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Choo YH, Seo Y, Choi J. Extremely delayed solitary cerebral metastasis in patient with T1N0M0 renal cell carcinoma after radical nephrectomy: Case report and literature review. Medicine (Baltimore) 2021; 100:e25586. [PMID: 33847690 PMCID: PMC8052049 DOI: 10.1097/md.0000000000025586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Although renal cell carcinoma (RCC) is one of the common origins of brain metastasis, few cases of extremely delayed brain metastasis from RCC, more than 10 years after nephrectomy, have been reported. We present a rare case of extremely delayed brain metastasis from RCC, also performed a literature review to increase knowledge of the characteristics for extremely delayed brain metastasis from RCC. PATIENT CONCERNS A 72-year-old man presented with right-sided hemiplegia and dysarthria. The patient had a history of radical nephrectomy for RCC with stage T1N0M0 15 years earlier. DIAGNOSIS Magnetic resonance imaging with contrast revealed a 2-cm sized non-homogenous enhanced mass in the left frontal lobe with peritumoral edema. The pathological examination after surgery reported metastatic clear cell RCC. INTERVENTIONS A craniotomy for removal of the mass was performed at the time of diagnosis. Stereotactic radiosurgery was performed for the tumor bed 3 weeks after craniotomy, and then, chemotherapy was started 2 months after the SRS. OUTCOMES Metastasis progressed to multiple organs 6 months after the craniotomy. The patient chose a hospice and no longer visited the hospital. LESSONS In cases with a history of nephrectomy for RCC, long period follow-up is necessary for monitoring RCC brain metastasis and pathologic diagnosis should be confirmed.
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Affiliation(s)
| | | | - Joonhyuk Choi
- Department of Pathology, Yeungnam University Hospital, Yeungnam University College of Medicine Daegu, Republic of Korea
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Lang A, Dehner LP. Delayed Metastasis of Clear Cell Sarcoma of Kidney to Bladder After 7 Disease-Free Years. Fetal Pediatr Pathol 2018; 37:126-133. [PMID: 29509095 DOI: 10.1080/15513815.2018.1435757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Clear cell sarcoma of the kidney (CCSK) is childhood neoplasm with its own distinctive pattern of metastasis and may appear after a disease free interval of 5 years or more. MATERIALS AND METHODS Histopathology and immunohistochemistry were available from the radical nephrectomy and the later partial cystectomy, which was performed after a seven disease-free interval. RESULTS The pathologic features of the primary tumor were those of a classic CCSK with a monotypic pattern of uniform rounded to ovoid tumor cells with a background network of delicate blood vessels. By contrast, the bladder recurrence had a myxoid hypocellular appearance (one of the known variant patterns of CCSK). Both tumors displayed immunopositivity for Cyclin-D1 and CD117 with a less intense reaction in the bladder metastasis. CONCLUSIONS This case demonstrates that CCSK has the potential to metastasize after a prolonged disease-free interval and may have deceptively bland histopathologic features.
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Affiliation(s)
- Adam Lang
- a Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish Hospital/St. Louis Children's Hospital , Washington University Medical Center , St. Louis , Missouri , USA
| | - Louis P Dehner
- a Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish Hospital/St. Louis Children's Hospital , Washington University Medical Center , St. Louis , Missouri , USA
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Gutenberg A, Nischwitz MD, Gunawan B, Enders C, Jung K, Bergmann M, Feiden W, Egensperger R, Keyvani K, Stolke D, Sure U, Schroeder HWS, Warzok R, Schober R, Meixensberger J, Paulus W, Wassmann H, Stummer W, Blumcke I, Buchfelder M, van Landeghem FKH, Vajkoczy P, Günther M, Bedke J, Giese A, Rohde V, Brück W, Füzesi L, Sander B. Predictive chromosomal clusters of synchronous and metachronous brain metastases in clear cell renal cell carcinoma. Cancer Genet 2014; 207:206-13. [PMID: 25027636 DOI: 10.1016/j.cancergen.2014.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/01/2014] [Accepted: 05/10/2014] [Indexed: 01/21/2023]
Abstract
Synchronous (early) and metachronous (late) brain metastasis (BM) events of sporadic clear cell renal cell carcinoma (ccRCC) (n = 148) were retrospectively analyzed using comparative genomic hybridization (CGH). Using oncogenetic tree models and cluster analyses, chromosomal imbalances related to recurrence-free survival until BM (RFS-BM) were analyzed. Losses at 9p and 9q appeared to be hallmarks of metachronous BM events, whereas an absence of detectable chromosomal changes at 3p was often associated with synchronous BM events. Correspondingly, k-means clustering showed that cluster 1 cases generally exhibited low copy number chromosomal changes that did not involve 3p. Cluster 2 cases had a high occurrence of -9p/-9q (94-98%) deletions, whereas cluster 3 cases had a higher frequency of copy number changes, including loss at chromosome 14 (80%). The higher number of synchronous cases in cluster 1 was also associated with a significantly shorter RFS-BM compared with clusters 2 and 3 (P = 0.02). Conversely, a significantly longer RFS-BM was observed for cluster 2 versus clusters 1 and 3 (P = 0.02). Taken together, these data suggest that metachronous BM events of ccRCC are characterized by loss of chromosome 9, whereas synchronous BM events may form independently of detectable genetic changes at chromosomes 9 and 3p.
