Renal cell carcinoma metastases. Review of unusual clinical metastases, metastatic modes and patterns and comparison between clinical and autopsy metastatic series

Isolated Urinary Bladder Metastasis in Renal Cell Carcinoma Detected on 18F-FDG PET/CT Scan

ABSTRACT

Renal cell carcinoma (RCC) is an aggressive carcinoma with hematogenous spread commonly to lungs, liver, and bones. However, few cases of isolated urinary bladder metastasis have also been reported. Here we report a case of 63-year-old man, a known case of left RCC (clear cell type), post left nephrectomy, who was on regular clinicoradiological follow-up. He presented with complaints of painless hematuria; on further evaluation, 18F-FDG PET/CT revealed few FDG-avid intramural nodular lesions along the walls of urinary bladder. He underwent TURBT, and the tissue was sent for histopathological examination, which was diagnostic of metastatic RCC.

Clear-cell renal cell carcinoma single urinary bladder metastasis: a case report and review of the literature

Renal cell carcinoma (RCC) is the most frequent solid lesion accounting for ~90% of all kidney malignancies. Clear-cell RCC (ccRCC) represents the most frequent subtype. Urinary bladder is a rare metastatic site either synchronous or metachronous. Hereby, we report the case of an 85-year-old male patient with a single urinary bladder metastasis due to ccRCC and we present a review of the literature.

Renal Cell Carcinoma Metastasis to the Breast: A Rare Presentation

Worldwide breast malignancy is the most common cancer in women; however, metastases to the breast from extramammary malignancies are very rare and only a few sporadic cases are reported in the international literature. In this article, the authors report a case of a 73-year-old woman, who underwent nephrectomy for clear cell renal cell carcinoma and 3 years later presented with a breast metastasis from renal cell carcinoma (clear cell type).

Metastatic clear cell renal cell carcinoma presenting as breast lump: A rare case report

Renal cell carcinoma is as an aggressive tumor associated with metastasis in about one-third of the cases, but it rarely metastasizes to breast, which further is a rare site of metastasis from extramammary solid tumors. Here, we report the case of a 60-year-old female who presented with breast metastasis from renal cell carcinoma. The mammogram showed a well-defined hyperdense mass of 2.5 × 2.7 cm with microlobulated margins. The mass was hypervascular on ultrasound. Further, contrast enhanced computed tomography (CECT) abdomen revealed a 6.3 × 6.0 × 6.2 cm mass arising from the middle and the lower pole of right kidney. Fine-needle aspiration cytology (FNAC) of the right breast lump, along with cellblock preparation from the aspirated material and immunohistochemistry (IHC) on the cellblock was performed. The tumor was positive for pan-cytokeratin, vimentin, and CD10, while the markers for primary breast carcinoma were negative. On the basis of morphology and IHC, the final diagnosis of the breast mass was metastatic clear cell renal cell carcinoma. This case highlights the importance of ruling out possibility of metastasis in cases of breast mass. The correct diagnosis of these cases is crucial since the mastectomy is not required. Here, we discuss the radiological and morphological features on cytology and cellblock of this rare case of breast metastasis from renal cell carcinoma.

Deceptive Features on Surveillance Imaging of Intraneural Metastatic Deposits in Metastatic Renal Cell Cancer

BACKGROUND

Spinal renal cell metastases are a common insidious pathological manifestation of the oncological process but less common are intramedullary and intraneural spinal metastases. The differential diagnosis of such pathological features can be difficult in the presence of conflicting radiological evidence.

CASE DESCRIPTION

In the present case report, we have detailed the clinical, diagnostic, surgical, and therapeutic progression of a 54-year-old man diagnosed with metastatic renal cell carcinoma. After the initial presentation and treatment, he had presented with symptomatic right lower limb radiculopathy. Magnetic resonance imaging identified a well-defined cystic lesion expanding in the right exit foramina at L5-S1, suggestive of a benign schwannoma. After a multidisciplinary review, he was treated symptomatically and imaging surveillance for a 19-month period, with static lesion findings. Failure of symptomatic management resulted in operative intervention and subsequent histological diagnosis of the metastatic deposit.

CONCLUSION

To the best of our knowledge, the present report is the first documented case of intraneural metastatic deposits from renal cell carcinoma that showed benign radiographic features and demonstrated a stable appearance on surveillance imaging studies for a significant period. These findings suggest that clinicians should have a high index of suspicion for a metastatic process in symptomatic patients with a known renal cell cancer regardless of the lesion's radiographic or temporal characteristics.

