Other malignant neoplasms of the renal parenchyma

Percutaneous Thermal Ablation for Managing Small Renal Metastatic Tumors

PURPOSE

To retrospectively evaluate the treatment outcomes of thermal ablation for renal metastatic tumors.

MATERIALS AND METHODS

Thirteen consecutive patients with small renal metastatic tumors (≤3 cm), who underwent thermal ablation between 2009 and 2020, were included in this study. Eight patients had extra-renal tumors during renal ablation. The primary tumors were adenoid cystic carcinoma in four patients, lung cancer in three, hemangiopericytoma in three, leiomyosarcoma in two, and thyroid cancer in one. The therapeutic effects, safety, survival rate, prognostic factor, and renal function were evaluated.

RESULTS

We performed 18 ablation sessions (cryoablation, n = 13; radiofrequency ablation, n = 5) on 19 renal metastases with a mean diameter of 1.7 cm, which resulted in a primary technique efficacy rate of 100% without procedure-related deaths or major complications. Renal function significantly declined 6 months after ablation (P = 0.0039). During the mean follow-up period of 31.2 ± 22.4 months (range, 2.7-71.4 months), one patient had local tumor progression at 11.9 months following radiofrequency ablation. The overall survival rates at 1 and 3 years after ablation were 76.9% (95% confidence interval [CI], 54.0%-99.8%) and 59.3% (95% CI, 31.3%-87.3%), respectively. Tumor size ≥ 2 cm (P = 0.02) and metastasis from non-small cell lung cancer (P = 0.001) were significant worse prognostic factors in univariate analysis, and metastasis from non-small cell lung cancer (P = 0.01) was significant in multivariate analysis.

CONCLUSIONS

Percutaneous thermal ablation for small renal metastases is safe and feasible and can control local tumors.

Secondary Tumors of the Kidney: A Comprehensive Clinicopathologic Analysis

Metastases to the kidney are rare and were historically described in autopsy series, and the incidence ranged between 2.36% and 12.6%. However, in the contemporary literature with the improvements in imaging modalities (computed tomography scan and magnetic resonance imaging) and other health care screening services, metastatic tumors to the kidney are being diagnosed more frequently in surgical specimens. The utility of needle core biopsies in the primary evaluation of renal masses has also increased the number of sampled metastases, and as a result, only limited histologic material is available for evaluation in some cases and may potentially lead to diagnostic pitfalls. In the last decade, a few large clinical series have been published. In these series, the majority of metastatic tumors to the kidney are carcinomas, with the lung being the most common primary site. A significant number of the various tumor types with metastasis to the kidney are also associated with widespread metastases to other organs, and the renal metastasis may present several years after diagnosis of the primary tumor. The majority of secondary tumors of the kidney are asymptomatic, incidentally discovered, and solitary. There should be a high index of suspicion of metastasis to the kidney in patients with an associated enlarging renal lesion with minimal to no enhancement on imaging and tumor progression of a known high-grade nonrenal malignancy. Secondary tumors of the kidney can be accurately diagnosed by correlating histopathologic features with clinical and radiographic findings and the judicious use of ancillary studies.

Solitary Squamous Cell Carcinoma in the Kidney after Metachronous Development of Esophageal and Lung Cancer

Solitary metastatic renal tumors are rarely encountered clinically. We report the case of a 65-year-old man who developed a solitary renal metastasis after undergoing an esophagectomy for esophageal cancer and subsequent lobectomy for lung cancer. The present case serves to demonstrate that careful follow-up is needed for esophageal cancer patients with cancer of another organ.

Renal capsule metastasis from renal pelvic cancer: a case report

Background

Metastatic renal cancers are relatively common. Most are metastases to the renal parenchyma via a hematogenous route and are derived from lung, breast, and gastrointestinal cancer, malignant melanoma, and hematologic malignant cancer. However, little is known about renal capsule metastasis from other cancers.

Case presentation

We report a 71-year-old woman with breast cancer who was treated with endocrine therapy. She presented with gross hematuria and was diagnosed as having right renal pelvic cancer and renal cell cancer. She underwent right laparoscopic radical nephroureterectomy. Pathological findings revealed right pelvic cancer and renal capsule metastasis.

Conclusion

Renal capsule metastasis derived from renal pelvic cancer is very rare. When diagnosing renal capsule cancer, we believe that renal capsule metastasis should also be taken into consideration. Clinical and radiological differential diagnosis of renal capsule metastasis from renal cell cancer and primary renal capsule cancer is difficult. Assessment of the histopathological findings of the surgical specimens seems to be the only realistic approach to achieving the correct diagnosis.