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Affiliation(s)
- Angelika Gutenberg
- Department of Neurosurgery, Georg August University, Göttingen, Germany; Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany.
| | - Martin D Nischwitz
- Department of Gastroenteropathology, Georg August University, Göttingen, Germany
| | - Bastian Gunawan
- Department of Gastroenteropathology, Georg August University, Göttingen, Germany
| | - Christina Enders
- Department of Gastroenteropathology, Georg August University, Göttingen, Germany
| | - Klaus Jung
- Department of Medical Statistics, Georg August University, Göttingen, Germany
| | - Markus Bergmann
- Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Wolfgang Feiden
- Departments of Gastroenteropathology and Neuropathology, University of the Saarland, Homburg, Germany
| | - Rupert Egensperger
- Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany
| | - Kathy Keyvani
- Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany
| | - Dietmar Stolke
- Department of Neurosurgery, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University of Duisburg-Essen, Essen, Germany
| | - Henry W S Schroeder
- Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany
| | - Rolf Warzok
- Department of Neuropathology, Ernst Moritz Arndt University, Greifswald, Germany
| | - Ralf Schober
- Department of Neuropathology, University of Leipzig, Leipzig, Germany
| | | | - Werner Paulus
- Department of Neuropathology, Westphalian Wilhelm University, Münster, Germany
| | - Hansdetlef Wassmann
- Department of Neurosurgery, Westphalian Wilhelm University, Münster, Germany
| | - Wolfgang Stummer
- Department of Neurosurgery, Westphalian Wilhelm University, Münster, Germany
| | - Ingmar Blumcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Frank K H van Landeghem
- Department of Neuropathology, Charité University Medicine, Berlin, Germany; Department of Neuropathology, University of Alberta, Edmonton, Canada
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine, Berlin, Germany
| | - Marlis Günther
- Department of Pathology, Health Care Center Brandenburg, Brandenburg, Germany
| | - Jens Bedke
- Department of Urology, Eberhard Karls University, Tübingen, Germany
| | - Alf Giese
- Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany
| | - Veit Rohde
- Department of Neurosurgery, Georg August University, Göttingen, Germany
| | - Wolfgang Brück
- Department of Neuropathology, Georg August University, Göttingen, Germany
| | - Laszlo Füzesi
- Department of Gastroenteropathology, Georg August University, Göttingen, Germany
| | - Bjoern Sander
- Stereology and Electron Microscopy Laboratory, Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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Dalhaug A, Haukland E, Nieder C. Leptomeningeal carcinomatosis from renal cell cancer: treatment attempt with radiation and sunitinib (case report). World J Surg Oncol 2010; 8:36. [PMID: 20441600 PMCID: PMC2873341 DOI: 10.1186/1477-7819-8-36] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 05/05/2010] [Indexed: 11/10/2022] Open
Abstract
A case of leptomeningeal carcinomatosis in a patient with known brain and lung metastases from renal cell cancer without previous systemic therapy is presented. Neoplastic meningitis (NM) developed 31 months after first diagnosis of simultaneous extra- and intracranial recurrence of kidney cancer and surgical resection of a cerebellar metastasis. In spite of local radiotherapy to the macroscopic NM lesions in the cervical and lumbar spine followed by initiation of sunitinib, the patient succumbed to his disease 4 months after the diagnosis of NM. The untreated lung metastases progressed very slowly during almost 3 years of observation. This case illustrates important issues around both biological behaviour and treatment approaches in metastatic renal cell cancer.
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Affiliation(s)
- Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.
