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A SOLITARY METASTASIS OF RENAL CELL CARCINOMA TO THE URETHRA
0022-5347/00/1634-1245/0 THE JOURNAL OF UROLOGY® Copyright © 2000 by AMERICAN UROLOGICAL ASSOCIATION, INC.®
Vol. 163, 1245–1246, April 2000 Printed in U.S.A.
A SOLITARY METASTASIS OF RENAL CELL CARCINOMA TO THE URETHRA SATOSHI FUKATA, KEIJI INOUE,* TOSHIAKI MORIKI
AND
TARO SHUIN
From the Department of Urology and Clinical Laboratory, Kochi Medical School, Kochi, Japan KEY WORDS: carcinoma, renal cell; neoplasm metastasis; urethra
Renal cell carcinoma generally metastasizes widely. A solitary metastasis of renal cell cancer to the urethra is rare and its etiology is unclear. We report a case of a solitary metastasis to the urethra from previously resected renal cell cancer.
CASE REPORT
A 77-year-old man presented with painless urethral bleeding 1 week in duration. History revealed that 5 years earlier he had undergone right radical nephrectomy for localized pT2N0M0 renal cell carcinoma. Surgical margins were tumor-free on microscopic examination. Histology was consistent with common type, clear cell subtype adenocarcinoma. At 3-year followup chest computerized tomography (CT) revealed 3 ⫻ 3 cm. and 2 ⫻ 2 cm. lesions in the left lung. However, there were no malignant findings on histological assessment of needle biopsy under CT guidance, and the tumors did not change in size. At 5-year followup the patient had asymptomatic urethral bleeding. Cystoscopy revealed a globular yellow mass on a stalk in the membranous urethra (fig. 1). Metastatic evaluation with CT of the abdomen, excretory urography of the upper urinary tract and bladder, cystoscopy and bone scan was negative. Furthermore, urinary cytology consistently revealed no malignancy. Transurethral resection of the lesion yielded tissue consistent with renal cell carcinoma (fig. 2). Although adjuvant therapies including interferon were recommended, the patient declined further treatment. At 6-month followup the patient was disease-free. He is being followed on an outpatient basis.
DISCUSSION
Renal cell carcinoma is the third most common genitourinary malignancy in the United States. It is diagnosed in Accepted for publication November 5, 1999. * Requests for reprints: Department of Urology, Kochi Medical School, Nankoku, Kochi, 783-8505 Japan.
FIG. 1. Cystoscopy shows globular yellow mass on stalk in membranous urethra.
about 29,900 patients annually and resulted in about 11,600 deaths in 1998.1 Approximately a third of patients with renal cell carcinoma have metastasis at presentation. Common metastatic sites are lung, bone, liver adrenal glands and brain. Renal cell carcinoma generally metastasizes widely. A solitary metastasis of renal cell carcinoma, particularly to the urethra, is rare. There are approximately 20 cases reported in the literature of metastatic renal cell carcinoma to the remnant ureteral stump, bladder or urethra.2 Grasso et al suggested that there is a higher incidence of tumors that perforate the collecting system.2 However, in our case no metastases were found on the surface of the urinary tracts, ureter, bladder and urethra on radiological examination. Metastasis from other primary cancer to the urethra is also
FIG. 2. Renal cell carcinoma, common type, clear cell subtype, G1 to G2. A, primary tumor. B, metastatic urethral tumor. H & E, reduced from ⫻200. 1245
1246
METASTASIS OF RENAL CELL CANCER TO URETHRA
rare. Bladder cancer, prostate cancer, melanoma and lymphoma have been reported previously to metastasize to the urethra but in these cases the metastatic sites usually were widespread. To our knowledge we report only the second case of a solitary metastasis to the urethra from previously resected renal cell carcinoma.3 Although the etiology of this phenomenon is unclear, in our case there appeared to be retrograde venous emboli of tumor cells.
REFERENCES
1. Landis, S. H., Murray, T., Bolden, S. et al: Cancer statistics, 1998. CA Cancer J Clin, 48: 6, 1998 2. Grasso, M., McCue, P. and Bagley, D. H.: Multiple urothelial recurrences of renal cell carcinoma after initial diagnostic ureteroscopy. J Urol, 147: 1358, 1992 3. Goldberg, M. G. and Plaine, L.: Solitary metastasis of renal cell carcinoma to urethra. Urology, 35: 351, 1990
Vol. 163, 1245–1246, April 2000 Printed in U.S.A.