Esophageal Cancer Metastases to Unexpected Sites: A Systematic Review

The most common pattern of esophageal cancer metastases (ECM) is to the lymph nodes, lung, liver, bones, adrenal glands, and brain. On the other hand, unexpected metastasis (UM) spread to uncommon sites has increasingly reported and consequently affected the pathway of diagnosis, staging, and management. Using the PubMed database, a systematic search of the following headings “Esophageal” and “Metastasis” or “Metastases” was performed, 10049 articles were identified, and the articles were included if they demonstrated unexpected ECM. 84% of cases were men with an average age of 60.7 years. EC was located in the lower third in 65%. Two-thirds of the UM originated from the lower esophagus, and the two major histological types were adenocarcinoma 40% and squamous cell carcinoma 60%. Metastases were disseminated toward five main anatomical sites: the head and neck (42%), thoracic (17%), abdomen and pelvis (25%), extremities (9%), and multiple skin and muscle metastases (7%). The EC metastases were found to be synchronous 42% and metachronous 58%, isolated in 53.5% and multiple in 46.5%. The overall survival rate was 10.2 months. Since distant metastases are responsible for most EC-related deaths, understanding of ECM dissemination patterns needs more extensive studies. These critical data are the cornerstone of optimal cancer approach and treatment.

CT Analysis of Metastatic Neoplasms of the Kidney

The CT findings in 32 patients with pathologically proven metastases to the kidney were compared to findings in 74 patients with renal cell carcinoma. Fourteen CT criteria were chosen to describe and characterize the lesions and 2 radiologists evaluated the CT images retrospectively according to these criteria. Renal metastases were characterized as small, multiple, bilateral, wedge-shaped, less exophytic, and located within the renal capsule. Renal cell carcinomas were single, unilateral, nonwedge-shaped, and exophytic, and easily transgressed the renal capsule. The sensitivity of CT to discriminate renal cell carcinoma from renal metastasis was 93.2% for renal cell carcinoma, and to discriminate renal metastasis from renal cell carcinoma was 75.0% for renal metastases by computer posterior probabilities. This study indicates that CT is useful for distinguishing these clinically important tumors. By using posterior probability, some unnecessary biopsies may be avoided.

Solitary renal metastasis of esophageal squamous cell carcinoma mimicking primary renal neoplasm - A case report and literature review

Solitary renal metastasis of esophageal cancer is rare clinically, with only 14 cases being reported in the literature. The authors here report a case of a 53-year-old man with a metachronous hypopharyngeal and esophageal squamous cell carcinoma who developed a solitary renal metastasis after complete chemoradiotherapy for esophageal cancer, and subsequently received a left nephrectomy. The metastatic esophageal cancer was indistinguishable from primary renal neoplasm in the computed tomography but showed the histopathologic characteristic of esophageal cancer in directly invading the renal artery, and the tumor spreading in the kidney. The patient died of pneumonia two months after diagnosis. Among the previous 14 reported cases, 12 occurred in Asians, and their overall survival time ranges from two months to nine years after nephrectomy, either with or without adjuvant chemotherapy. Accordingly, a solitary renal mass in patients with a history of esophageal cancer is warranted to differentiate metastatic esophageal cancer from primary renal neoplasm, and a reliable therapy needs to be planned early for improving the patient's chance of survival.

Carcinoma of the lungs causing enlarged kidneys

Bilateral enlarged kidneys can be caused by a number of conditions. Renal metastasis is included in the differential diagnosis. We report a case of a 67-year-old woman with a 6-month history of productive cough and unintentional weight loss. Cavitary pulmonary lesions and bilateral enlarged kidneys were noted on imaging studies. Hematuria, azotemia, and proteinuria were present. Renal biopsy showed squamous carcinoma cells invading normal-appearing glomeruli and atrophic tubules. The invasive squamous cells stained negative for CK7 and CK 20. Lung biopsy confirmed squamous cell carcinoma. Our case shows that in patients with renal enlargement, even with the absence of a focal mass, renal metastasis should be considered, especially in those with suspected or diagnosed malignancy elsewhere.