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Treatment of brain metastases from renal cell cancer. Urol Oncol 2009; 29:405-10. [PMID: 19854078 DOI: 10.1016/j.urolonc.2009.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 07/07/2009] [Accepted: 07/07/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate disease pattern, patient characteristics, and survival in patients treated for brain metastases from renal cell carcinoma. METHODS Retrospective analysis of all patients with brain metastases from renal cell carcinoma treated between 1983 and 2009 in northern Norway. RESULTS The time interval between first cancer diagnosis and brain metastases was dependent on initial TNM stage (median 42 months in stage II vs. 10 months in both stage III and stage IV). Only few patients did not harbor extracranial metastases. Systemic therapy after diagnosis of brain metastases has been used in only three patients. Surgical resection and/or radiosurgery have been administered in 34% of patients, but whole-brain radiotherapy (WBRT) alone remained the cornerstone. Median survival was 4.1 months (3.7 months in the WBRT alone group, 10.1 months in the surgery and/or radiosurgery group). Two factors were significantly associated with better survival: solitary brain metastasis and age ≤64 years. The prognostic impact of the recursive partitioning analysis classes was not confirmed, while the new graded prognostic assessment index performed better. CONCLUSIONS Surgical resection and/or radiosurgery contribute to prolonged survival. As most patients harbor extracranial metastases that threaten their lives, systemic treatment theoretically might play a role in the management of these patients, but more data need to be collected to confirm the clinical impact of immunotherapy, angiogenesis inhibition, and other signal transduction inhibitor approaches.
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Hassaneen W, Hatiboglu MA, Chowdhury S, Sawaya R. Asymptomatic cerebellopontine angle and lateral ventricle metastases from renal cell carcinoma: case report and literature review. J Neurooncol 2008; 91:101-6. [PMID: 18726184 DOI: 10.1007/s11060-008-9677-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 08/04/2008] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Wael Hassaneen
- Department of Neurosurgery-Unit 442, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
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Tena-Suck ML, Salinas-Lara C, Gómez C, Bojórquez DR. Frontotemporal clear cell meningioma. Report of 3 cases. Ann Diagn Pathol 2007; 11:182-9. [PMID: 17498592 DOI: 10.1016/j.anndiagpath.2006.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Clear cell meningioma (CCM) is an uncommon meningioma. Some cases have been reported, and the localization of most of them is the spinal region. We present 3 cases of CCMs in the frontotemporal lobes. All cases were postmenopausal women with a history of arterial hypertension and uterine leiomyomatosis. The radiologic appearance in 2 cases was similar to that of dural hematomas, and in 1 case, the imaging study was consistent with the diagnosis of meningioma. On histologic examination, there were sheets of glycogenated polygonal cells with abundant clear cytoplasm and round, uniform, bland appearing nuclei. Numerous hyalinized blood vessels and collagenous stroma with fibrillary appearance were present in 2 cases. They were immunoreactive to epithelial membrane antigen, epithelial cell adhesion molecule, and progesterone receptors. However, 2 cases showed weak and focal reaction to Her-2/neu. In our knowledge, some cases of CCMs have been reported and no immunoexpression has been noted with those markers used. These cases illustrate a rare variant of meningioma in the frontotemporal lobes and their immunohistochemical profiles. Differential diagnosis is discussed.
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Affiliation(s)
- Martha Lilia Tena-Suck
- Neuropathology Department, National Institute of Neurology and Neurosurgery, Mexico, DF 14269, Mexico.
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Abstract
When should surgery be used? First, when there is a need to establish the diagnosis of metastatic cancer, particularly in patients who have no known primary lesion. Second, as an effective therapy in patients who have a single brain metastasis, symptomatic or recurrent metastases, or when a metastasis threatens hydrocephalus if treated with radiation alone. Surgery is probably more effective in relieving symptoms from metastases than other treatments,although formal proof of this is lacking. Stereotactic radiosurgery can replace resection when the metastases are smaller than 3 cm and symptoms can be controlled with an acceptable steroid dose. Location of larger lesions in the posterior fossa is a relative contraindication to radiosurgery. The best candidates for resection and radiosurgery are those who have good systemic control of the primary disease; older age is a relative contraindication to resection. Aggressive treatment of oligometastatic brain disease probably is underused in current U.S. practice.
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Affiliation(s)
- Fred G Barker
- Department of Surgery (Neurosurgery), Harvard Medical School, Boston, MA, USA.
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