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A Case of Epidermoid Carcinoma of the Larynx with Metastases to the Kidney
Vol. 102, Nov. Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright
© 1969 by The Williams
& Wilkins Co.
A CASE OF EPIDERMOID CARCINOMA OF THE LARYNX WITH METASTASES TO THE KIDNEY IGAL SILBER
AND
WILLIAM T. BOWLES
From the Department of Surgery, Division of Urology, Washington University School of Medicine, St. Louis, Missouri
The kidney is not an uncommon site of metastatic involvement by various tumors. Abrams and associates found the kidney involved in 12.6 per cent of 1,000 autopsy cases of various types of carcinoma.1 They found a similar incidence of 12.6 per cent metastatic disease involving the kidney in a series of 167 consecutive autopsy cases of breast carcinoma. In 119 consecutive cases of stomach carcinoma, renal involvement was found in 10.8 per cent. Klinger found 142 cases of metastatic disease involving the urinary tract in 5,000 consecutive autopsies (3 per cent)bilateral renal involvement was seen in 85 cases and unilateral renal involvement was seen in 33. 2 No patient with primary carcinoma of the larynx had distant metastatic disease in this series of 5,000 cases. Carcinoma of the larynx is well known for its tendency to metastasize to the adjacent lymphatics of the neck. Metastases below the clavicle are uncommon and, when seen, usually involve pulmonary tissue. Braund and Martin studied the distribution of distant metastases in 284 autopsies of patients who died of cancer of the upper respiratory and upper alimentary tracts. 3 Of these 284 cases, 55 cases of laryngeal cancer were noted, none of which showed metastatic spread to the kidneys. Pulmonary and hepatic metastases were most frequently seen in these 55 patients. Pietrantoni and Fior studied 570 autopsies performed on patients who died of cancer of the larynx and hypopharynx and found distant metastatic disease in 24 patients (4.15 per cent). 4 Metastases were
seen mostly in the lung and liver; no case of metastatic disease involved the kidneys. We thought that our case should be reported because of the observed rarity of renal involvement by metastatic epidermoid carcinoma of the larynx.
Accepted for publication December 3, 1968. 1 Abrams, H. L., Spiro, R. and Goldstein, N.: Metastases in carcinoma: analysis of 1000 autopsied cases. Cancer, 3: 74, 1950. 2 Klinger, M. E.: Secondary tumors of the genito-urinary tract. J. Urol., 65: 144, 1951. 3 Braund, R. R. and Martin, H. E.: Distant metastases in cancer of the upper respiratory and alimentary tracts. Surg., Gynec. & Obst., 73:
May 18, 1968. He had also noticed a sensation of a mass in the right side of his neck for 2 to 3 months. Laryngoscopy disclosed a polypoid mass in the area of the right arytenoid and right
63, 1941.
4 Pietrantoni, L. and Fior, R.: Clinical and surgical problems of cancer of the larynx and
CASE REPORT
A 57-year-old white man had hemoptysis for 3 weeks prior to admission to Barnes Hospital on
FIG. 1
hypopharynx; a review of 570 consecutive cases operated on in the Ear, Nose and Throat Clinic of the University of Milan between 1948 and 1954, with special regard to the problem of metastases. Acta Otolar., suppl. 142, 1958. 549
550
SILBER AND BOWLES
FIG. 2
FIG. 3
aryepiglottic folds. The right true vocal cord was mobile. A 2 cm. node was palpable in the right anterior cervical triangle. Biopsy disclosed undifferentiated epidermoid carcinoma of the right aryepiglottic fold. X-ray therapy was given and on July 8 partial laryngopharyngectomy and right radical neck dissection were done. Histological examination showed epidermoid carcinoma of the right aryepiglottic fold with one positive lymph node. Convalescence was uneventful.
The patient was re-admitted to the hospital in September for removal of his nasogastric tube. Two weeks prior to this admission he had had a brief episode of hematuria and right flank pain but he had been asymptomatic since then. Admission diagnostic studies were within normal limits. A chest film showed slight left ventricular enlargement and a small area of discoid atelectasis in the left lower lung field. An excretory urogram (IVP) showed a right lower pole renal mass. Cystoscopy was negative. A retrograde pyelogram showed lack of filling of the lower calyx on the right side with a suggestion of a widened lower pole in the right kidney (fig. 1). On September 5 a right renal arteriogram was performed. The arterial filling phase showed significant narrowing and a stretched out appearance of the intrarenal arteries of the inferior pole (fig. 2, A). The nephrographic phase showed pooling of the contrast material in tumor vessels (fig. 2, B). However, the vessels were not abundant like those seen in a typical case of hypernephroma. The diagnosis of metastatic carcinoma from the previous laryngeal carcinoma was considered unlikely. On September 9 a transabdominal
EPIDEHMOID CARCINOMA OF LARYNX WITH J:rf)NAL )IE'l'AS'l'ASBS
FIG. 4
right nephrectomy was performed. There was no evidence of metastatic disease in the liver or other abdominal viscera. Figure 3 shows the right kidney transected in t,he midline. There is a infiltration of the lower pole with a wide rriass. HistologicaJ examination showed pleo-
morphic squamous tumor cell~ growing in ne~t.s and cords in the renal parenchyma 4). No site of origin from pelvic urotheliurn. could be seen and the t.umor pattern was judged mwroscopicRlly identical to that of the ca.reinoma of tlw aryepigloUic fold
THE JOURNAL OF UROLOGY
Copyright
© 1969 by The Williams
& Wilkins Co.
