A Rare Presentation of Bilateral Multifocal and Multitype Renal Cell Carcinoma in End Stage Renal Disease

Abstract

Introduction: Renal cell carcinoma (RCC) is the most common tumour of the kidney. The common histological subtypes are clear cell, papillary and chromophobe renal cell carcinomas. This case has several unique features, which makes it a rare presentation. The most important unique fact is the presence of all the three common histological types of renal cell carcinoma in the same patient, which is a rarity.Presentation: 63-years-old male from Tanzania with End Stage Renal Disease came to hospital for Live Donor renal transplantation. Incidental detection of left renal tumor of size 3 cm diameter in the lower pole of kidney was made. He underwent laparoscopic radical nephrectomy. The histopathology was clear cell renal cell carcinoma. He came back later after 3 years with persistent cough. On evaluation was found to have a 5 cm pulmonary metastasis and two tumors in the upper pole of right kidney. One of the tumours was 3 cm and was solid and the other was 2.5 cm complex cystic tumor. Laparoscopic right radical nephrectomy with partial pneumonectomy was done. Histopathology was papillary renal cell carcinoma in the cystic renal tumor and pulmonary metastasis. Chromophobe renal cell carcinoma reported in the solid renal tumor. The following immunohistochemical markers were used in the sub typing: Cytokeratin 7, vimentin and progesterone receptor. Conclusion:Multitype and multifocal renal cell carcinoma though rare we may come across them. In these situations, it is prudent to suspect HRTS (Hereditary renal tumor syndrome). If these patients are on hemodialysis with ESRD a radical nephrectomy would be better option than partial nephrectomy. B/L radical nephrectomy in ESRD patients can be done in patients with good vascular access.