Asynchronous abdominal wall and sigmoid metastases in clear cell renal cell carcinoma: A case report and literature review

Cecal Metastasis of Clear Cell Renal Cell Carcinoma After Previous Nephrectomy

Metastasis of renal cell carcinoma (RCC) to the gastrointestinal (GI) tract is exceedingly rare. We present a case of a man in his 40s with a history of RCC that had metastasized to his abdominal wall and brain who then presented with abdominal pain and melena. On presentation, imaging showed new bone metastases and a colonic mass in the ascending colon. The biopsy of the mass from colonoscopy demonstrated RCC primary. Although rare, this case report highlights the importance of a thorough evaluation of patients with a history of RCC and considers GI tract involvement in those presenting with GI bleeding.

Late recurrence of chromophobe renal cell carcinoma to unusual sites after 12 years of radical nephrectomy and radiotherapy: a rare case report from Syria

In 2020, renal cell carcinoma (RCC) had an incidence of 73 750 new cases. This cancer is well known for its ability to give early and late metastases to some usual and unusual sites. The term 'late recurrence' is widely used to indicate a period exceeding 10 years from curative nephrectomy. This not-understood behaviour is almost specific to RCC, and it happens in a range between 4.3 and 11% of cases of RCC.

Case Presentation

We report a case of a 67-year-old nonalcoholic smoker Syrian male presented with a 2-month painful mass located at the left upper posterolateral abdominal wall's region. He has had a history of left chromophobe cell RCC treated with radical nephrectomy with adjuvant radiotherapy for 12 years. In light of computed tomography's findings, a surgical biopsy was performed, and a pathological and immunohistochemical examination confirmed the diagnosis of chromophobe RCC.

Clinical Discussion

Malignant cells seeding the surgical cut path and staying dormant for 12 years is the best theory of many to explain our case.

Conclusion

We reported evidence for the potential of a relatively indolent histologic type of RCC (i.e. chromophobe cell carcinoma) to cause late recurrence after 12 years to a very rare site (i.e. abdominal wall's superficial muscles). Research should focus on addressing late recurrence to determine the best surveillance protocols; investigating malignant cells seeding during surgery to improve surgical oncology's outcomes; and studying late recurrence's genetics to boost our targeted therapy options.

Laparoscopic right hemicolectomy for metastatic renal cell carcinoma in the ascending colon: A case report

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Although it is rare, renal cell carcinoma can metastasize to the colon.

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Colonic metastasis can cause abdominal symptoms, hematochezia, or anemia.

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Resection of colonic metastasis, if solitary, may result in long-term prognosis.

Introduction

Renal cell carcinoma (RCC) arises from the renal parenchyma and is the most common primary malignancy of the kidney. RCC frequently metastasizes to the lung, bone, lymph nodes, and other locations, but rarely to the colon. We report a case of metastatic RCC of the ascending colon that was successfully resected with laparoscopic right hemicolectomy.

Presentation of case

The patient is a 65-year-old man who developed hip joint pain and was diagnosed with polymyalgia rheumatica during the first year after laparoscopic right nephrectomy for right RCC. A screening colonoscopy was performed and a tumor was found in the ascending colon. Biopsy strongly suggested metastatic RCC. No other distant metastases were found, and laparoscopic right hemicolectomy was performed. The tumor extended from the mucosa to the subserosa and was diagnosed histopathologically as colonic metastasis of RCC. There were no lymph node metastases in the simultaneously resected mesentery, but venous invasion was observed.

Discussion

RCC can metastasize to various organs, but metastasis to the colon is extremely rare. In cases of colon metastasis, abdominal symptoms, hematochezia, or anemia may occur, and their occurrence should be checked during follow-up. Based on past reports, resection of metastatic lesion is considered the most appropriate treatment.

Conclusion

Although it is rare for RCC to metastasize to the colon, it is possible. Resection can be recommended for colon metastasis with no other metastases, and colectomy with R0, including the regional mesocolon, may provide a favorable long-term prognosis.

Identification of significant genes with prognostic influence in clear cell renal cell carcinoma via bioinformatics analysis

Background

Clear cell renal cell carcinoma (ccRCC) is the most common malignant tumor of kidney with high mortality. The pathogenesis of ccRCC is complicated and effective prognostic predictors for clinical practice are still limited. This study aimed to identify significant genes with prognostic influence in ccRCC via bioinformatics analysis.

Methods

Four gene expression profiles were acquired from the Gene Expression Omnibus (GEO) database, including 168 ccRCC tissues and 143 normal tissues. Common differentially expressed genes (DEGs) between ccRCC tissues and normal kidney tissues were screened out. Then gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were investigated. Protein-protein interaction (PPI) network of the common DEGs was diagrammed and analyzed. Kaplan–Meier analysis was conducted to identify genes with prognostic influence in ccRCC. Gene Expression Profiling Interactive Analysis (GEPIA) was finally applied to validating differential expression of genes.

Results

Ninety-nine common DEGs between ccRCC tissues and normal kidney tissues were eventually screened out (P<0.05, |log FC| >2). GO functional analysis showed that the down-regulated genes were enriched in excretion, negative regulation of cell proliferation, heparin binding and cellular response to BMP stimulus, etc. KEGG pathway analysis indicated that the common DEGs were particularly enriched in HIF-1 signaling pathway and aldosterone-regulated sodium reabsorption. Seven core DEGs were distinguished through PPI network analysis, of which 6 core genes ANGPTL4, CA9, CXCR4, LOX, EGF and HRG showed significantly prognostic difference in patients with ccRCC by Kaplan–Meier analysis (P<0.05). And GEPIA confirmed these genes were expressed differentially between tumor and normal tissues (P<0.05). High expression of HRG was correlated with good OS in ccRCC patients. Specifically, HRG was commonly down-regulated in ccRCC tissues compared with normal tissues according to GEPIA.

Conclusions

Our study shows that high expression of HRG denotes a better prognosis in ccRCC patients. HRG is down-regulated in ccRCC tissues compared with normal kidney tissues. The selective expression pattern suggests that HRG could be a novel prognostic predictor and potential therapeutic target for ccRCC patients.

Colonic metastasis of renal cell carcinoma following curative nephrectomy: A case report and review of the literature

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Colonic metastasis of the renal cell carcinoma (RCC) following curative nephrectomy is an extremely rare.

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Early diagnosis of colonic metastasis of the RCC is an important for survival.

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Surgical resection is a effective treatment method for colonic metastasis of the RCC.

Introduction

Renal cell carcinoma (RCC) is a rare tumor that comprises only 3% of adult cancers, while renal parenchymal tumors constitute 85% of all RCC cases. RCC frequently metastasizes to the lungs, bones, brain or liver; however, the gastrointestinal tract, particularly the colon, is an unusual location for metastasis.

Case report

A 63-year-old male patient was admitted complaining of hematochezia. The patient had undergone left-side nephrectomy for RCC, 5 years previously. Computed tomography and colonoscopy detected a splenic flexure tumor and after left hemicolectomy and splenectomy, histopathological examination revealed a colonic metastasis of the renal cell carcinoma.

Discussion

Cases of colonic metastasis following resection of a RCC are uncommon in the literature and their location can be very varied, but include the sigmoid colon, splenic flexure, transvers colon and hepatic flexure. Recurrence of RCC is frequently seen during the first three postoperative years, and surgical resection is suggested for solitary non-metastatic tumor.

Conclusion

RCC rarely metastases to the colon but may occur years after curative resection. Therefore, RCC patients should be closely followed for the long term. In case of isolated metastasis, long-term survival can be achieved with R0 resection.