A CASE OF EPIDERMOID CARCINOMA OF THE LARYNX WITH METASTASES TO THE KIDNEY IGAL SILBER
AND
WILLIAM T. BOWLES
From the Department of Surgery, Division of Urology, Washington University School of Medicine, St. Louis, Missouri
The kidney is not an uncommon site of metastatic involvement by various tumors. Abrams and associates found the kidney involved in 12.6 per cent of 1,000 autopsy cases of various types of carcinoma.1 They found a similar incidence of 12.6 per cent metastatic disease involving the kidney in a series of 167 consecutive autopsy cases of breast carcinoma. In 119 consecutive cases of stomach carcinoma, renal involvement was found in 10.8 per cent. Klinger found 142 cases of metastatic disease involving the urinary tract in 5,000 consecutive autopsies (3 per cent)bilateral renal involvement was seen in 85 cases and unilateral renal involvement was seen in 33. 2 No patient with primary carcinoma of the larynx had distant metastatic disease in this series of 5,000 cases. Carcinoma of the larynx is well known for its tendency to metastasize to the adjacent lymphatics of the neck. Metastases below the clavicle are uncommon and, when seen, usually involve pulmonary tissue. Braund and Martin studied the distribution of distant metastases in 284 autopsies of patients who died of cancer of the upper respiratory and upper alimentary tracts. 3 Of these 284 cases, 55 cases of laryngeal cancer were noted, none of which showed metastatic spread to the kidneys. Pulmonary and hepatic metastases were most frequently seen in these 55 patients. Pietrantoni and Fior studied 570 autopsies performed on patients who died of cancer of the larynx and hypopharynx and found distant metastatic disease in 24 patients (4.15 per cent). 4 Metastases were
seen mostly in the lung and liver; no case of metastatic disease involved the kidneys. We thought that our case should be reported because of the observed rarity of renal involvement by metastatic epidermoid carcinoma of the larynx.
Accepted for publication December 3, 1968. 1 Abrams, H. L., Spiro, R. and Goldstein, N.: Metastases in carcinoma: analysis of 1000 autopsied cases. Cancer, 3: 74, 1950. 2 Klinger, M. E.: Secondary tumors of the genito-urinary tract. J. Urol., 65: 144, 1951. 3 Braund, R. R. and Martin, H. E.: Distant metastases in cancer of the upper respiratory and alimentary tracts. Surg., Gynec. & Obst., 73:
May 18, 1968. He had also noticed a sensation of a mass in the right side of his neck for 2 to 3 months. Laryngoscopy disclosed a polypoid mass in the area of the right arytenoid and right
63, 1941.
4 Pietrantoni, L. and Fior, R.: Clinical and surgical problems of cancer of the larynx and
CASE REPORT
A 57-year-old white man had hemoptysis for 3 weeks prior to admission to Barnes Hospital on
FIG. 1
hypopharynx; a review of 570 consecutive cases operated on in the Ear, Nose and Throat Clinic of the University of Milan between 1948 and 1954, with special regard to the problem of metastases. Acta Otolar., suppl. 142, 1958. 549
550
SILBER AND BOWLES
FIG. 2
FIG. 3
aryepiglottic folds. The right true vocal cord was mobile. A 2 cm. node was palpable in the right anterior cervical triangle. Biopsy disclosed undifferentiated epidermoid carcinoma of the right aryepiglottic fold. X-ray therapy was given and on July 8 partial laryngopharyngectomy and right radical neck dissection were done. Histological examination showed epidermoid carcinoma of the right aryepiglottic fold with one positive lymph node. Convalescence was uneventful.
The patient was re-admitted to the hospital in September for removal of his nasogastric tube. Two weeks prior to this admission he had had a brief episode of hematuria and right flank pain but he had been asymptomatic since then. Admission diagnostic studies were within normal limits. A chest film showed slight left ventricular enlargement and a small area of discoid atelectasis in the left lower lung field. An excretory urogram (IVP) showed a right lower pole renal mass. Cystoscopy was negative. A retrograde pyelogram showed lack of filling of the lower calyx on the right side with a suggestion of a widened lower pole in the right kidney (fig. 1). On September 5 a right renal arteriogram was performed. The arterial filling phase showed significant narrowing and a stretched out appearance of the intrarenal arteries of the inferior pole (fig. 2, A). The nephrographic phase showed pooling of the contrast material in tumor vessels (fig. 2, B). However, the vessels were not abundant like those seen in a typical case of hypernephroma. The diagnosis of metastatic carcinoma from the previous laryngeal carcinoma was considered unlikely. On September 9 a transabdominal
EPIDEHMOID CARCINOMA OF LARYNX WITH J:rf)NAL )IE'l'AS'l'ASBS
FIG. 4
right nephrectomy was performed. There was no evidence of metastatic disease in the liver or other abdominal viscera. Figure 3 shows the right kidney transected in t,he midline. There is a infiltration of the lower pole with a wide rriass. HistologicaJ examination showed pleo-
morphic squamous tumor cell~ growing in ne~t.s and cords in the renal parenchyma 4). No site of origin from pelvic urotheliurn. could be seen and the t.umor pattern was judged mwroscopicRlly identical to that of the ca.reinoma of tlw aryepigloUic fold