Renal metastasis from pancreatic adenocarcinoma: a rare case along with literature review

Metastatic masses in the kidney are rare, and metastasis of pancreatic adenocarcinoma to the kidney is even rarer. A 58-year-old male patient with macroscopic hematuria presented to the emergency department. Abdominopelvic computed tomography revealed a lesion that was not visualized as a complete mass but instead appeared as a patch extending from the pelvis to the parenchyma. Biopsy indicated metastasis of pancreatic adenocarcinoma to the right kidney. These findings indicate that metastatic pancreatic adenocarcinoma should be considered in patients presenting with hematuria and findings of patch-like suspicious masses in the right kidney. After diagnosis is confirmed by prompt biopsy, chemotherapy should be initiated to prolong the patient's life. To the best of our knowledge, the present case is the first report of renal metastasis from pancreatic adenocarcinoma in a living patient.

Renal metastasis after esophagectomy of esophageal squamous cell carcinoma: a case report and literature review

Solitary metastatic renal tumors are rarely encountered. We report the case of a 63-year-old man who developed a solitary renal metastasis after undergoing an esophagectomy for esophageal squamous cell carcinoma and subsequent nephrectomy of the right kidney.

The role of percutaneous renal biopsy in the management of small renal masses

The use of percutaneous renal mass biopsy (RMB) has increased in recent years, likely in parallel with the growing incidence of renal cell carcinoma and small renal masses in particular. Biopsy and imaging techniques are improving, and diagnostic sufficiency and accuracy of RMB now are much higher in large-volume, experienced centers. Overall morbidity is low. This has led to a significant expansion of the indications for biopsy beyond documenting renal involvement for patients with metastatic disease or other systemic illnesses. While there still are limitations to its use and clinical judgment is paramount, RMB is proving to be a valuable tool in the clinical diagnosis and management of small renal masses.

ASSOCIATION BETWEEN RENAL HYPOECHOIC SUBCAPSULAR THICKENING AND LYMPHOSARCOMA IN CATS

The purpose of this study was to investigate the association between renal hypoechoic subcapsular thickening observed ultrasonographically and the presence of renal lymphosarcoma in cats. The ultrasonography database was retrospectively searched for cats that underwent ultrasound examination and ultrasound guided needle renal aspirate, renal biopsy, or necropsy. One radiologist unaware of the final diagnosis evaluated the images for the presence of hypoechoic subcapsular thickening and other abnormal findings. Fifty-four cats met the inclusion criteria. Hypoechoic subcapsular thickening was found in 21 cats of which 17 had lymphosarcoma; the remaining four cats had a different diagnosis. Eleven out of 33 cats without hypoechoic subcapsular thickening were positive for lymphosarcoma, and the rest had a different diagnosis. There was a significant association between hypoechoic subcapsular thickening and renal lymphosarcoma (P = 0.001). The positive predictive value of hypoechoic subcapsular thickening for lymphosarcoma was 80.9% and the negative predictive value was 66.7%. The sensitivity and specificity of hypoechoic subcapsular thickening for the diagnosis of renal lymphosarcoma were 60.7% and 84.6%, respectively. The results of this study indicate that the presence of hypoechoic subcapsular thickening in feline kidneys is associated with renal lymphosarcoma.

FDG PET in solitary metastastic/secondary tumor of the kidney: A report of three cases and a review of the relevant literature

Metastatic tumors or secondary lymphoma of the kidney are rare and can often be missed on conventional computed tomography (CT) imaging. On the other hand, many types of metastatic tumor or lymphoma can be detected clearly as hotspots of elevated uptake on FDG PET. However, excreted FDG present in the urinary tract mimics these findings and interferes with image reading. Careful investigation of the renal cortex by FDG PET and review of anatomical images, such as the findings of CT and MRI, have important roles in the detection of renal tumor. Here, we present three cases of solitary metastatic/secondary tumor of the kidney, and discuss the features of the lesions on FDG PET in comparison with their appearance on CT.

Metastatic ocular melanoma to the kidney 20 years after initial diagnosis

Metastatic tumors are the most common malignancies of the kidney. We report a rare case of isolated metastatic ocular melanoma to the kidney occurring 20 years after diagnosis. A 71-year-old man presented with gross hematuria. He had undergone left enucleation 20 years previously for ocular melanoma and had not required adjuvant therapy. A right upper pole mass was identified on computed tomography and was excised laparoscopically. Pathologic examination revealed metastatic melanoma. Metastatic melanoma to the kidney is rare. A high index of suspicion must be maintained in any patient with a renal mass and a history of a nonrenal malignancy.

A renal mass in the setting of a nonrenal malignancy: When is a renal tumor biopsy appropriate?

