Superior vena cava syndrome caused by supraclavicular lymph node metastasis of renal cell carcinoma

A 65-year-old woman presented with gross hematuria in February 1997. Left renal tumor was revealed and radical nephrectomy was performed. Pathological examination revealed papillary renal cell carcinoma, pT3aN1M1 (ipsilateral adrenal gland). Interferon-α was administered for 1 year. Two years after the nephrectomy, metastasis to the left supraclavicular lymph node appeared. Seven years after the nephrectomy, the metastatic tumor invaded the brachiocephalic vein and extended to the superior vena cava (SVC), compatible with SVC syndrome. Although interferon-α and external-beam radiotherapy was performed, she died in February 2005. Autopsy revealed a left supraclavicular lymph node metastasis invading the thyroid gland, mediastinum, and brachiocephalic vein. The tumor thrombus descended via the SVC into the right atrium. The right lung artery was obstructed by tumor thrombus. There were no visceral metastases and no local recurrence.     

Pulmonary Metastasis of Renal Cell Carcinoma Resected Sixteen Years after Nephrectomy

A 50-year-old man underwent a left nephrectomy for renal cellcarcinoma of the clear cell type in February, 1978. He was examinedusing computed tomography in September, 1993, and was foundto have a small coin lesion in his right lung. A fine needleaspiration biopsy failed to disclose any tumor cells. He underwenta video-assisted thoracoscopic biopsy of the right lung in February,1994, 16 years after his nephrectomy. The resected specimencontained a coin lesion measuring approximately 1 cm in diameter,and the lesion was microscopically diagnosed as a renal cellcarcinoma of the clear cell type metastatic to the lung. Thepatient is doing well with no signs of re-recurrence six monthsafter the resection of the metastatic lesion. To our knowledge,the time interval between his nephrectomy and resection of themetastatic lesion is the longest ever reported in Japan     

Asymptomatic cerebellopontine angle and lateral ventricle metastases from renal cell carcinoma: case report and literature review

Tumors rarely metastasize to the cerebellopontine angle. We report the first instance of simultaneous metastasis of renal cell carcinoma to the cerebellopontine angle and the lateral ventricle. A 51-year-old man presented with anemia and fatigue owing to stomach metastases from renal cell carcinoma 8 years after undergoing partial left nephrectomy for grade II clear cell renal carcinoma and radical right nephrectomy for grade III clear cell renal carcinoma. He also suffered metastases to the lung, both adrenal glands, the L-3 vertebra, and the brain (asymptomatic, but revealed by magnetic resonance imaging): a 1-cm (maximum diameter) mass in the left medullary cistern and a 2-cm (maximum diameter) mass in the right lateral ventricle trigone. Both brain lesions were treated with stereotactic radiosurgery, followed by gross-total resection of the right trigonal mass 7 months later. Both tumors shrank significantly, but the patient died from progressive systemic cancer 1 year after diagnosis of brain metastasis.     

A case of bilateral 3-lung lesion (metastatic and primary tumour, tumourlet) resected simultaneously

A 70-year-old male patient underwent right nephrectomy for renal clear cell carcinoma. After 8 years an X-ray showed a nodule on the left lung, and CT scan detected it to be a 15 × 12 mm mass in S1+2 segment of the left lung. CT also detected another 15 × 7 mm mass in the right S3 segment. These lesions had a high FDG accumulation. Pre-operative diagnosis is bilateral pulmonary metastases from renal cell carcinoma, and bilateral lung segmentectomy was performed. Left S1+2 resected tumor was histologically clear cell carcinoma by intra-operative examination, then right S3 segmentectomy was done. And that time, small tumor was found in the middle lung lobe, and a wedge resection was performed. These specimens revealed a primary lung carcinoma of right S3, and tumourlet of middle lobe. It is very rare that three different histlogical types of lung tumor were found.     

Treatment of a Case of Asynchronous Bilateral Renal Cell Carcinomas with Inferior Vena Caval Thrombus and Hepatic Metastases

A 56-year-old man underwent a right radical nephrectomy withremoval of a vena caval thrombus and resection of hepatic metastasesfor right renal cell carcinoma. Twenty-one months after thefirst operation, a left renal cell carcinoma was detected whichwas treated with left radical nephrectomy and followed by hemodialysis.The patient then enjoyed an active life for 14 months but died18 months after his second operation due to lung metastasis.Bilateral radical nephrectomy and hepatic resection may be justifiedsince there is no strongly effective adjuvant therapy for suchadvanced cases.     

Renal cell carcinoma metastatic to skeletal muscle mass: A case report

An unusual case of metastases to the right thigh muscles and region of the external iliac vessels is presented. This followed 5 1/2 years following a right nephrectomy for renal cell carcinoma. The patient's metastases were removed and one year later the patient remains free of recurrence.     

