Journal List > Korean J Urol > v.48(5) > 1004926

Kwak, Cho, Seo, Kim, and Cho: Unusual Metastasis in Renal Cell Carcinoma

Abstract

Approximately one-third of all patients with renal cell carcinoma have metastasis at the time of diagnosis. Metastatic lesions of renal cell carcinoma are most commonly seen in the lung, and they are frequently seen in the bone and liver. However, spleen and rectal metastases are extremely rare. A 63-year-old man had undergone left radical nephrectomy for renal cell carcinoma. About 22 months later, computed tomography revealed multiple enhanced masses in the spleen. Spleen metastasis was suspected and splenectomy was then performed. One year later, the patient visited with complaints of voiding difficulty. A huge pelvic mass was detected by performing prostate ultrasonography and MRI. The mass was 13cm in diameter and it was between the rectum and the prostate. Removal of the pelvic mass and lower anterior resection with end colostomy was done. Histologically, the resected specimens were diagnosed as metastases from the renal cell cancer. Herein, we report on a case of metachronous splenic and rectal metastasis from renal cell carcinoma.

Figures and Tables

Fig. 1
There is a 6cm sized well marginated mass lesion in the upper pole of left kidney (arrow). The mass is confined to the renal capsule. Renal cell carcinoma of the left kidney is suggested.
kju-48-548-g001
Fig. 2
The tumor cells show clear cytoplasms surrounded by distinct cell membranes and small, round, uniform nuclei with inconspicuous nucleoli (H&E, ×40).
kju-48-548-g002
Fig. 3
There are multiple low attenuated lesions in the spleen (arrow). There is no abnormal mass lesion in the left renal fossa. Multiple splenic metastases are suggested.
kju-48-548-g003
Fig. 4
There is a huge well defined mass lesion between the rectum and the prostate. This mass shows intermediate signal intensity on the T2 weighted image. There are necrosis and hemorrhage in the central portion.
kju-48-548-g004
Fig. 5
The pelvic mass was measured 14.5×7.5cm in dimension. The surface of the mass is grayish and covered with fibrinous exudate (A). The segment of large intestine measured 36cm in length and 13cm in maximum circumference. The serosal surface shows focal fibrotic adhesion and it is focally covered with hemorrhagic exudate (B). On sectioning, the mass shows a yellowish granular appearance with focal hemorrhage and necrosis (C).
kju-48-548-g005
Fig. 6
The submucosa and muscle layer are invaded by the tumor cells, the same as those of the kidney (H&E, ×40).
kju-48-548-g006

References

1. Golimbu M, Joshi P, Sperber A, Tessler A, Al-Askari S, Morales P. Renal cell carcinoma: survival and prognostic factors. Urology. 1986. 27:291–301.
2. Russo P. Renal cell carcinoma: presentation, staging, and surgical treatment. Semin Oncol. 2000. 27:160–176.
3. Imada H, Nakata H, Horie A. Radiological diagnosis of splenic metastasis and its prevalence at autopsy. Nippon Igaku Hoshasen Gakkai Zasshi. 1991. 51:498–503.
4. Rosito MA, Damin DC, Lazzaron AR, Andre C, Schwartsmann G. Metastatic renal cell carcinoma involving the rectum. Int J Colorectal Dis. 2002. 17:359–361.
5. Lee DH, Yang KM, Lee KW, Oh YT, Hong SJ. Contralateral testicular single metastasis from renal cell carcinoma. Korean J Urol. 2006. 47:108–109.
6. Kim HW, Kim SH, Min KO, Cho SY. Renal cell carcinoma detected by solitary vaginal metastasis. Korean J Urol. 2005. 46:770–772.
7. Tatsuta M, Shiozaki K, Masutani S, Hashimoto K, Imamura H, Ikeda M, et al. Splenic and pulmonary metastases from renal cell carcinoma: report of a case. Surg Today. 2001. 31:463–465.
8. Chinegwundoh FI, Khor T, Leedham PW. Bladder metastasis from renal cell carcinoma. Br J Urol. 1997. 79:650–651.
9. McGregor DH, Wu Y, Weston AP, McAnaw MP, Bromfield C, Bhattatiry MM. Metastatic renal cell carcinoma of spleen diagnosed by fine-needle aspiration. Am J Med Sci. 2003. 326:51–54.
10. O'dea MJ, Zincke H, Utz DC, Bernatz PE. The treatment of renal cell carcinoma with solitary metastasis. J Urol. 1978. 120:540–542.
TOOLS
Similar articles