[Renal clear-cell adenocarcinoma and type B lymphomatous proliferation: a fortuitous association?]

Occurrence of renal cell carcinoma and hematologic malignancies (predominantly lymphoid) in individuals and in families

The relationship between renal cell cancer (RCC) and hematologic malignancy (HM) in the same individual has been reported for more than 20 years, and is noted in SEER database studies. Family histories suggest a familial association as well. This study evaluates the occurrence of renal cell cancer and hematologic malignancies in individual patients and families, and the occurrence of age-of-onset anticipation among generations. Family history data from our familial patient registry, including more than 700 pedigrees of familial hematologic malignancies, and 700 patients with renal cell cancer, were reviewed. Twenty-six patients with a personal history of both RCC and HM are reported. Seventy four patients with RCC are noted to have 95 family members with HM. Consistent with past reports, there was male predominance among the patients with both diseases (71 %), and among the RCC patients' relatives with HM (57 %). Also consistent was a predominance of lymphoid malignancies in those with both diseases (92 %) and in the HMs among family members of RCC patients (79 %). The majority (95 %) of HM relatives were first or second degree relatives of the patient with RCC. Thirty of 34 parent/child pairs demonstrated age of onset anticipation in which the child developed either disease at a younger age than the parent. The co-occurrence of RCC and HM in the same patient has been shown to be significantly greater than expected. Families also appear to have an increased association. The appearance of anticipation suggests that genetic factors may be significant in this association of RCC and HM.

Synchronous and Metachronous Malignant Epithelial and Lymphoid Tumors: a Clinicopathologic Study of 10 Patients from a Major Tertiary Care Center in Pakistan

Case reports and case series documenting unfortunate patients with more than one malignant neoplasm are rare but well established. While majority of such patients have two malignancies, cases with three or even four malignant neoplasms in the same patient have been published in literature. A number of factors influencing carcinogenesis have been implicated in such cases including exposure to large amounts of radiation, chemotherapy for the original malignancy; prolonged history of heavy smoking and exposure to other environmental carcinogens; aging; and underlying genetic alterations. Concomitant multiple malignant neoplasms may be synchronous-two or more malignant neoplasms histologically distinct from each other, arising in the same site and detected simultaneously (for example during the same hospital admission) or detected one after the other in sequence in a period less than 6 months; or metachronous-two or more malignant neoplasms of similar or distinct histologic type detected at different times (after an interval of greater than 6 months) in different anatomic sites. Any combination of malignant tumors can occur in the same patient for example carcinomas with other carcinomas, carcinomas with Non-Hodgkin or Hodgkin lymphomas, carcinomas with mesotheliomas, carcinomas with sarcomas etc. We have reported several cases with multiple malignancies during our practice, and these cases were composed of the different combinations described above. The aim of the present study is to document 10 such cases of combined carcinoma and Non Hodgkin lymphoma in the same patient which were diagnosed in our section.

The association between renal cell carcinoma and multiple myeloma: insights from population-based data

OBJECTIVE

• To evaluate the hypothesis of an association between renal cell carcinoma and multiple myeloma.

PATIENTS AND METHODS

• Data from nine population-based registries in the Surveillance, Epidemiology and End Results programme were used to evaluate two separate cohorts of patients diagnosed between 1973 and 2006: patients diagnosed with renal cell carcinoma as a primary malignancy (n= 57,190) and patients diagnosed with multiple myeloma as a primary malignancy (n= 34,156). • We estimated standardized incidence ratios (SIRs) with corresponding 95% confidence intervals (CIs) by dividing the number of observed cases of multiple myeloma within the renal cell carcinoma cohort and the number of renal cell carcinoma cases within the multiple myeloma cohort by the number of expected cases for each malignancy in the US general population.

RESULTS

• The renal cell carcinoma cohort yielded 88 multiple myeloma cases during 293,511 person-years of follow up. Patients with renal cell carcinoma had a higher relative risk of multiple myeloma than the general population (SIR = 1.51, 95% CI 1.21-1.85). • The multiple myeloma cohort yielded 69 renal cell carcinoma cases during 100,804 person-years of follow up. Patients with multiple myeloma had a higher relative risk of renal cell carcinoma than the general population (SIR = 1.89, 95% CI 1.47-2.40).

CONCLUSION

• Our analyses revealed a bidirectional association between renal cell carcinoma and multiple myeloma, which typically indicates shared risk factors.

