Chromophobe renal cell carcinoma occurring in the renal allograft of a transplant recipient presenting with weight loss

Abstract

The incidence of renal cell carcinomas (RCCs) in renal transplant recipients is reported as 1.1-1.5% in the native kidneys and 0.22-0.25% in the renal allograft. There are no data to support routine surveillance for tumors in transplant recipients. Most reported cases of RCCs occurring in renal allografts were incidental findings in asymptomatic patients. Herein, we report the second case of lone chromophobe RCC (ChRCC) of the renal allograft presenting with weight loss. Loss of weight is a presenting symptom in one-third of ChRCCs occurring in the native kidneys in the general population. Based on the age of the patient, R.E.N.A.L nephrometry score of the tumor and the lack of data on the prognosis of this histological subtype in a climate of long-term immunosuppression, we elected for radical nephrectomy. We suggest that RCCs should be considered in the differential diagnosis of a transplant recipient presenting with weight loss even in the absence of localizing symptoms or signs.

Incidental Eosinophilic Chromophobe Renal Cell Carcinoma in Renal Allograft

“…Similar to the current case, all reported ChRCC were discovered incidentally by radiological investigations for other clinical indications [7, 14] or as part of routine checkup or surveillance [15, 16]. This highlights the importance of the clinical relevance of radiological graft screening in kidney transplant recipients, which allow early detection of the tumour, provide wider range of treatment options, and result in excellent clinical outcome.…”

“…In most reported series of cases, papillary RCC was the most common type, followed by clear cell (conventional) RCC [6, 13]. De novo ChRCC in renal allograft is extremely rare and only five cases were found in the English literature, one in paediatric age group and the remaining ones in adults [7, 14–17]. Table 2 summarizes the clinicopathological features of reported renal allografts ChRCC.…”

“…The eosinophilic variant of CRCC is very rare and exhibits similar nuclear features encountered in classical CRCC; however, the neoplastic cells tend to be arranged in more solid growth pattern and have dense eosinophilic, slightly granular, abundant cytoplasm and visible to indistinct cell membrane [19]. All previously reported ChRCC in renal allografts were classical variant [7, 14–17]. To the best of our knowledge, the current case represents the first eosinophilic ChRCC in renal allograft, which expands the spectrum of histomorphology of renal allograft RCC.…”

“…Nonmelanoma skin, genitourinary tract malignancies, and malignant lymphoproliferative diseases are the commonest in kidney transplant recipients [4]. The risk of renal cell carcinoma (RCC) in native kidneys of transplant recipients is approximately 15–30-fold more than general population [5, 6] and the incidence of RCC in native and renal allograft in kidney transplant recipients is 1.1–1.5% and 0.22–0.25%, respectively [7]. Clear cell (conventional) and papillary RCCs are the most common histological tumour types in both native and transplanted kidney [6].…”

Chromophobe Renal Cell Carcinoma of a Renal Allograft

“…Rare subtypes of RCC include carcinoma of the collecting ducts of Bellini, renal medullary carcinoma, multilocular clear cell RCC, mucinous tubular and spindle cell carcinoma, and other unclassified RCC [ 5 ]. The incidence of various types of renal cell carcinoma (RCC) in the recipient’s native kidneys is 15–30 times higher than in the general population, and the development of RCC in the graft occurs in 0.22–0.25% of cases [ 6 ]. In this clinical case report, we describe the development of the eosinophilic variant of chromophobe renal cell carcinoma in a transplanted kidney 3 years after kidney transplantation from a living related donor.…”