Breast metastasis nine years after nephrectomy for renal cell carcinoma: A case report

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We report an extremely rare case of breast metastasis from RCC.

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Including the present case, only 23 cases of breast metastasis from RCC have been described in the literature.

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It is important that the differential diagnosis of primary breast cancer and metastatic breast cancer be de determined by histological examination.

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Minimally invasive surgery or nonsurgical ablation should be performed in accordance with the prognosis.

Introduction

The breast is a rare site for metastatic disease. We report a rare case of breast metastasis 9 years after nephrectomy for renal cell carcinoma (RCC) and include a review of the relevant literature.

Presentation of case

An 82-year-old woman who developed an RCC underwent left nephrectomy in 2005. In October 2014, computed tomography (CT) revealed a mass of approximately 1 cm in the lateral portion of the right breast. Breast ultrasonography (US) revealed a well-circumscribed, hypoechoic mass at the same site. Fine needle aspiration (FNA) was performed, but the sample was inadequate because it did not capture breast duct epithelial cells. In June 2015, follow-up US revealed enlargement of the mass, and core needle biopsy (CNB) was performed to confirm the diagnosis. Histological examination resulted in the diagnosis of breast metastasis from an RCC. The patient underwent surgery for partial mastectomy in November 2015. The patient was asymptomatic and free of detectable disease at 18-month follow-up.

Discussion

The diagnosis of breast metastasis by imaging examination is difficult, and the results of FNA examination are often inconclusive because of the absence of breast duct epithelial cells. Only 22 cases of breast metastasis from RCC have been described in the literature. In almost all the reported cases, lumpectomy or partial mastectomy was performed.

Conclusion

It is important that histological diagnosis be determined by CNB and by other methods if the patient has a history of malignancy, and minimally invasive therapy should be performed in accordance with the prognosis.

Synchronous urinary bladder metastasis of chromophobe renal cell carcinoma

Urinary bladder metastasis in patients with renal cell carcinoma is rare and until now <70 cases have been documented in literature. Majority of these reported cases were histologically clear cell variant of renal cell carcinoma. Urinary bladder metastasis of chromophobe variant of renal cell carcinoma is extremely rare and is limited to only isolated case reports. We present here a case of a man aged 24 years who was diagnosed to have a left renal mass and right renal calculi on evaluation for complaints of left-sided abdominal pain and was incidentally detected to have suspicious bladder lesions during cystoscopy. Postoperative histopathology from the renal mass as well as the urinary bladder lesions showed chromophobe variant of renal cell carcinoma. The patient did not develop any recurrence on follow-up.

Interfascicular Renal Cell Carcinoma Metastasis to the Ulnar Nerve: A Case Report

BACKGROUND

Metastatic solid tumors to the hand and peripheral nerves are exceedingly rare independent occurrences. Their occurrence together has never been reported in the literature.

METHODS

We present a case report of a 69 year old male with a previous history of renal cell carcinoma (RCC) presenting with a rapidly-growing painful mass located at the right volar ulnar wrist, found to have endoneural solid tumor metastatic RCC to the ulnar nerve.

RESULTS

Preoperative MRI imaging of the wrist revealed a heterogeneous mass on the volar aspect of the wrist extending along the length of the ulnar artery and nerve to the level of Guyon's canal. Pathologic examination of an incisional biopsy of the mass was consistent with metastatic renal clear cell carcinoma cells, which were infiltrating nerve and surrounding soft tissue. The patient underwent local radiation therapy to the wrist and hand with interval decrease in size of the mass and symptom improvement.

CONCLUSION

Solid tumor metastasis, although exceedingly rare, must be considered in the differential diagnosis of a patient with previous cancer history presenting with a wrist or hand mass associated with peripheral neuropathy.

