Synchronous bilateral multiple chromophobe cell renal carcinoma complicated with right kidney cyst: a case report

   

JOURNAL OF MEDICAL COLLEGES OF PLA

Journal of Medical Colleges of PLA 27 (2012) 58-62

www.elsevier.com/locate/jmcpla

 

Synchronous bilateral multiple chromophobe cell renal carcinoma complicated with right kidney cyst: a case report   Li Xungang1, Cui Xingang1, Zhang Dongxu1, Xu Danfeng1*, Gao Yi1, Yin Lei1, Jiang Lei2, Li Yuli3, Chen Ming1 1

Departments of Urology, Urology Center of PLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China 2

Department of Dentistry, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China

3

Department of Pathology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China Received 11 November 2011; accepted 25 December 2011

Abstract Synchronous bilateral multiple chromophobe cell renal carcinoma is rare; here we report a case diagnosed with bilateral renal multiple tumors complicated with a cyst in the right kidney. Retroperitoneal laparoscopic bilateral nephron sparing surgery was performed and there was no serious postoperative renal dysfunction. Pathological and immunohistochemical diagnoses of both tumors were chromophobe cell renal carcinoma. The patient has been doing well without any evidence of recurrence or metastasis for 6 months.

*

Corresponding author.

E-mail address: [email protected] (Xu D.)

   

Li Xungang et al./ Journal of Medical Colleges of PLA 27(2012) 58-62

59

Keywords: Chromophobe cell renal carcinoma; Nephron sparing surgery; Retroperitoneal laparoscopy

hospital due to detection of bilateral renal masses a 1. Introduction

week ago. Physical examination revealed no abnormalities. Abdominal computed tomography

Chromophobe

cell

renal

carcinoma,

first

scan showed bilateral multiple small tumors.

described by Thoenes in 1985, represents about

Magnetic resonance imaging revealed bilateral

4%-6% of total renal cell carcinoma. Most patients

multiple tumors and a cyst in the right kidney (Fig.

have unilateral renal cancer, and multicentricity

1), and the chest X-ray result was normal.

cancers in the same kidney occur in approximately 4%

Retroperitoneal laparoscopic right nephron sparing

of patients, whereas bilateral ones are seen in 0.5% to

surgery was then performed. Two tumors of 3.5 cm

3.0%. Among multifocal cases, 75% of the lesions are

and 1 cm in diameter were found in the upper central

synchronous. Chromophobe cell renal carcinoma is

part of dorsal right kidney, two tumors of 2 cm and

bilateral in 11% of patients and multifocal in 22% of

1cm in diameter were in the upper and central parts

patients [1, 2]. It can be concluded that synchronous

of the ventral right kidney, a small cyst of 1 cm in

bilateral multiple chromophobe cell carcinoma is very

diameter was located in the upper part of the right

rare. As far as we know, there have been four reports

kidney

about synchronous bilateral multiple chromophobe

retroperitoneal laparoscopic left nephron sparing

cell renal carcinoma by searching of PubMed [3-6]. In

surgery was performed, two tumors of 2 cm in

the paper, we firstly report a young man who was

diameter were found in the upper pole of dorsal left

diagnosed as having synchronous bilateral multiple

kidney and seven tumors of 0.5 cm in diameter were

renal tumors with a cyst in the right kidney.

scattered in the upper and lower pole of ventral left

and

left

alone.

One

month

later,

kidney (Fig. 2). Postoperative pathological and 2. Case report

immunohistochemical findings showed that both tumors were chromophobe renal carcinoma (Fig. 3).

A 28-year-old male patient was admitted to our

The patient recovered without any postoperative

60

Li Xungang et al./ Journal of Medical Colleges of PLA 27(2012) 58-62 

  complications. After receiving immunotherapy, he had no any evident recurrence or metastasis, and he was continuously followed up.

Fig. 3. A: Postoperative pathological diagnosis confirmed chromophobe cell renal carcinoma. Electronic microscopic findings showed rich reticulation in the cytoplasm and clear perinuclear Fig. 1. CT scan revealed bilateral renal multiple small tumors (arrows).

halo

(Original

magnification

Postoperative immunohistochemical

×200).