Brain metastasis of a papillary renal cell carcinoma, identified as type 2

Papillary renal cell carcinomas (PRCCs) tend to metastasize to lymph nodes, while metastasis to the brain is extremely rare. We report the case of a man who had a brain metastasis of PRCC type 2. He was brought to our hospital due to the sudden onset of convulsions. Diagnostic imaging studies showed a metastatic brain tumor in the left parietal lobe, and a primary renal tumor in the right kidney, with paraaortal lymph node metastases. An excision of brain tumor was performed. The brain tumor had a papillary structure with eosinophilic cytoplasm. Five weeks later nephrectomy was carried out. Histological analysis of the nephrectomy specimen revealed the same papillary structure, which was compatible with PRCC type 2.     

Pancreatic resection for metastatic tumors to the pancreas

We report 3 cases of resectable pancreatic metastasis. CASE 1: A 76-year-old woman was followed after nephrectomy for renal cell carcinoma for 13 years. CT examination demonstrated a high vascular lesion in the pancreatic body and tail. We conducted distal pancreatectomy and diagnosed with metastatic tumor from renal cell carcinoma. She died of liver metastasis 8 years after pancreatic resection. CASE 2: A 64-year-old man, who had undergone right lower lobectomy for lung cancer a year ago, was found to have a mass in the pancreatic tail. We performed distal pancreatectomy and diagnosed with metastatic tumor from lung cancer. He died of lung metastasis 12 months after pancreatic resection. CASE 3: A 62- year-old woman, who had undergone left nephrectomy for renal cell carcinoma 3 years ago, was found to have a mass in the pancreatic body. With a diagnosis of metastatic pancreatic tumor from renal cell carcinoma, distal pancreatectomy was done. She died of liver and lung metastases 15 months after pancreatic resection. Long-term survival can be achieved in patients undergoing a pancreatic standard resection including lymphadenectomy for isolated metastasis from nonpancreatic sites.     

Colon cancer with isolated metastasis to the kidney at the time of initial diagnosis

Blood-borne metastases to the kidneys from solid tumors have received little attention in the medical literature because they usually occur in a setting of advanced systemic disease, and renal involvement is a elatively minor cause of symptoms. Although the frequency of metastases to the kidney in cancer patients is 7–13% in large autopsy series, incidental discovery of a renal metastasis as the first manifestation of a primary tumor is a very rare event. The most common primary malignancy to involve the kidney is bronchogenic carcinoma, followed by breast and gastrointestinal cancers. In this article, we report a patient with left colon cancer and isolated metastasis to the right kidney at the time of initial diagnosis. Left hemicolectomy and right nephrectomy were performed. Adjuvant systemic chemotherapy consisting of 5-fluorouracil (5-FU) and folinic acid (FA) was given. 5-FU and FA were stopped after four cycles because metastases to the lung and liver occurred about 3 mo after the surgery during adjuvant chemotherapy. Capecitabine was started. The patient died 9 mo after the discovery of the isolated renal metastasis. Nephrectomy is more for diagnostic clarification in the setting of synchronous primary because it has no effect on survival and its effect on quality of life is minimal; as seen in our case, the other organ metastases rapidly occur and the survival is limited. Nephrectomy may also compromise the choice of chemotherapy agents that require renal clearance, thus a careful evaluation of renal functions is necessary if a nephrectomy is performed. In the matter of a decreased renal clearance, the doses of these drugs should be decreased or the choice should be reevaluated.     

Cryotreatment against metastatic renal cell bone tumour reduced multiple lung metastases

Metastatic renal cell carcinoma (RCC) has a poor response to anticancer chemotherapy and radiotherapy. While immunotherapy and molecular targeted drugs have been used as first-line therapy for RCC metastasis, the response rate to these agents is low. We report the case of a patient with lung and bone metastases of RCC whose lung metastases disappeared after reconstruction using the resected specimen treated by liquid nitrogen for the bone metastasis. This 60-year-old female had a left RCC with multiple lung metastases and a left femoral bone metastasis at the time of diagnosis. After left nephrectomy followed by immunotherapy, we performed tumour excision and reconstruction with frozen recycled autograft. The lung metastases had disappeared by 10 months after surgery, while serum levels of interferon-gamma and interleukin-12 had increased. We postulate that the antitumour activity resulted from immunotherapy plus cryotreatment of her bone metastasis and believe that this case supports continued research into immunotherapy for cancer.     

