Zwei synchrone Malignome in einem Nephrektomiepräparat

Abstract

We report a case of a 65-year-old man examined for hematuria and neurologic symptoms. Radiologically a tumour of the kidney was suspected, with metastatic involvement of the brain and both lungs. The urologists then performed a cytoreductive nephrectomy.In histopathological examination of the nephrectomy specimen a clear cell renal cell carcinoma (clear cell RCC) was found. However, an additional focus of a high-grade adenocarcinoma was discovered that turned out to be a metastasis of a poor differentiated lung adenocarcinoma. This diagnosis was supported by positive TTF1 and napsin-A as well as good clinical correlations.The article summarizes the differential diagnostic considerations of poor differentiated adenocarcinoma of the kidney, aimed at gross and microscopic morphology, immunohistochemistry and clinical-pathological correlation. A review of literature about a tumour-in-tumour metastasis is included.

Secondary Tumors of the Kidney: A Comprehensive Clinicopathologic Analysis

“…In 1987, Sella and Ro 148 reported that renal cell carcinoma was the most common tumor recipient of metastasis and lung carcinoma was the most common tumor donor. A variety of renal neoplasms have been reported to be involved in tumor-to-tumor metastasis as a recipient neoplasm, [7][8][9][10][11][12][13][14][15][16][17][18][19][20] including oncocytoma, chromophobe renal cell carcinoma, and angiomyolipoma; however, clear cell renal cell carcinoma is the most common tumor recipient involved by tumor-to-tumor metastasis. The exact mechanism of tumor-to-tumor metastasis is still under investigation.…”

“…Metastases to the kidney can pose a significant diagnostic challenge for the pathologist as they can histologically mimic both low-grade and high-grade primary renal neoplasms. Rare cases of a secondary malignancy metastasizing to a primary renal tumor, so-called tumor-to-tumor metastasis, have also been reported 7–20. Secondary tumors of the kidney can be accurately diagnosed by correlating pathologic features with clinical and radiographic findings and the judicious use of ancillary studies 4,5…”

“…Rare cases of a secondary malignancy metastasizing to a primary renal tumor, so-called tumor-totumor metastasis, have also been reported. [7][8][9][10][11][12][13][14][15][16][17][18][19][20] Secondary tumors of the kidney can be accurately diagnosed by correlating pathologic features with clinical and radiographic findings and the judicious use of ancillary studies. 4,5…”