Simultaneous metastases of clear cell renal cell carcinoma to the urinary bladder and left retroperitoneal space: A case report and review of the literature

Abstract

Abstract. The present study describes an extremely rare case of simultaneous metastases of clear cell renal cell carcinoma (ccRCC) to the urinary bladder and left retroperitoneal space, occurring subsequent to an open radical nephrectomy. A review of the literature is also considered. A 70-year-old man presenting with diabetes mellitus and hypertension was referred to West China Hospital (Chengdu, China) with constant left flank pain that had been apparent for 2 months. Ultrasonography identified a heterogeneous tumor with a solid component measuring 4.4x3.4x5.0 cm, and computed tomography (CT) revealed a circumscribed and contrast-enhanced tumor in the left kidney. Subsequent pathological analysis of the specimen, obtained from an open radical nephrectomy, confirmed the presence of ccRCC. At 1 month after the radical nephrectomy, an abdominopelvic CT scan identified tumors located on the posterior bladder wall and also in the left retroperitoneal space, forming due to hematuria and acute urinary clot retention. There was no evidence of metastasis to the lungs, bones or other organs. A transurethral resection of the bladder tumor was performed and pathological analysis of the bladder specimen demonstrated metastatic ccRCC. Extensive hydrothorax and general anasarca presented half a month after the transurethral resection, with the patient subsequently succumbing 15 days later. IntroductionDuring 2010, renal cell carcinoma (RCC) was estimated to account for 58,240 novel cases of the disease and 13,040 mortalities in the United States, and at present, cases are steadily increasing at a rate of 2.5% per year across population groups (1,2). Clear cell RCC (ccRCC) is one of the most common subtypes of the disease, accounting for 70-80% of all RCC cases (3). A key characteristic of kidney cancer is its tendency to metastasize widely prior to the appearance of any local symptoms or signs (4). In 20-30% of patients with recently diagnosed RCC, radiological evidence of metastases exists at the time of presentation, and 20-40% of patients undergoing a nephrectomy to treat clinically localized RCC will develop metastases (4). The most common locations prone to metastases are the lungs and bones, followed in frequency by the regional lymph nodes, liver, adrenal gland, brain, gall bladder, pancreas and breasts (5,6). Additionally, several studies have reported a number of rare metastatic sites, including the ureteric stump, the ipsilateral and contralateral ureter, and the prostatic fossa (7-9). However, simultaneous metastases of RCC to the urinary bladder and left retroperitoneal space have not yet been reported. To the best of our knowledge, the current study describes the first case of RCC presenting with simultaneous metastases to the urinary bladder and left retroperitoneal space, occurring a short period after a radical nephrectomy. Case reportA 70-year-old man was referred to West China Hospital (Chengdu, China) with chronic left flank pain that had been present for a period of 2 months on December 15, 2014. For the ...