Surgical Treatment of Adrenal Metastasis Following hepatectomy for Hepatocellular Carcinoma

In three patients who underwent hepatectomy for solitary hepatocellularcarcinoma (HCC), adrenal metastases, on the right sides of twopatients and the left side of the third were subsequently detectedby ultrasonography (US) and/or computed tomography (CT), andsuccessfully resected after an average interval of 16 monthsfrom hepatectomy. There were no metastatic lesions in the lung,lymph node or bone. Two patients, however, who were found tohave metastasis in the right adrenal also had multiple smallrecurrent foci in the residual liver. The latter were controlledby arterial embolization therapy and the patients are aliveat 12 and three months post-adrenalectomy. In the other patient,with left adrenal metastasis, the serum alpha fetoprotein levelof 3,000 ng/ml returned to normal and he is doing well threeand a half years after adrenalectomy. Since there is no effectivetherapy for metastatic adrenal HCC after hepatectomy, surgerywould appear to be indicated, should no other distant metastasisbe recognized clinically.     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

以指骨转移为首发症状肺癌23例临床分析

目的 探讨原发性肺癌单纯以指骨转移为首发症状的临床特点以及肺癌发生指骨转移的机制.方法 搜集自1991年至2010年见渚于各专业文献报道的单纯以指骨转移为首发症状的原发性肺癌患者的资料,并进行综合性分析.结果 在文献报道的单纯以指骨转移为首发症状的23例原发性肺癌中,其转移病灶位于左手指骨者10例,右手指骨者12例,双...     

Successful treatment for metastases from renal cell carcinoma with alternation of interferon-alpha subtypes

Here we present a case in which alternation of interferon-alpha (IFN-α) treatments was effective in treating pulmonary metastases and lymph node metastases from renal cell carcinoma (RCC). A 56-year-old man underwent left radical nephrectomy under the diagnosis of left RCC. The histological diagnosis was clear cell carcinoma G2, IFN-α, pT1b. He subsequently underwent two operations for right pulmonary metastasis and right hilar lymph node metastasis. Postoperatively he was treated with intramuscular administration of natural IFN-α (Sumiferon) which prevented definite recurrence for 1 year. However, multiple pulmonary metastases and left hilar lymph node metastasis occurred 11 months after discontinuation of Sumiferon. Therefore, treatment with another natural IFN-α (OIF) was started. Although OIF was continued for 7 months, pulmonary metastases and left hilar lymph node metastasis continued to progress. Therefore, treatment was changed to Sumiferon, after which the pulmonary metastases and left hilar lymph node metastasis decreased in size. The metastases showed no progression for 16 months after switching from OIF to Sumiferon.     

转移性肾上腺癌的临床治疗（附15例报告）

目的:分析我院收治的15例肾上腺转移性恶性肿瘤的临床资料，结合文献复习，总结临床诊治体会。方法:回顾性分析我院2011年1月至2019年5月收治的15例肾上腺转移性恶性肿瘤患者的临床资料。男12例，女3例；平均年龄为63岁(53～73岁)。肾上腺转移瘤的最大径中位值为4.4 cm（2.0~9.8 cm），左侧11例，右侧3例，双侧1例。原发恶性肿瘤来源:肺7例，肝3例，肾2例，子宫1例，胰腺1例，腹膜后肿物1例。本研究中15例肾上腺转移恶性肿瘤为原发肿瘤确诊后诊断，距离原发肿瘤诊断的中位时间为15.6个月(5~28个月)。15例患者均行手术切除治疗。结果:术后病理细胞类型:腺癌4例，肝细胞癌3例，透明细胞癌2例，弥漫性大B细胞瘤2例，神经内分泌癌1例，癌肉瘤1例，肺小细胞癌1例，肺大细胞癌1例。术后定期随访患者，15例患者生存4~78个月。患者最终死于肿瘤广泛转移。结论:我院肾上腺转移性恶性肿瘤的原发肿瘤以肺癌最为常见，多数转移瘤在定期复查中无意发现。我院肾上腺转移瘤以左侧多见。肾上腺转移瘤治疗方式有手术治疗、介入治疗、经皮肿瘤消融、免疫治疗、放疗和化疗等。     

Pulmonary adenocarcinoma metastatic to the gingiva

Gingival metastasis from lung cancer is very uncommon. We report a case of distant metastasis of pulmonary adenocarcinoma in the mandibular gingiva. A 54-year-old man was admitted to our hospital on September 1, 1997 with hemoptysis. Right upper lobectomy with mediastinal lymph node dissection was performed on September 16. On the 14th postoperative day, the patient complained of a gingival swelling. In the lower right premolar area, a wide pedunculated mass was seen on the mandibular gingiva. Excisional biopsy of the tumor was performed, and histopathological examination revealed that the tumor was a metastatic lesion from the pulmonary adenocarcinoma. The patient received 46.8 Gy of linac irradiation to the tumor area and the entire oral condition improved markedly. However, bilateral adrenal gland metastases were recognized, and left inguinal lymph node metastasis was detected 2 months after lung resection. He developed tumor metastases to multiple organs and died of respiratory failure on December 12, 1997. Received: October 7, 1998 / Accepted: March 8, 1999     

