Mediastinal lymph node metastasis of renal cell carcinoma: A case report

Abstract

Abstract. Renal cell carcinoma (RCC) may metastasize to mediastinal lymph nodes without any abdominal lymph node involvement. The present study describes an autopsy-proven case of RCC presenting with a large mediastinal mass; the case had been previously misdiagnosed as small cell lung carcinoma due to imaging analysis results, an elevated serum level of neuron-specific enolase and the presence of small atypical cells with a high nuclear/cytoplasmic ratio. Despite RCC occurrence being rare, it should be considered in the differential diagnosis, particularly when a mass located in the kidneys presents with metastases to the mediastinal lymph nodes, even if there is no involvement of the abdominal lymph nodes and the primary lesion is of a small size. IntroductionRenal cell carcinoma (RCC) accounts for 95% of renal neoplasms and ~3% of adult malignancies (1). In the United States, ~61,560 patients with RCC were identified and 14,080 patients were predicted to have succumbed to the disease in 2015 (2). Generally, patients with RCC present with gross hematuria, flank pain and a palpable mass; however, these symptoms are not always present. RCC is a heterogeneous disease and several histological subtypes have been categorized according to the 2004 World Health Organization (WHO) renal tumor classification (3). The mortality rate of patients with RCC depends on the histological subtype and the clinical stage of the tumor. Since RCC has a hemorrhagic tendency, biopsy of the tumor is disputed (4). A diagnosis of RCC is provided according to the results observed using imaging methodologies, including computed tomography (CT), and a diagnosis of RCC is confirmed by the surgical removal of the tumor en bloc. The present study reports the case of a patient who presented with a large, right mediastinal mass appearing to mimic small cell lung cancer (SCLC); however, following autopsy examination, the diagnosis was confirmed as RCC. Case reportA 56-year-old male presented at the Ryugasaki Saiseikai Hospital (Ryugasaki, Japan) in September 2011 with a dry cough that had persisted for 3 months. Physical examination identified decreased breath sounds at the right hemithorax. Laboratory evaluations were undertaken and included urinalysis and testing of blood urea nitrogen, creatinine and serum calcium concentrations. All laboratory analyses were normal, with the exception of an increased concentration of white blood cells (12,100 cells/µl; normal range, 3,900-9,800 cells/µl), C-reactive protein (12.9 mg/dl; normal range, 0.0-0.3 mg/dl) and serum neuron-specific enolase (NSE; 50.0 ng/ml; normal range, 0.0-16.3 ng/ml). Following a CT scan of the chest, a large mass was detected at the right mediastinum, extending directly to the heart, with the presence of pericardial fluid (Fig. 1). Pleural fluid was identified in the right hemithorax, but no abnormalities were observed in the lungs and the abdominal lymph nodes were not swollen. However, a small nodule was detected in the upper pole of the right kidney. A bronchoscopy was performe...

Long-term Outcome After Resection of Isolated Thoracic Lymph Node Metastases of Renal Cell Cancer

“…However, there is little literature about patients with ITLNMs. Other than some case reports, [20][21][22] only Whitson and colleagues 19 reported a cohort study of 9 patients with asynchronous ITLNMs and demonstrated 3-and 5year survival rates of 80% and 80%, respectively. In total, of 386 patients treated for renal cell cancer in their clinic, only 9 patients had isolated mediastinal lymph node metastases.…”

“…In the literature, there are only a few case reports, and only one study that included 9 patients with asynchronous mediastinal lymph node metastases by Whitson and colleagues 19 and others. [20][21][22] For this reason, the goal of this study was to analyze our experiences, long-term survival outcomes, and recurrence-free survival outcomes after resection of ITLNMs.…”

Echoendoscopic appearance of mediastinal metastasis from papillary renal carcinoma

“…Here, we present a rare case of intrathoracic metastases of papillary renal carcinoma in which ecoendoscopic study was essential to highlight the peculiar cystic morphology nature and to perform ultrasound‐guided needle aspiration, which was safe and effective in order to achieve a diagnosis (Fig 2). Given that renal cell carcinoma may metastasize to mediastinal lymph nodes (even without any abdominal lymph node involvement), 5 it should be considered in the differential diagnosis of mediastinal abnormalities, particularly when a mass is located in the kidneys. In light of strong renal cell carcinoma resistance to chemo‐ and radiotherapy, and its high metastatic index enhanced by hypoxia‐inducible factors (HIFs), the early and precise identification of neoplastic cells, even far from the site of origin, alongside with deep characterization of their biomarkers, may favor efficient therapeutic strategies.…”

Solitary Metastasis in the Mediastinal Lymph Node After Radical Nephrectomy for Clear Cell Renal Cell Carcinoma: A Case Report and Literature Review

“…The low incidence of isolated MLN metastasis and the lack of specificity of clinical symptoms and imaging manifestations in CCRCC often make it difficult to differentiate from primary mediastinal lymphadenopathy, which can lead to preoperative misdiagnosis. Even so, it is essential to distinguish metastatic MLNs from other mediastinal lymphadenopathies in patients with mediastinal lesions and a previous history of RCC (13,39). The differential diagnosis of MLN enlargement includes lymphoma, sarcoidosis, tuberculosis, histoplasmosis, and solid malignancy (40).…”