Lung cancer metastasizing to ipsilateral renal cell carcinoma and the contralateral perirenal space

Abstract

through a bilateral subcostal incision. Pathology revealed Case report a 4.5×3.5×3 cm tumour involving the upper portion of the right kidney; the histological interpretation was A 62-year-old man in poor general condition was admitted with a cough and haematochezia. ClinicalFuhrman grade 2 adenocarcinoma of the kidney with associated metastatic lung cancer (Fig. 2a). Neuronexamination revealed a left abdominal mass which was tender, hard and fixed. A chest X-ray showed a specific enolase (NSE) stained positively and was consistent with the diagnosis of a SCC (Fig. 2b). The surgical 3.5×7 cm mass in the region of the right hilus, an obliteration of the cardiac border at the right lower lobe specimen of the left perirenal mass was 10×5×3 cm; the histological interpretation was SCC with neuroand pleural eCusion. Chest CT revealed the primary lung malignancy in the right lower lobe with displacement and occlusion of segmental bronchi, and lymphadenopathies in the right hilum, subcarina and anterior mediastinum. Bronchoscopy-guided fine-needle biopsies of the lung mass showed a small cell carcinoma (SCC). Abdominal CT revealed a right renal and left perirenal mass. The left perirenal mass displaced the kidney anteriorly and medially, but did not invade the renal parenchyma (Fig. 1). CT-guided fine-needle biopsies of the left perirenal mass showed a metastasis from lung cancer. The preoperative diagnosis was lung cancer metastasizing to the ipsilateral kidney and contralateral perirenal space, or right RCC and lung cancer metastasizing to the contralateral perirenal space. The left perirenal mass was excised and the right renal mass enucleated a b Fig. 2. a, The small cell carcinoma (left portion, small cells, dark stained and disorganized) contrasts vividly with well-diCerentiated

Unusual presentation of perirenal lung metastases

“…The adrenal glands and kidneys are not uncommon sites for metastatic spread of lung carcinoma, however, spread to the perirenal space is exceedingly rare 1 . Only five such cases have been described in the published works to date, all of which show perirenal nodules or masses 1–3 . To the authors’ knowledge, the case we present is the first case of diffuse infiltration the perirenal fat by metastatic lung carcinoma.…”

“…Shirkhoda describes 18 patients with primary malignancies and perirenal nodules or masses, only one of whom had primary lung cancer, the histological type unspecified 2 . Kwak et al describe a patient with known small‐cell carcinoma of the lung and a large perirenal mass 3 …”

Renal Metastasis From Pulmonary Adenocarcinoma

“…2 Data from the English literature (Table 1) report 35 well-described cases of renal involvement from lung cancer. [1][2][3][4][5][6][7][8][9][10][11] The median age at presentation was 57 years, with a male sex predominance (male to female ratio, 9:1) and a latency of presentation from the diagnosis of the primary lung lesion of 30 months. In 5 cases, the renal involvement was present before the lung primaries and in 3 cases both were discovered at the same time.…”

Unusual Perirenal Metastasis from Lung Adenocarcinoma

“…In five cases, there were perirenal nodules or masses as metastasis (2,3,4). Only in one case, diffuse metastatic perirenal fat infiltration was detected.…”

“…Metastases from lung cancer and some other cancers, such as malignant melanoma, prostate and breast carcinoma may be detected (3). Metastatic spread through the lymphatics is thought to be the mechanism of perirenal metastasis (3,4). The lymphatic system in the perirenal region communicates with mediastinal lymph nodes through the thoracic duct and diaphragmatic perforations as well as with para-aortic lymph nodes through the renal hilum.…”