Metastatic renal cell carcinoma initially presented with a longitudinally extensive spinal cord lesion on MRI

A 48-year old male patient developed numbness in the lower half of the body 5 months after the curative operation of left renal cell carcinoma. Neurological examinations revealed the sensory disturbance below the T10 dermatome. A sagittal T2WI of the spinal MRI demonstrated a longitudinally extensive spinal cord lesion (LESCL) ranging from the C7 to L1 vertebral level. The neurological deficits rapidly deteriorated to paraplegia with bladder bowel disturbance. The high dose steroid pulse therapy showed temporary effect. The Gd enhanced T1WI of the spinal MRI taken on the 24th hospital day demonstrated a solitary intramedullary mass in the T8-9 level with ring enhancement, and a subsequent total resection of the tumor was performed. The histopathological studies of the tumor lead to the diagnosis of intramedullary spinal cord metastasis of the renal cell carcinoma. The post-operative T2WI of the spinal MRI revealed disappearance of the longitudinally extensive lesion. On the 112 hospital day, he was discharged with ambulatory aid. While solitary intramedullary spinal cord metastasis of renal cell carcinoma is quite rare, it should be suspected when the LESCL is revealed on a spinal MRI, even after the curative operation of the primary tumor.

Spontaneous regression of multiple pulmonary nodules in a patient with unclassified renal cell carcinoma following laparoscopic partial nephrectomy: A case report

Spontaneous regression of metastatic renal cell carcinoma (RCC) is rare, but well-documented in clear cell RCC. However, there are no reports on spontaneous regression of unclassified RCC. Since the radiological findings of pulmonary infarcts and inflammatory pseudotumors are similar to those of metastases from RCC, a definitive diagnosis is difficult without performing a histological examination. A 56-year-old woman underwent medical examination by a physician. An abdominal computed tomography (CT) scan revealed a 22-mm mass with a cystic area in the right kidney, as well as multiple enlarged lymph nodes in the common iliac, external iliac and groin areas, bilaterally. A chest CT revealed multiple pulmonary nodules bilaterally, the largest measuring 15 mm. Since the right renal tumor was suspected to be an RCC, laparoscopic partial nephrectomy was performed. The final pathological diagnosis of the renal tumor was unclassified RCC. One month following surgery, a CT scan revealed spontaneous regression of the pulmonary nodules. We herein present a rare case of spontaneous regression of pulmonary nodules in a patient with unclassified RCC following laparoscopic partial nephrectomy. To the best of our knowledge, this is the first case of spontaneous regression in unclassified RCC.

Renal cell carcinoma presenting with malignant ascites

It is rare for renal cell carcinoma to involve the peritoneum and cause malignant ascites. Furthermore, it is uncommon for malignant ascites to be a presenting feature of this cancer. An unusual case of renal cell carcinoma presenting with malignant ascites is reported, and its response to sunitinib described.

Bladder metastasis from renal cell carcinoma: retrospective analysis of 65 reported cases

This study was carried out to clarify the presentation, treatment options, and prognosis of renal cell carcinoma (RCC) metastasis to the bladder in which we do not yet have a comprehensive understanding. A systematic Medline, Web of Science, Embase, Google, and Ichushi Web search was performed to identify articles describing RCC metastasis to the bladder. The final cohort included 65 patients. The majority (75%) experienced gross hematuria at the point of diagnosis of RCC. RCC metastasis to the bladder occurred both synchronously (23%) and metachronously (77%), and the median time for metachronous bladder metastasis following the diagnosis of RCC was 33 months. Of the 58 patients whose metastatic data were available, 36 (62%) had metastasis to the bladder only, while 22 (38%) had additional sites of metastasis. On pathology, clear cell carcinoma was the most common histology (92%) and all bladder tumors were consistent with RCC metastasis; the median tumor size was 2.1 cm, and two-thirds of cases were superficial (non-muscle invasive) disease. The 2-year cancer-specific survival rate in patients with solitary bladder metastasis was 71.1%, which was significantly higher than in patients with additional distant metastasis (25.8%, p = 0.007). Regarding the interval after the diagnosis of primary RCC, the 2-year cancer-specific survival rate in patients who experienced bladder metastasis after more than a 1 year follow-up was 58.4%, compared to 34.6% in their counterparts (p = 0.063). A curative resection may provide a good possibility of long-term survival, particularly in those with a solitary bladder metastasis and/or a long interval after nephrectomy.

[Infratemporal metastasis from a renal cell carcinoma]

INTRODUCTION

Kidney cancer, particularly clear cell carcinoma, has an unpredictable clinical course with a variable metastatic potential in time. Some metastatic sites are atypical, such as head and neck (6% of cases). We report an extremely rare case of clear cell renal carcinoma with a metastasis in the infratemporal fossa.