Concomitant renal cell carcinoma and lymphoid malignancies: a case series of five patients and review of the literature

Appearance of non-Hodgkin's lymphomas (NHL) and renal cell carcinoma (RCC) in same person has been reported in the literature. There is a higher-than-expected incidence of co-occurrence of these neoplastic disorders. The cause for this association remains speculative. Two epidemiological studies have shown that the observed-to-expected ratio for occurrence of RCC in NHL patients were 1.86 to 2.67. We herein describe five patients with both RCC and lymphoid malignancies, and reviewed possible explanations for the association. In three of the five patients, RCC was diagnosed during lymphoproliferative disease work-up, and remaining two cases had been diagnosed with chronic lymphocytic leukemia 1 and 5 years prior to RCC. All RCC cases were detected during staging of the primary tumor, usually by CT scan and/or ultrasound. Our data are in correlation with the literature that there is an increased association of RCC and NHL more often among male patients, and that the lymphoproliferative disease often presents with extranodal involvement. The specialists should be alerted for this possibility when evaluating patients at diagnosis or during follow-up.

Renal cell carcinoma with non-Hodgkin's lymphoma infiltration: a case report

The coexistence of renal cell carcinoma and non-Hodgkin's lymphoma is more common than expected in the general population; however, renal cell carcinoma with infiltration by non-Hodgkin's lymphoma has rarely been reported. Here we report on a 77-year-old patient who presented with small lymphocytic lymphoma in the jugulodigastric lymph node. He underwent nephrectomy for a renal mass 5 months later. On histopathological examination, the mass was diagnosed as a grade III renal cell carcinoma with infiltrated small lymphocytic lymphoma that was positive for B-cells (CD20). This case is discussed in terms of the coexistence of these tumors and tumor to tumor metastasis.

Renal parenchymal tumors and lymphoma in the same patient: case series and review of the literature

We reviewed the incidence of diagnosis of renal cell carcinoma and lymphoma in the same patient and analyzed the characteristics of this association. Nine patients in 4 years had the diagnosis of renal cell carcinoma (RCC) and lymphoma, including 2 with Hodgkin disease, 1 with chronic lymphocytic leukemia (CLL), and 3 each with low-grade follicular and intermediate-grade non-Hodgkin lymphoma (NHL). In SEER data, the observed/expected (O/E) ratio of NHL and RCC is 1.86 to 2.07. In our series, 2 patients were diagnosed with NHL after the diagnosis of RCC, 1 was diagnosed concurrently, and in the other 6, lymphoma preceded diagnosis of RCC. In reviews of second malignancies following treatment of Hodgkin disease, RCC is less common (O/E 1.5, with 1/3 being transitional cell carcinoma and 2/3 being adenocarcinoma). We report 2 cases with Hodgkin disease preceding RCC, and in both, Hodgkin disease occurred as an adult. There is a male predominance for patients with both diagnoses, which is greater than the male predominance for either RCC or NHL alone (2.2 vs. 2.0 vs. 1.2). There is an increased likelihood of the lymphoma being extranodal. There is an increased association of RCC and NHL more often among male patients, and often with extranodal lymphoma. Potential common etiological factors include prior treatment for malignancy, genetic predisposition, environmental factors, including a search for viral sequences, and possible immune dysregulation generating the lymphoma and subsequently leading to solid tumors such as RCC or melanoma.

Acute myelofibrosis in a patient with diffuse large cell non Hodgkin's lymphoma and renal cancer

Relapse after anthracycline based combination chemotherapy is frequently seen in patients with aggressive non Hodgkin's Lymphomas (NHL), whereas complications such as secondary leukemia or solid tumor rarely occur. We report a patient with diffuse large cell (DLC) NHL and concurrent renal cancer, who developed acute myelofibrosis (AMF) later in the course of her disease. This 60-year-old female patient presented with pancytopenia and a right sided renal mass. Diagnostic work up revealed severe bone marrow infiltration by DLC NHL and renal cancer T1N0M0G2. Cytogenetic and molecular evaluation of bone marow cells showed three distinct clones, (a normal 46XX karyotype, a ringed chromosome 7 and a third clone with an enlarged chromosome 2 as well as several fragments). The patient underwent nephrectomy and eventually received 6 cycles of CHOP 14 chemotherapy. Anemia persisted followed by severe granulocytopenia and thrombocytopenia 6 weeks later. Repeated bone marrow biopsy showed absence of lymphoma and/or cancer metastasis, but massive myelofibrosis with an increased number of atypical megakaryocytes. Considering the short clinical course and the absence of hepatosplenomegaly AMF was diagnosed. The concurrence of three distinctneoplasms within a short period of time as well as the complex cytogenetic aberrations found in her bone marrow cells reflect a strong individual susceptibility to malignant disease in this patient.