A SOLITARY METASTASIS OF RENAL CELL CARCINOMA TO THE URETHRA SATOSHI FUKATA, KEIJI INOUE,* TOSHIAKI MORIKI
AND
TARO SHUIN
From the Department of Urology and Clinical Laboratory, Kochi Medical School, Kochi, Japan KEY WORDS: carcinoma, renal cell; neoplasm metastasis; urethra
Renal cell carcinoma generally metastasizes widely. A solitary metastasis of renal cell cancer to the urethra is rare and its etiology is unclear. We report a case of a solitary metastasis to the urethra from previously resected renal cell cancer.
CASE REPORT
A 77-year-old man presented with painless urethral bleeding 1 week in duration. History revealed that 5 years earlier he had undergone right radical nephrectomy for localized pT2N0M0 renal cell carcinoma. Surgical margins were tumor-free on microscopic examination. Histology was consistent with common type, clear cell subtype adenocarcinoma. At 3-year followup chest computerized tomography (CT) revealed 3 ⫻ 3 cm. and 2 ⫻ 2 cm. lesions in the left lung. However, there were no malignant findings on histological assessment of needle biopsy under CT guidance, and the tumors did not change in size. At 5-year followup the patient had asymptomatic urethral bleeding. Cystoscopy revealed a globular yellow mass on a stalk in the membranous urethra (fig. 1). Metastatic evaluation with CT of the abdomen, excretory urography of the upper urinary tract and bladder, cystoscopy and bone scan was negative. Furthermore, urinary cytology consistently revealed no malignancy. Transurethral resection of the lesion yielded tissue consistent with renal cell carcinoma (fig. 2). Although adjuvant therapies including interferon were recommended, the patient declined further treatment. At 6-month followup the patient was disease-free. He is being followed on an outpatient basis.
DISCUSSION
Renal cell carcinoma is the third most common genitourinary malignancy in the United States. It is diagnosed in Accepted for publication November 5, 1999. * Requests for reprints: Department of Urology, Kochi Medical School, Nankoku, Kochi, 783-8505 Japan.
FIG. 1. Cystoscopy shows globular yellow mass on stalk in membranous urethra.
about 29,900 patients annually and resulted in about 11,600 deaths in 1998.1 Approximately a third of patients with renal cell carcinoma have metastasis at presentation. Common metastatic sites are lung, bone, liver adrenal glands and brain. Renal cell carcinoma generally metastasizes widely. A solitary metastasis of renal cell carcinoma, particularly to the urethra, is rare. There are approximately 20 cases reported in the literature of metastatic renal cell carcinoma to the remnant ureteral stump, bladder or urethra.2 Grasso et al suggested that there is a higher incidence of tumors that perforate the collecting system.2 However, in our case no metastases were found on the surface of the urinary tracts, ureter, bladder and urethra on radiological examination. Metastasis from other primary cancer to the urethra is also
FIG. 2. Renal cell carcinoma, common type, clear cell subtype, G1 to G2. A, primary tumor. B, metastatic urethral tumor. H & E, reduced from ⫻200. 1245
1246
METASTASIS OF RENAL CELL CANCER TO URETHRA
rare. Bladder cancer, prostate cancer, melanoma and lymphoma have been reported previously to metastasize to the urethra but in these cases the metastatic sites usually were widespread. To our knowledge we report only the second case of a solitary metastasis to the urethra from previously resected renal cell carcinoma.3 Although the etiology of this phenomenon is unclear, in our case there appeared to be retrograde venous emboli of tumor cells.
REFERENCES
1. Landis, S. H., Murray, T., Bolden, S. et al: Cancer statistics, 1998. CA Cancer J Clin, 48: 6, 1998 2. Grasso, M., McCue, P. and Bagley, D. H.: Multiple urothelial recurrences of renal cell carcinoma after initial diagnostic ureteroscopy. J Urol, 147: 1358, 1992 3. Goldberg, M. G. and Plaine, L.: Solitary metastasis of renal cell carcinoma to urethra. Urology, 35: 351, 1990