OBSERVATION

A 67 year old male patient, operated in 2007 for a Fuhrman grade I clear cell carcinoma of the left kidney (radical nephrectomy), consulted for swelling of the left temporo-zygomatic region. A local biopsy allowed diagnosing clear cell renal carcinoma metastases. The patient was inoperable and was treated by antiangiogenic drugs.

DISCUSSION

The recommended treatment is surgical exeresis when the metastasis is single and can be resected. Antiangiogenic therapy is an alternative in other cases.

Malignant ascites and small renal mass: an unusual presentation of advanced renal cell carcinoma

Metastatic renal cell carcinoma (RCC) presenting with peritoneal involvement or ascites is rare and has been previously described clinically in the setting of large renal mass or other distant metastases. We report an unusual case of RCC presenting with ascites without large mass or other distant metastases. Advances in cytologic diagnosis of metastatic RCC in serous ascitic fluid is discussed, while a potential mechanism of tumor spread is presented.

Intradural cauda equina metastasis of renal cell carcinoma: a case report with literature review of 10 cases

STUDY DESIGN

Case report with literature review.

OBJECTIVE

To describe a rare case of intradural spinal metastasis from renal cell carcinoma (RCC) spread to the cauda equina, and to discuss the clinical features of metastatic RCC in the cauda equina from the data available in the literature.

SUMMARY OF BACKGROUND DATA

Intradural spinal metastasis is rare, representing 6% of all spinal metastasis. Indeed, intradural metastasis from a RCC to the cauda equina is extremely rare with previously only 9 case reports.

METHODS

A 68-year-old male presented with a 2-month history of worsening lower back pain radiating to both legs. The patient had undergone nephrectomy for the treatment of the clear cell RCC 16 years before admission. Magnetic resonance imaging showed a well-defined intradural extramedullary mass in the cauda equina at T12 to L1.

RESULTS

The pathological examination displayed metastatic clear cell RCC. Additional imaging studies showed no metastatic in other locations. The patient was discharged without neurological deficit and pain after the operation, and maintained an optimal condition for 2 years.

CONCLUSION

When a lesion of the cauda equina presents, intradural metastasis should be in the differential diagnosis in patients who had been previously treated for RCC although any other metastatic lesion was not observed.

LEVEL OF EVIDENCE

N/A.

Surgical treatment options and management strategies of metastatic renal cell carcinoma to the lumbar spinal nerve roots

Spinal nerve root metastasis of renal cell carcinoma is a rare occurrence. In addition to treatment of the primary lesion, surgical resection of the nerve root metastasis, occasionally with sacrifice of the involved nerve, is the accepted standard of treatment. Resection often resolves presenting motor and pain symptoms due to relief of neural compression. We describe two patients with nerve root metastasis of renal cell carcinoma and their management. While locally advanced and metastatic renal cell carcinoma has been shown to be chemo- and radio-resistant, immunotherapy is a promising treatment. Given the high prevalence of systemic disease in patients with intradural metastases, systemic (and possibly intracranial) imaging can be used to identify other potential areas of disease.

Breast metastasis from renal cell carcinoma: rare initial presentation of disease recurrence after 5 years

Metastasis to the breast from extra-mammary tumors is rare with only a few sporadic cases reported. We present a 58-year-old female patient diagnosed with renal cell carcinoma. Five years ago she had a radical nephrectomy and was free of disease, then discovered solitary breast mass following self-examination. The patient presented to the breast clinic for evaluation whereupon the breast mass was identified on physical and radiological examinations. Fine needle aspiration was diagnostic of metastatic renal cell carcinoma and subsequent imaging studies demonstrated multiple pulmonary deposits and recurrent renal mass in the tumor bed of the diseased site. In a multidisciplinary clinic, the patient was elected for excision biopsy followed by systemic tyrosine kinase inhibitor therapy. Six months later she had brain metastasis and received whole brain irradiation followed by palliative therapy. We are presenting this rare case with the aim of increasing awareness of breast secondaries.

[Cardiac metastasis of renal cell carcinoma, a rare location]

The renal carcinoma is situated in the third rank of the urologic cancers. It is metastatic in a third of the cases, when we made the diagnosis of the cancer. Lungs, bone, the liver, the suprarenal gland and the brain stay metastatic sites of preference. Some metastatic locations are anecdotal and made the object of some publications. We report the case of a cardiac metastasis of renal carcinoma at an old patient 81 years old operated for cardiac tumor.

