Benefit of a Second Opinion for Lung Cancer: No Metastasis to the Kidney but a Synchronous Primary Renal Neoplasm

Abstract

Background: The finding of a renal mass on imaging is suggestive of metastatic non-small cell lung cancer in the presence of a lung tumor but can also have another origin. Case Report: We describe the case of a patient diagnosed with stage IV lung cancer based on a renal metastasis. A second opinion including review of histopathological data and additional imaging followed by lung surgery and cryoablation of the kidney lesion revealed two tumors of different origins, non-small cell lung cancer and a renal cell carcinoma. Discussion: The presence of a renal mass diagnosed on a CT scan in a patient with lung cancer is not always synonymous with metastatic disease. Confirmation of diagnosis by tissue sampling is mandatory, especially if a synchronous primary tumor is possible.

Deploying Team Science Principles to Optimize Interdisciplinary Lung Cancer Care Delivery: Avoiding the Long and Winding Road to Optimal Care

“…11 It is likely that early interaction with a pulmonologist or thoracic surgeon would have raised questions about the discrepancy between the patient's performance status and the radiologic severity of her disease. [11][12][13] The patient's care suffered from serial failure to activate the appropriate expertise of interdisciplinary lung cancer team members, underdeveloped coordinating mechanisms, and limited mutual performance monitoring 14,15 of specialists involved in her care. Practice leaders must create the conditions for workgroups to be effective, including fostering real teams that are interdependent in their work 16 ; providing an appropriate team structure, reward structure, and supportive organizational context; and equipping teams with expert coaching and facilitation, when needed.…”

“…In addition, successful teams engage patients and caregivers in the decision-making process and help facilitate second opinions when desired. [11][12][13]28 Health care delivery is a service profession, and providers, rightly, expect to be paid for their services. The volume-based health care reimbursement model, which prevails in the United States, incentivizes providers to give more services, sometimes without sufficient linkage to patient benefit.…”

Secondary Tumors of the Kidney: A Comprehensive Clinicopathologic Analysis

“…The lung represents the main primary site for renal metastasis in the majority of studies; the incidence of renal metastases from a lung primary in clinical series is estimated between 26% and 46.5% 4–6,27,28. All different histologic types of lung carcinoma can metastasize to the kidney 22,29–48. In a Japanese series, Ichimatsu et al49 reviewed 64 cases of metastatic renal tumors originating from a lung primary and documented that the histologic subtypes were 57.6% squamous cell carcinoma, 28.8% adenocarcinoma, and 5.1% small cell carcinoma.…”

“…[4][5][6]27,28 All different histologic types of lung carcinoma can metastasize to the kidney. 22,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] In a Japanese series, Ichimatsu et al 49 reviewed 64 cases of metastatic renal tumors originating from a lung primary and documented that the histologic subtypes were 57.6% squamous cell carcinoma, 28.8% adenocarcinoma, and 5.1% small cell carcinoma. Wu et al 4 documented adenocarcinoma (55%), and Huang et al 5 noted squamous cell carcinoma (68%) as the most common histologic types to metastasize to the kidney in their series.…”