Investig Magn Reson Imaging.  2017 Jun;21(2):119-124. 10.13104/imri.2017.21.2.119.

Seeding Metastasis of Chromophobe Renal Cell Carcinoma after Robot-Assisted Laparoscopic Partial Nephrectomy

Affiliations
  • 1Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. cmh@catholic.ac.kr

Abstract

Chromophobe renal cell carcinoma (RCC) is an uncommon subtype of RCC having a better prognosis than clear cell RCC. Although there are several reports of seeding metastasis of RCC after biopsy, seeding metastasis of chromophobe RCC after surgical resection has seldom been reported. Here, we describe a case of multiple seeding metastases in the abdomen and pelvis 78 months after robot-assisted laparoscopic partial nephrectomy, without prior history of biopsy for chromophobe RCC in the right kidney. As magnetic resonance imaging (MRI) of the pelvic mass showed a similar appearance to the primary renal mass and displayed separate margins with the rectum and prostate gland, we were able to make a diagnosis before pathologic confirmation.

Keyword

Chromophobe renal cell carcinoma; Seeding metastasis; Partial nephrectomy; Magnetic resonance imaging

MeSH Terms

Abdomen
Biopsy
Carcinoma, Renal Cell*
Diagnosis
Kidney
Magnetic Resonance Imaging
Neoplasm Metastasis*
Nephrectomy*
Pelvis
Prognosis
Prostate
Rectum

Figure

  • Fig. 1 A 71-year-old man with an 11.4-cm-sized mass in the pelvic cavity. (a) Pelvic CT scan showed a mass with lobulated contour with heterogeneous enhancement and a non-enhancing portion in the center. The mass compressed the urinary bladder and the rectum. (b) Abdominal CT scan showed another similar mass (arrow) in the right upper quadrant (RUQ) of the abdomen.

  • Fig. 2 A 71-year-old man with an 11.4-cm-sized mass in the pelvic cavity. (a) T2-wegithed sagittal image showed that a huge mass compressed the prostate gland, whereas the rectum had a clear margin. (b) T2-weighted axial image showed low signal intensity in peripheral portion and high signal intensity in central portion of the mass, with thin low signal intensity capsule. (c) Contrast-enhanced T1-weighted axial image displayed heterogeneous enhancement of the mass. Diffusion-weighted image (d) and apparent diffusion coefficient (ADC) map (e) showed definite diffusion restriction in peripheral solid portion.

  • Fig. 3 Initial MRI of right kidney mass that was confirmed as chromophobe renal cell carcinoma. The mass showed lower signal intensity than the renal parenchyma, with a central high signal intensity portion and thin low signal intensity capsule, on T2-weighted coronal image (a). Contrast-enhanced T1-weighted coronal image (b) showed the spoke-wheel-like enhancement in the mass (arrow).

  • Fig. 4 The specimens obtained by partial resection of right kidney (a) and ultrasound-guided transrectal biopsy (b). The tumor showed typical features of chromophobe RCC, including pale eosinophilic cytoplasm with distinct cell membranes and perinuclear halos (Hematoxylin & Eosin staining, × 400).


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