Intradural spinal metastasis to the cauda equina in renal cell carcinoma: a case report and review of the literature

STUDY DESIGN

Case description.

OBJECTIVES

To describe a case of intradural metastasis from a renal cell carcinoma (RCC) spread to the cauda equina, and review the pertinent medical literature.

SUMMARY OF BACKGROUND DATA

Intradural spinal metastasis is rare, accounting for 6% of all spinal metastases. Only 7 cases of intradural metastasis from a RCC to the cauda equina have been previously reported.

METHODS

A 41-year-old male presented with a 1-month history of severe back pain radiating to both legs. The patient underwent a right nephrectomy for treatment of a RCC 1-year before admission. Magnetic resonance imaging showed a well-demarcated, intradural extramedullary mass at the L2 vertebra.

RESULTS

After a total laminectomy, total excision of the tumor was achieved followed by rapid improvement of the back pain. The tumor was histologically verified as metastatic RCC, identical to that of a previous tumor specimen. The patient was asymptomatic on the 1-year follow-up.

CONCLUSION

Although the majority of cauda equina tumors are primary tumors, intradural metastasis should be considered before surgery in patients with previously treated RCC.

Intradural spinal metastasis of renal cell cancer. Report of a case and review of 26 published cases

Metastatic disease in the intradural compartment of the spine is a rare manifestation of cancer. We report the case of an 82-year-old patient with an intradural, extramedullary metastasis of renal cell carcinoma in the cervical spine. A literature search for intradural spinal metastases of renal cell carcinoma yielded a total of 26 further cases. 18 patients had sporadic renal cell carcinoma, and 9 patients had von Hippel-Lindau disease (VHL) in which the metastases of the renal cell carcinoma were embedded within spinal haemangioblastomas. Patients presented with paresis, back pain, altered sensation or, less frequently, bladder dysfunction. Intradural spinal metastases were diagnosed at an earlier age in VHL patients than in sporadic cases (mean 43 +/- 5 years vs. 60 +/- 14.5 years). The metastasis was surgically removed in 81% of patients. Pain improved in all patients, paresis in 90%, hypaesthesia in 38% and bladder dysfunction in 50%. Death occurred as a result of systemic cancer progression. 93% of patients in the sporadic renal cell cancer group died within 1.5 years, whereas two thirds of the VHL patients were alive after 2 years.

Thyroid metastases of renal cell carcinoma: clinical course in 45 patients undergoing surgery. Assessment of factors affecting patients' survival

BACKGROUND

Metastases of renal cell carcinoma (RCC) to the thyroid gland are uncommon. There is no clear consensus regarding the role of surgery in metastatic disease to the thyroid since most clinical studies include small numbers of patients. Also, risk factors associated with disease progression following thyroidectomy are not yet defined. We examined the determinants of the outcome in patients undergoing surgery for thyroid metastases of RCC.

METHODS

The medical records of 45 patients undergoing resection of thyroid metastases of RCC at 15 institutions in Germany and Austria were reviewed retrospectively. The outcome parameters assessed were overall survival and tumor-related survival. Factors associated with disease progression following thyroid surgery have been calculated.

RESULTS

The overall 5-year survival rate following thyroid metastasectomy was 51%. Nineteen patients died during the study: 14 of disseminated disease and 5 of non-tumor-related causes. In the multivariate analysis, the prognosis was significantly worse in patients older than > or = 70 years and in patients who had undergone nephrectomy for metastases in the contralateral kidney during the course of the disease. Nine patients developed a thyroid recurrence following surgery. No local disease relapse occurred if resection margins were documented to be free of the tumor. Of the 45 patients with thyroid metastases, 14 (31%) developed pancreatic metastases during the course of disease. Ten of these patients also underwent pancreatic surgery with a 5-year survival rate of 43% in this subgroup.

CONCLUSIONS

The overall survival of patients undergoing thyroidectomy for metastases of RCC is affected rather by general health status than by tumor-related factors. There is a significant coincidence of thyroid and pancreatic metastases of RCC.

Renal cell carcinoma metastases to the thyroid gland-8 cases reported

OBJECTIVE

Clinically important, isolated metastases to the thyroid gland is a rare occurrence. Renal cell carcinoma (RCC) is the most common primary tumor site. We report on 8 cases of late onset metachronous thyroid metastases of RCC.

