardiac work up was negative for ischemia. A push enteroscopy and colonoscopy were performed for ongoing intermittent hematochezia. The enteroscope was advanced to approximately 40cm past the ligament of treitz and examination was entirely normal. The colonoscopy revealed an ulcerated 1.5cm pedunculated mass lesion 35cm from the anal verge (image 1) with biopsies consistent with clear cell RCC (image 2). Intestinal metastasis from renal cancers often present as hemorrhage, bowel intussusception, bowel obstruction due to luminal occlusion, or rarely as perforation. In our case, the patient presented with hematochezia secondary to RCC with metastatic spread to colon in the setting of recent initiation of antiplatelet therapy. Our case illustrates that although metastatic RCC is common, colonic metastases are rare and careful history and surveillance for recurrence should be performed for RCC patients presenting with abdominal symptoms.Figure 1Figure 2

Undifferentiated metastatic renal cell carcinoma presenting as a cutaneous nodular lesion.

Cutaneous metastases may be the first sign of clinically silent visceral cancer. Approximately 30% of patients with primary renal cell carcinoma present with metastatic disease, and only 8% of them have skin metastases. We present the case of a 59-year-old male patient with a subcutaneous nodular on the upper chest extending to the jugular region. The lesion appeared skin colored and was not painful and 5 cm × 3.5 cm in diameter. The histological examination of the cutaneous biopsy showed an infiltration of undifferentiated epithelial cells positive to cytokeratins AE1/AE3, whereas they were negative to CK-20, CK5/6, cluster of differentiation 10, vimentin, thyroid transcription factor-1, S-100, human melanoma black-45, hepatocyte-specific antigen, carcinoembryonic antigen, and chromogranin A. A total-body computed tomography (CT) showed the presence of a tumoral lesion in the left kidney with multiple metastases in the lung, brain, and bones. According to the cutaneous biopsy and total-body CT, a final diagnosis of an undifferentiated renal carcinoma presenting as a subcutaneous metastasis was made. A chemotherapeutic treatment with gemcitabine and cisplatin resulted in the stabilization of the renal and metastatic lesions with an improvement in the quality of life of the patient. Considering that the prognosis of patients with cutaneous metastases is very poor, it is necessary to obtain an appropriate diagnosis in order to identify patients with treatable disease with the purpose of starting a therapeutic protocol.

Metastatic Renal Cell Carcinoma Presenting as a Thyroid Mass

Metastatic Renal Cell Carcinoma Presenting as a Thyroid Mass