Metastatic Renal Cell Carcinoma in a Supraclavicular Lymph Node with No Known Primary: A Case Report

Choi, Young Rak; Han, Hye Sung; Lee, Ok Jun; Lim, Sung Cil; Kim, Mi Jin; Yeon, Myeong Ho; Jeon, Hae Myung; Lee, Ki Hyeong; Kim, Seung Taik

doi:10.4143/crt.2012.44.3.215

Cited by 17 publications

(22 citation statements)

References 8 publications

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“…This is an important issue to address, as dose reductions could lead to lower toxicity. This is supported by clinical trials in which decreased sunitinib doses resulted in lower toxicity rates and by case reports that observed no change in response upon dose reduction . This warrants more preclinical research to resolve the optimal dose‐scheduling of radiotherapy and sunitinib.…”

Section: Introductionmentioning

confidence: 85%

Optimal treatment scheduling of ionizing radiation and sunitinib improves the antitumor activity and allows dose reduction

et al. 2015

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The combination of radiotherapy with sunitinib is clinically hampered by rare but severe side effects and varying results with respect to clinical benefit. We studied different scheduling regimes and dose reduction in sunitinib and radiotherapy in preclinical tumor models to improve potential outcome of this combination treatment strategy. The chicken chorioallantoic membrane (CAM) was used as an angiogenesis in vivo model and as a xenograft model with human tumor cells (HT29 colorectal adenocarcinoma, OE19 esophageal adenocarcinoma). Treatment consisted of ionizing radiation (IR) and sunitinib as single therapy or in combination, using different dose-scheduling regimes. Sunitinib potentiated the inhibitory effect of IR (4 Gy) on angiogenesis. In addition, IR (4 Gy) and sunitinib (4 days of 32.5 mg/kg per day) inhibited tumor growth. Ionizing radiation induced tumor cell apoptosis and reduced proliferation, whereas sunitinib decreased tumor angiogenesis and reduced tumor cell proliferation. When IR was applied before sunitinib, this almost completely inhibited tumor growth, whereas concurrent IR was less effective and IR after sunitinib had no additional effect on tumor growth. Moreover, optimal scheduling allowed a 50% dose reduction in sunitinib while maintaining comparable antitumor effects. This study shows that the therapeutic efficacy of combination therapy improves when proper dose-scheduling is applied. More importantly, optimal treatment regimes permit dose reductions in the angiogenesis inhibitor, which will likely reduce the side effects of combination therapy in the clinical setting. Our study provides important leads to optimize combination treatment in the clinical setting.

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Section: Introductionmentioning

confidence: 85%

Optimal treatment scheduling of ionizing radiation and sunitinib improves the antitumor activity and allows dose reduction

et al. 2015

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“…However, presenting with mRCC with an undetectable primary is infrequent. A total of 12 cases were documented based on our literature review [5][6][7][8][9][10][11][12]; none of which had diffuse lymphadenopathy metastasizing from an unidentifiable renal primary as presented in our case. In such a challenging situation, immunohistochemical profiling as well as the promising field of molecular genetics aid in reaching a diagnosis.…”

Section: Discussionmentioning

confidence: 94%

“…It still remains unclear how mRCC occurs with an unidentifiable primary lesion; however, there have been several possible explanations [5,6]. The mass could be occult, hence undetectable by imaging modalities.…”

Section: Discussionmentioning

confidence: 99%

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Metastatic renal cell carcinoma with undetectable renal mass presenting as lymphadenopathy

2016

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Renal cell carcinoma has the ability to metastasize to any organ; about 16 % of affected patients present initially with metastasis. However, it is rare for this tumor to present with metastasis from an unidentified primary. The current use of immunohistochemistry and molecular genetics has enabled clinicians to reach a precise diagnosis. It has been hypothesized that the treatment protocol for metastatic renal cell carcinoma can be applied to cases with undetectable primary. In this paper, a novel case of metastatic renal cell carcinoma presenting with lymphadenopathy with no evidence of a primary renal lesion is reported from Kuwait cancer center.

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“…Patients with mrcc presenting in this manner are extremely rare; to the best of our knowledge, only 5 other cases have been reported to date worldwide [7][8][9][10] . It remains unclear how mrcc develops in the absence of a primary renal tumour.…”

Section: Discussionmentioning

confidence: 99%

Metastatic Renal Cell Carcinoma without Evidence of a Primary Renal Tumour

et al. 2014

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new cases of rcc and 13,500 deaths every year are attributed to this type of renal cancer 1 . In recent decades, the incidence of rcc has been increasing, and the average tumour size at diagnosis has been declining 2 . Those trends are partially attributable to the widespread use of noninvasive abdominal imaging modalities, which have allowed for more incidental findings of asymptomatic tumours. Renal cell carcinoma is about 50% more common in men than in women, and it is unusual in patients under 40 years of age 1 . Several distinct subtypes of rcc have been identified, including the clear cell, papillary, chromophobe, and collecting duct variants 3 . Clear cell rcc, the most common subtype, accounts for 75% of all rcc tumours 2 .Metastatic rcc (mrcc) generally presents with evidence of a primary renal mass, except in cases of metachronous mrcc after nephrectomy for rcc. Here, we present two unusual cases of metastatic clear cell rcc with no evidence of a primary renal tumour. CASE DESCRIPTIONS Patient 1A 70-year-old man was admitted for a fall-induced hip fracture and subsequently underwent arthroplasty. He was readmitted to hospital 8 months later for hypercalcemia and confusion. At that time, computerized tomography (ct) imaging showed bilateral native kidneys in situ; bony lesions in the left scapula, seventh right rib, fifth left rib, and left sternoclavicular joint; and two nodules in the upper lobe of the left lung. There was also destruction of the left pubo-iliac bone from a multi-lobulated lesion (measuring 11 cm) replacing bone, and no evidence of soft-tissue disease (Figure 1).An ABSTRACTAlthough metastases are common in patients with renal cell carcinoma (rcc), it is extremely rare for patients to present with metastatic rcc (mrcc) without evidence of a primary mass in the kidney. Two cases of mrcc with no detectable primary renal mass are reported here. Both patients had bilateral native kidneys in situ and no significant prior urologic history. The first patient presented with a hip fracture and was found to have multiple radiologic bony and lung metastases. Biopsy of a mass involving the pubic bone demonstrated clear cell mrcc. Multiple scans by computed tomography (ct) and confirmatory imaging by magnetic resonance demonstrated no renal mass. This first patient had disease stabilization for 18 months on sunitinib and was still alive at last follow-up. The second patient was diagnosed with clear-cell mrcc after thickened synovium was discovered and biopsied during a knee arthroplasty. Multiple scans by ct in this second patient demonstrated no primary renal mass. Sunitinib and radiotherapy to the knee lesion were initiated, but unfortunately, the patient deteriorated clinically and passed away from disease progression shortly after diagnosis. Because of the rare nature of these cases, a standardized course of action has not yet been established. However, we hypothesize that it is reasonable to manage metastases in these patients by following established mrcc protocols. KEY WORDSMetastatic renal...

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Metastatic Renal Cell Carcinoma in a Supraclavicular Lymph Node with No Known Primary: A Case Report

Cited by 17 publications

References 8 publications

Optimal treatment scheduling of ionizing radiation and sunitinib improves the antitumor activity and allows dose reduction

Optimal treatment scheduling of ionizing radiation and sunitinib improves the antitumor activity and allows dose reduction

Metastatic renal cell carcinoma with undetectable renal mass presenting as lymphadenopathy

Metastatic Renal Cell Carcinoma without Evidence of a Primary Renal Tumour

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