DESIGN

Eight patients presented with metachronous thyroid metastases at a median of 12 years (range 9-18 years) after nephrectomy for RCC. Two patients had simultaneous lung and lymph node metastases, respectively. Four patients had been previously operated for other metastases 1 to 5 years earlier, three of them due to pancreatic metastases. The leading symptom was neck enlargement in all but one case.

MAIN OUTCOME

Four total thyroidectomies, 3 subtotal resections, and 1 lobectomy were performed. Complete removal of metastases were achieved in all but one case. There was no postoperative morbidity. Six metastases were bilateral, two unilateral. The 4 year overall survival rate following metastasectomy was 53%, median survival from the date of nephrectomy was 21 years.

CONCLUSION

Long-term survival can be achieved after resection of isolated metachronous RCC metastases to the thyroid gland. Total thyroidectomy is not required, unless it is necessary for complete metastasectomy.

[Unusual metastasis of renal carcinoma]

Renal carcinoma, the third most common urological cancer, induces presence of metastases in 75% of cases. The most affected sites for metastasis are the lungs, the lymphatic system, bones, the liver, adrenal glands and the brain with sometimes a cancer free period of several years prior to evolutionary recurrence of the disease. The aim of this literature review is to report on secondary uncommon renal localizations by underlining their clinical significance, as well as main characteristics, in order to provide guidelines for effective patient diagnosis and therapeutic management.

Solitary breast mass as initial presentation of clinically silent metastatic renal cell carcinoma

Metastasis to the breast from extramammary tumors is rare. Breast metastases of renal cell carcinoma (RCC) origin have been described in sporadic case reports. We present a patient with a solitary breast mass representing the manifestation of clinically silent, metastatic RCC. A 76-year-old female was 12 years prior removed from radical nephrectomy for localized RCC. Her new breast mass was identified on physical examination. Pathology of the resected mass was diagnostic of metastatic RCC and subsequent imaging studies demonstrated a 1.9 cm renal mass in her solitary kidney. The patient elected subcutaneous Interleukin-2 immunotherapy as primary treatment for her recurrent RCC.

Metastatic renal clear cell carcinoma mimicking stage IV lung cancer

We present a 63-year-old man who was investigated for a lesion in the apex of the left lung and a coexisting osteolytic lesion in the right major trochanter. FNA of the thoracic mass was suggestive for malignancy yet not diagnostic regarding the tumor type and the site of the primary tumor. A diagnosis of a stage IV lung cancer was favored and he underwent a left exploratory thoracotomy in view to resect the primary tumor. An extrapulmonary mass localized to the pleura not involving the ipsilateral lung was disclosed. Multiple biopsies revealed metastatic clear cell RCC. A 5 x 7 cm left renal tumor was revealed in a postoperative abdominal CT scan. He was treated with combination of interferon A and vinblastin followed by radical nephrectomy. Twenty-four months after the diagnosis he is alive without evidence of local or distant recurrence. Pleural metastases from RCC are mainly presented as malignant pleural effusions. Thoracic metastatic lesions localized to the pleura, forming solitary or multiple mass(es) have been rarely reported. We review the literature regarding this rare clinical manifestation of the disease and we discuss diagnostic and therapeutic options.

Clinicopathological factors predicting recurrence of N0M0 renal cell carcinoma: A case series analysis of one facility

BACKGROUND

Although many factors have been reported as predictors of the recurrence of renal cell carcinoma (RCC), none of the factors are consistent among different studies. In the study presented here, the potential clinicopathological predictors of the recurrence of N0M0 RCC were examined.

METHODS

A total of 201 patients who underwent nephrectomy for N0M0 RCC were examined to determine the pathological tumor stage (pT stage), pathological tumor grade of malignancy (tumor grade), symptoms, and tumor size.

RESULTS

RCC recurred in 29 patients (14.4%), 50% of whom developed new tumors within 24 months after nephrectomy. The disease-free 3- and 10-year survival rates declined as the pT stage and tumor grade increased: these rates were, respectively, 98.6% and 86.5% for pT1a; 93.7% and 87.9% for pT1b; 100% and 100% for pT2; 78.6% and 58.0% for pT3a; and 88.9% and 16.7% for pT3b. Significant differences in the recurrence rate were noted between pT3 and pT1 or pT2, as well as between grade 3 disease and grade 1 or grade 2 tumors. Multivariate analysis showed that a combination of the pT stage, grade, and presence of symptoms was useful for predicting the recurrence of RCC.

