Malignant effusion of chromophobe renal‐cell carcinoma: Cytological and immunohistochemical findings

Abstract

Malignant effusions because of renal-cell carcinoma (RCC) are an unusual event and occur in patients with papillary and clear cell tumors. We have studied a 65-year-old man who underwent right renal tumorectomy, diagnosed as chromophobe RCC (pT1). After 16 months, the patient presented cough and fever. Positron emission computed tomography demonstrated extensive mediastinal lymphadenopathy. Chest radiograph showed right pleural effusion. The cytological examination of the fluid showed malignant cells. Immunohistochemistry had been performed on primary renal tumor and on cell block of pleural effusion. The renal tumor showed positivity for parvalbumin, cytokeratin (CK) 7, C-kit (CD117), E-cadherin, and RCC marker. The neoplastic cells of pleural effusion showed positive immunohistochemical staining for parvalbumin, RCC marker, pancytokeratin, epithelial membrane antigen, CK7, C-kit (CD117), E-cadherin, and CD10. They were negative for thyroid transcription factor-1, CK20, calretinin, CK5, D2-40 podoplanin, CDX2, and Wilms' tumor suppressor gene. Malignant effusion secondary to RCC is rare. In several studies, RCC had been the cause of 1-2.2% of malignant pleural fluids. Chromophobe RCC tends to be localized into the kidney and to be of nuclear grade 2 at presentation, factors that probably explain its more favorable outlook. In our case, the chromophobe RCC was asymptomatic and was discovered because abdominal pain due to stone in the gallbladder. The tumor had an unusual aggressive clinical behavior. Immunohistochemistry performed on the cell block let to establish the renal origin and the chromophobe histotype of malignant cells found in the pleural fluid.

Tunneled Pleural Catheter Dysfunction

“…Notably, pain requiring removal of catheter was seen only in 0.4% of cases. [5][6][7] In our opinion, predisposing factors include decreased muscle mass and a poor nutritional status with a low albumin level that slows healing and decreases scar formation, which is essential for the catheter to stay in place. 10 When complete drainage occurs, the pleural layers repose each other and the catheter occasionally causes pain.…”

Clinical Spectrum of Patients with Renal Cell Carcinoma

“…There are reports of special cases of malignant effusion secondary to RCC.As an example; Chetcuti K et al reported a case of massive spontaneous hemothorax in a 78 year-old man with a history of RCC. The culprit was a chest wall metastasis of RCC (Chetcuti et al, 2010;Teresa et al, 2011).…”

Fine-Needle Aspiration Cytology with c-kit Immunocytochemical Staining in the Diagnosis of Warthin’s Tumor

“…The most common tumors for c-kit-positive immunostaining are gastrointestinal stromal tumors. Other tumors showing c-kit positivity are melanocytic lesions, testicular seminoma, chromophobe renal cell carcinoma, renal oncocytoma, cholangiocellular carcinoma, hepatocellular carcinoma, carcinoma showing thymus-like elements, osteosarcoma, pancreatic endocrine tumor, neuroendocrine carcinoma of the uterine cervix, and endometrial and ovarian carcinoma [2,3,4,5,6,7,8,9,10,11,12,13]. Carcinoembryonic antigen (CEA) has been reported in a large number of carcinomas, particularly in adenocarcinomas of the gastrointestinal tract and lung.…”