B:

diagnosis confirmed

chromophobe cell renal carcinoma (immunohistochemical staining,

original magnification ×200, EMA[+], CD10[+],

HCK[+], nm23[+]).

3. Discussion

Chromophobe renal cell carcinoma is a relatively rare renal cell carcinoma and with moderate malignancy and better prognoses. According to Fig. 2. Retroperitoneal laparoscopic right partial nephrectomy

previous studies, losses of chromosomes 1, 2, 6, 10,

and enucleation of the renal tumors.

and 17 were detected in chromophobe renal cell

Li Xungang et al./ Journal of Medical Colleges of PLA 27(2012) 58-62

61

carcinomas[7]. The patients may have a wide range,

1%-6% of all patients with sporadic renal masses.

but it tends to occur in patients between 20 and 40

Bilateral synchronous renal tumors pose multiple

years old, which is a younger age compared with

prognostic and therapeutic challenges, similar to

other RCC subtypes. Chromophobe renal cell

those of patients with hereditary renal cell carcinoma

carcinoma is generally detected incidentally[8]. As

(RCC). According to Rothman’s report, for bilateral

far as we know, up to now there have been only four

sporadic localized synchronous renal masses, a

reports

multiple

diagnosis of ipsilateral renal cell carcinoma is

chromophobe cell renal carcinoma by searching

associated with contralateral renal cell carcinoma in

PubMed. Tsutsumi et al[3] reported “Multiple

the most patients, whereas ipsilateral benign

chromophobe renal cell carcinoma: a case report” in

pathology is associated with contralateral benign

2010; Mukai et al[4] reported “Synchronous bilateral

disease at a substantially lower rate. Moreover,

chromophobe

case

bilateral multiple renal cell carcinomas are highly

report” in 2009; Yakout et al [5] reported a case of

comparable in pathological diagnosis, the high

“Synchronous bilateral chromophobe renal cell

similarity between clear cell renal cell carcinoma and

carcinoma” in 2001; and Hidai et al [6] reported a

papilloma of renal pelvis is a good example.

case of “Bilateral chromophobe cell renal carcinoma

However, bilateral renal carcinomas are quite

in tuberous sclerosis complex” in 1997. The present

different in differentiation degrees, which is very

patient

important for diagnosis of synchronous bilateral

about

with

synchronous

renal

cell

bilateral

carcinoma:

synchronous

bilateral

a

multiple

chromophobe renal cell carcinoma complicated with

renal cell carcinomas[10].

right renal cysts is really rare. The origin of bilateral

Advances in medical imaging technology will

renal tumors has not been definitely established so

allow for detection of asymptomatic renal cell

far. As there are only limited information on the

carcinoma at an early stage; tumors with diameter

genetics of bilateral tumors, defining the clinical

less than 4 cm or bilateral renal tumors can be treated

behavior of these lesions remains very important for

by partial nephrectomy or enucleation of the renal

diagnosis of bilateral renal cell carcinoma[9].

tumors. Before operation it must be confirmed that

Bilateral renal tumors may occur synchronously or

metachronously.

Patients

with

the tumors are localized and there are no

bilateral

metastases[11]. According to previous reports,

synchronous renal tumors account for approximately

bilateral renal tumors can be treated safely by

Li Xungang et al./ Journal of Medical Colleges of PLA 27(2012) 58-62 

62

laparoscopic partial nephrectomy [12]. In our case the patient underwent bilateral laparoscopic nephron sparing

surgery

and

recovered

without

any

postoperative complications. He was followed up for 6 months without any evidence of recurrence or metastasis.

Urol, 1997; 4(1):86–89. 7. Brunelli M, Eble JN, Zhang S, et al. Eosinophilic and classic chromophobe renal cell carcinomas have similar frequent losses of multiple chromosomes from among chromosomes 1, 2, 6, 10, and 17, and this pattern of genetic abnormality is not present in renal oncocytoma. Mod Pathol, 2005; 18(2):161–169. 8. Quiroga-Garza G, Khurana H, Shen S, et al. Sarcomatoid

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(Editor Xu Jia)