BACKGROUND

Frequently, a renal mass is identified when patients with cancer undergo studies for staging or surveillance. In determining whether it represents a metastasis, patients are frequently subjected to percutaneous renal biopsies. The authors evaluated their experience with this dilemma to formulate management guidelines.

METHODS

The authors reviewed the medical records of 100 consecutive patients with nonrenal malignancies diagnosed with renal masses at presentation or follow-up. Renal mass histology was available for all patients after nephrectomy or biopsy. Clinical characteristics were assessed to identify factors predictive for a renal metastasis versus a primary renal neoplasm.

RESULTS

The only factors predictive of a metastasis to the kidney were progression of the nonrenal malignancy and lack of enhancement of the renal mass (P < 0.0001). Forty-six patients (46%) had evidence of progression of their nonrenal malignancy in addition to the renal mass. In these patients, the probability of a metastasis to the kidney was 86% (95% confidence interval [CI], 57.2-98.2%) without renal mass enhancement and 32% (95% CI, 14-55%) with enhancing renal masses. None of the 54 patients without signs of progression of their nonrenal malignancy proved to have metastases to the kidney, regardless of the imaging characteristics of the mass (zero probability; 95% CI, 0-7%; P < 0.001).

CONCLUSIONS

In patients presenting with renal masses and another clinically localized malignancy, renal mass biopsies were not indicated, as the mass rarely represented a metastasis. These patients may opt for close surveillance or extirpation based on the prognosis of their nonrenal malignancy.

Symptomatic renal metastasis 5 years after the management of a squamous cell carcinoma of the lung

A case of solitary renal metastasis five years after the management of a primary squamous cell carcinoma of the lung is presented.

Masa renal asintomática como primera manifestación de carcinoma folicular de tiroides

Metastases in the kidney are rare, evenmore if primary source is thyroid. We report the tenth case of metastases in the kidney from thyroid, and it is the first to be follicular type and absolutely asymptom. Sonography and computerized tomography with suspicion of renal tumour are showed in a asymtom female 75 years old. Left partial nephrectomy was perfomed, initially it has been pathologically diagnosed as renal clear cells tumour, however the definitive pathologic report showed follicular tumour of thyroid. Local and systemic stage was discovered with complementary techniques. Sources of metastases in kidney and diagnoses techniques are discussed.

Computed tomography of renal metastases

Since the advent of CT, secondary neoplastic lesions of the kidneys have been detected with increasing frequency. After reviewing a large series of cases of renal metastases, we have been able to classify the CT findings into seven major categories that are discussed and illustrated in this article. The differential diagnoses between metastatic disease of the kidneys and other lesions such as renal infarctions, renal lymphoma, and primary malignancies are also considered.

Metastatic osteosarcoma of the kidney presenting as renal hemorrhage

PURPOSE

Renal osteosarcoma may arise as a metastasis from a primary bone osteosarcoma or as a primary renal tumor. Metastatic renal osteosarcoma has been found at autopsy in approximately 10% of patients who die of this disease.

PATIENT AND METHODS

A case report of a young Chinese patient presenting with acute onset of renal infarction and hemorrhage from a renal metastasis of osteosarcoma is presented, as well as a review of the literature.

RESULTS

Some patients with solitary renal metastatic osteosarcoma may have long-term disease-free survival after nephrectomy. Early diagnosis and thus increased awareness of this condition is important.

Renal masses simulating primary renal cell carcinoma in patients with advanced malignancies

Most patients who present with a large solid renal mass and evidence of advanced malignancy will have primary renal cell carcinoma but a small subset with similar features have different and more treatable malignancies. We identified 7 patients with clinical and radiological findings suggestive of metastatic renal cell carcinoma who were ultimately diagnosed as have non-Hodgkin's lymphoma (5), germ cell tumor (1) or transitional cell carcinoma (1). Two of these patients presented with abdominal pain, gross hematuria and a flank mass. Computerized tomography was interpreted as showing renal cell carcinoma in all patients, although lymphoma and sarcoma were included in the differential diagnoses in 2. With the correct diagnosis and appropriate therapy, 4 of the 7 patients are currently disease-free. We emphasize the need for histological documentation in such patients in view of curative therapy available for possible underlying neoplasms simulating renal cell carcinoma.

Pseudotumor of left kidney due to sarcoidosis

Presence of granulomas in the kidney have been reported in up to 40 percent of patients with sarcoidosis. However, granulomatous infiltration producing renal enlargement with distortion of the normal renal contour, and mimicking renal "pseudotumor" is exceedingly rare and is the subject of this case report. Radiographic, scintigraphic, and histologic findings are presented.