Unusual Metastasis in Renal Cell Carcinoma
- Affiliations
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- 1Department of Urology, College of Medicine, Dong-A University, Busan, Korea. urobone@korea.com
- 2Department of Urology, Kang Nam Urology Clinic, Korea.
- KMID: 2061262
- DOI: http://doi.org/10.4111/kju.2007.48.5.548
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.
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MeSH Terms
Figure
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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.
Fig. 2 The tumor cells show clear cytoplasms surrounded by distinct cell membranes and small, round, uniform nuclei with inconspicuous nucleoli (H&E, ×40).
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.
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.
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).
Fig. 6 The submucosa and muscle layer are invaded by the tumor cells, the same as those of the kidney (H&E, ×40).
Reference
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