CONCLUSION

The present study showed that patients undergoing nephrectomy for N0M0 RCC should be followed-up carefully for 2 years postoperatively with special attention to high pT stage, high grade, and the development of symptoms.

Unusual metastasis to the cauda equina from renal cell carcinoma

STUDY DESIGN

This is a case report of a patient with renal cell carcinoma and intradural metastasis to the cauda equina.

OBJECTIVE

To present a rare case of an intradural metastasis from renal cell carcinoma and to discuss the clinical features of metastatic tumors in the cauda equina and the possible mechanism of the tumor spread to the cauda equina.

SUMMARY OF BACKGROUND DATA

Intradural spinal metastasis has been rarely reported in the English literature. Only two reports that describe the spread of metastatic renal cell carcinoma to the cauda equina have been published.

METHODS

A 61-year-old man who underwent a nephrectomy for the treatment of renal cell carcinoma presented with worsening low back pain that radiated to both legs. Magnetic resonance imaging showed an ill-defined tumor mass in the cauda equina at L3. After a recapping T-saw laminoplasty of L3 was performed, the tumor was excised and the nerves involved in the tumor were transected.

RESULTS

Pathologic examination showed papillary renal cell carcinoma with identical histology to the primary tumor. The patient's low back pain and radiating leg pain were relieved after operating.

CONCLUSION

The majority of cauda equina tumors are primary tumors, and metastases are very rare. Intradural spinal metastasis pain is a characteristic cramping pain provoked by light percussion on the lumbar spine, becoming severe when sleeping in the flexion or sitting position. Magnetic resonance imaging is a useful tool for detecting intraspinal metastasis when the patient is complaining of a unique pain. A recapping T-saw laminoplasty to preserve posterior elements with tumor removal is feasible for relieving pain and demonstrating the pathology.

[Renal cell carcinoma metastasis in a microfollicular adenoma of the thyroid gland]

A 60-year-old woman had a nephrectomy of her left kidney because of a renal cell carcinoma. She came to us for an oncologic F-18-fluordeoxyglucose-positron emission tomography (F-18-FDG-PET). In the positron emission tomography there was a pathologic fluordeoxyglucose-uptake in the left thyroid gland lobe. Thyroid investigation and Tc-99 m pertechnetate scintigraphy of the thyroid gland was done. It showed a hyperfunctioning nodule in the left thyroid gland lobe. Surgery was suggested. Histology showed a metastasis of a clear cell renal carcinoma in a microfollicular adenoma of the thyroid gland--a very rare combination.

Intramedullary spinal cord metastasis (ISCM) in renal cell carcinoma: a series of six cases

Intramedullary spinal cord metastasis (ISCM) has been infrequently diagnosed during the clinical course of renal cell carcinoma (RCC). With the advent of more sensitive diagnostic procedures including magnetic resonance imaging (MRI), more cases of ISCM have been documented. The management of these cases is particularly challenging as lack of prompt intervention often results in irreversible progressive neurological deficits. We describe the management and clinical course in six patients with RCC who developed ISCM. Two of these patients were treated surgically while four were treated with radiation therapy (RT). Although no major improvements in neurological function were noted, stabilizations were common. This prolonged their ability to live independently, a matter of utmost importance in these terminally ill patients.

Solitary breast metastases from a renal cell carcinoma

A case of solitary and metachronous breast metastases from a renal cell carcinoma is described nine years after surgery. The review of the literature proves that the breast is an unusual site for metastatic disease.

Renal cell carcinoma metastasizing to the thyroid gland

Renal cell carcinoma represents 3% of all adult malignancies. Metastases occur most frequently in the bone and lung. Four cases of renal cell carcinoma metastasizing to the thyroid gland are described here. A literature review is presented and guidelines for the management of this rare condition are suggested.

Simultaneous contralateral testicular metastasis from a renal clear cell carcinoma

The case of a 66-year-old male with a right renal cell carcinoma and a left testicular mass is reported. Radical nephrectomy and contralateral orchidectomy were performed. Histology revealed a metastasis of the renal cell carcinoma of clear cell type into the left testis. The patient died seven months post-operatively of disseminated lung metastases. The case demonstrates the multi-ocular metastatic potential of renal cell carcinoma.