Pancreatic and gastric metastases of leiomyosarcoma arising in the left leg

Pancreatic or gastric metastases from other primary malignancies are rare, especially from leiomyosarcoma. We report a case of leiomyosarcoma in the left lower leg with metastases to the pancreas and stomach. A 61-year-old man had liver cirrhosis caused by hepatitis C virus infection and was followed up by his primary physician. Two years before presentation at our hospital, he had undergone surgical resection of leiomyosarcoma in the left lower leg and systemic chemotherapy for multiple metastatic tumors in the lung. On admission, endoscopic examination and computed tomography were performed for a routine checkup to exclude esophageal varices and liver tumor. Although the patient had no specific symptoms, multiple gastric and pancreatic metastases were identified by endoscopy and computed tomography, respectively. In general, metastases to the pancreas and stomach are rare. We discuss the clinical and diagnostic findings of pancreatic and gastric metastases by reviewing previously reported cases.     

Metastatic sites and survival in lung cancer

Objectives

Population-based data on metastatic sites and survival in site-specific metastases are lacking for lung cancer and for any cancer because most cancer registries do not record metastases. This study uses a novel population-based approach to identify metastases from both death certificates and national inpatient data to describe metastatic pathways in lung cancer patients.

Materials and methods

17,431 deceased lung cancer patients diagnosed 2002–2010 were identified from the nationwide Swedish Cancer Registry, which is based on compulsory reports. The influence of age at diagnosis, sex, and histological subtype on metastatic spread was investigated. Survival in metastatic lung cancer was assessed by histology and metastatic site.

Results

The most frequent metastatic sites were the nervous system, bone, liver, respiratory system, and adrenal gland. Liver (35%) and nervous system (47%) metastases were common in patients with metastases from small cell lung cancer, and bone (39%) and respiratory system (22%) metastases in adenocarcinoma. Women (43% vs. 35%) and younger patients had more metastases to the nervous system. Median survival after diagnosis was 13 months for non-metastatic and five months for metastatic lung cancer. In this novel data, liver metastases conferred the worst prognosis (three months), especially for large cell histology. Bone metastases also featured poor survival, whereas survival in respiratory and nervous system metastases was better.

Conclusion

Metastatic sites and survival in metastatic lung cancer is influenced by sex, histological subtype, and age at diagnosis. Liver and bone metastases signal poor survival, compared with nervous system metastases.     

Familial cystic nephroma in two siblings with pleuropulmonary blastoma

Cystic nephroma (CN) and pleuropulmonary blastoma (PPB) are rare tumors. In the cases presented here, a 13-month-old boy underwent right radical nephrectomy for CN. From the family history we learned that four years ago the patient's older sister underwent left radical nephrectomy for CN at a different center when she was 4 years old. A lung tumor was detected in the sister one year after nephrectomy. Biopsy from the lung tumor revealed PPB, and the sister died within one year after biopsy. To the knowledge of the authors, these cases represent the second reported familial occurrence of CN and the fourth of CN and PPB.     

99Tcm-亚甲基二膦酸盐全身骨显像评价原发性肺癌骨转移的特征

目的 探讨原发性肺癌骨转移病灶的影像学特征.方法 对258例病理确诊的肺癌患者行99Tcm-亚甲基二膦酸盐(99Tcm-MDP)全身骨显像,分析各部位骨骼的骨转移率、病灶构成和病灶的形态特征等.结果 全组258例肺癌患者中,存在骨转移142例,骨转移率为55.0%,其中中轴骨的骨转移率为49.6%,四肢骨为36.0%;中轴躯干骨为48.4%,四肢带骨为31.4%;肋骨、胸椎、髂骨和腰椎骨的转移率较高,均>20%.共检出骨转移病灶1252个,其中位于身体左侧406个,居中387个,右侧459个,左右两侧病灶数的差异无统计学意义(χ2=3.3,P=0.072);浓聚病灶1224个(97.8%),混合性病灶26个(2.1%),稀疏病灶2个(0.2%).骨转移病灶按形态归类后共1133个,其中点状病灶810个(71.5%),团状病灶159个(14.0%),条状病灶108个(9.5%),片状病灶56个(4.9%).1-3个病灶的累积骨转移率为28.7%,随着病灶数的增加,骨转移率逐渐降低.早期骨转移病灶分布无明确规律,晚期骨转移病灶呈随机性广泛分布.结论 肺癌易发生骨转移,骨转移早期病例临床最为常见;骨转移好发于中轴躯干骨和四肢带骨,以放射性浓聚病灶为主,以点状为早期病灶形态;早期骨转移病灶分布无明确规律,晚期骨转移病灶呈随机性广泛分布,并且常呈多发性多形态病灶并存的特征.