A record-breaking lung metastasis from renal cell carcinoma 37 years after nephrectomy

Abstract

Development of distant metastases from renal cell carcinoma (RCC) is a frequent occurrence and, in nearly 95% of the cases, secondary lesions present within 5 years following nephrectomy. We performed a left pneumonectomy for a peri-hilar lung mass in an 81-year-old man with history of kidney cancer, resected 37 years earlier. Histopathological examination revealed a solitary lung metastasis from RCC, relapsed after an extraordinary 37-year time interval. To the best of our knowledge, this remarkable case represents the longest time interval between radical nephrectomy for RCC and the occurrence of a pulmonary metastasis. After an uneventful post-operative recovery, there are no signs of disease recurrence at a 3-year follow-up. The possibility of a lung metastasis should be taken into account in patients with history of RCC who present with pulmonary nodules, even decades after treatment of the primary neoplasm.

Lung Metastasis From Renal Cell Carcinoma 16 years After Nephrectomy: A Case Report and Review of the Literature

“…Left pneumonectomy was performed in this patient. The patient was recurrence-free at 3 years follow-up [9]. Genand et al reported solitary lung metastasis in a patient 17 years after nephrectomy for RCC [13].…”

“…Host immune response has been hypothesized to play a role to determine the time for the presentation of RCC metastasis. Duration decreases with compromised immune response [9]. The five and 10-year overall survival rate following pulmonary metastasectomy for metastatic renal cancer was 83% and 41.7% respectively according to Chen et al [14]and 75% and 59% respectively according to Meacciet al [15].…”

“…Here we report a rare case of RCC that presented with lung metastasis 16 years after nephrectomy. Based on our literature review, we found only ten reported cases with intervals longer than in our case between nephrectomy for RCC and lung metastasis: 17 years [5], 19 years [6], six cases with 20-28 years intervals [7], 31 years [8], and 37 years [9].…”

“…Disease recurrence likelihood for RCC depends on several known and unknown factors including host and tumor factors [5]. Prognostic indicators for RCC include complete resection of all metastasis, low number of metastasis, long disease-free interval between primary tumor diagnosis and lung lesions, lymph node involvement, and size of pulmonary nodule [9]. Host immune response has been hypothesized to play a role to determine the time for the presentation of RCC metastasis.…”

Case report of a patient with a rare location of renal cell carcinoma metastasis

“…When breaking down the occurrences of RCC metastatic locations to percentages, the numbers vary considerably, as a result, there are several case reports presenting rare metastatic sites 15 . The mean time for appearance of metastasis of RCC is 1-2 years after operation 16 although in the literature there is a case report with record lung metastasis from RCC 37 years after nephrectomy 17 . When compared to this After surgery the final pathohistological examination confirmed renal cancer metastasis.…”