RENAL CELL CARCINOMA , METASTATIC TO THE COLON

Case provided by Angela Darko, MD and Mirela Stancu, MD

Case History

A 56 year old male presented with abdominal pain. Imaging revealed a mass in the left colon. The only significant history was a resected renal mass several years prior to presentation.

Microscopic findings

Colonic mucosal biopsies revealed two populations of cells consisting of infiltrating and nested group of pleomorphic cells with abundant eosinophilic cytoplasm and slightly enlarged hyperchromatic nuclei, and another population of cells with abundant foamy and clear cytoplasm. Immunohistochemical staining for these cells revealed positivity for pancytokeratin, cytokeratin 7, vimentin, CD10 (patchy) and S100. Staining for RCC, MART-1, CDX2, and CK20 were all negative.

Diagnosis

RENAL CELL CARCINOMA, METASTATIC TO THE COLON

Discussion

Recurrent and metastatic renal cell carcinoma is known to occur several years after nephrectomy with metastasis commonly to lungs, lymph nodes and bones. Recurrent and metastatic cases have been reported as late as 31 years post nephrectomy.1 Metastasis of renal cell carcinoma to the colon is an unusual finding with only 11 eleven cases reported in the literature. 2- 12 Metastasis to other parts of the gastrointestinal tract has also been reported.13-14 Although grading and staging of renal tumors can give some indication of prognosis; the biological behavior of renal cell carcinoma is unpredictable. It has been reported that even well-differentiated tumors can metastasize and seem to occur more commonly in women.15 Because of the nature of these tumors, a long-term follow up and investigation of gastrointestinal symptoms is required in these patients.

Also of interest in this case is that the tumor cells were for s100 positive. S100 staining in renal cell carcinoma has been reported in the literature and this can be a diagnostic pitfall especially in metastatic cases with positive s100 and negative cytokeratin.16

References

1. Kradjian RM, Bennington JL: Renal cell carcinoma recurrence 31 years after nephrectomy. Arch Surg 1965, 90:192-5.

2. Nozaki Y, Inamori M, Fujita K, et al. Metastatic tumor in the colon from renal cell carcinoma. Intern Med. 2010;49(7):709. Epub

3. Jadav AM, Thrumurthy SG, DeSousa BA.. Solitary colonic metastasis from renal cell carcinoma presenting as a surgical emergency nine years post-nephrectomy. World J Surg Oncol. 2010 Jun 29;8:54.

4. Chetty R, Syed A, Kwast TV. Metastatic Clear Cell Renal Cell Carcinoma Presenting as Multiple Colonic Polyps. Int J Surg Pathol. 2009

5. Valdespino-Castillo VE, Ruiz-Jaime A. Renal cell carcinoma with colon metastases: an infrequent site for metastases. Cir Cir. 2008 Jul-Aug;76(4):339-42.

6. Ambe P. C., Fukindoki D, Hanisch R: Colonic Metastasis of a Renal Cell Carcinoma. A Rare Cause of Large-Bowel Obstruction. A Case Report. The Internet Journal of Surgery. 2009 Volume 18 Number 2

7. Tokonabe S, Sugimoto M, Komine Y, Horii H, Matsukuma S. Solitary colonic metastasis of renal cell carcinoma seven years after nephrectomy: a case report. Int J Urol. 1996 Nov;3 (6):501-3.

8.Thomason PA, Peterson LS, Staniunas RJ. Solitary colonic metastasis from renal-cell carcinoma 17 years after nephrectomy. Report of a case. Dis Colon Rectum. 1991 Aug; 34 (8):709-12.

9. Díaz-Candamio MJ, Pombo S, Pombo F. Colonic metastasis from renal cell carcinoma: helical-CT demonstration. Eur Radiol. 2000; 10 (1):139-40.

10. Utsunomiya K, Yamamoto H, Koiwai H, Kirii Y et.al. Solitary colonic metastasis from renal cell carcinoma 9 years after nephrectomy: report of a case. Int J Colorectal Dis. 2001 Jun; 16 (3):193-4.

11.Yetkin G, Uludağ M, Ozağari A. Solitary colonic metastasis of renal cell carcinoma. Acta Chir Belg. 2008 Mar-Apr; 108(2):264-5.

12.Lee JG, Kim JS, Kim HJ, et.al. Simultaneous duodenal and colon masses as late presentation of metastatic renal cell carcinoma. Korean J Intern Med. 2002 Jun; 17(2):143-6.

13. Sadler GJ, Anderson MR, Moss MS et.al. Metastases from renal cell carcinoma presenting as gastrointestinal bleeding: two case reports and a review of the literature. BMC Gastroenterology 2007, 7:4

14.Bhatia A, Das A, Kumar Y et.al. Renal cell carcinoma metastasizing to duodenum: a rare occurrence. Diagnostic Pathology 2006, 1:29

15.Nakano E, Fujioka H, Matsuda M, et al (1984) Late recurrence of renal cell carcinoma after nephrectomy. Eur Urol 10:347–349

16. Lin F, Yang W, Batten M et.al. Expression of S-100 protein in renal cell neoplasms. Volume 37, Issue 4, Pages 462-470 (April 2006)

 

Colonic mucosa infiltrated by nested groups of pleomorphic cells with abundant eosinophilic cytoplasm and slightly enlarged hyperchromatic nuclei. A second population of cells show abundant foamy and clear cytoplasm, H&E stain
Colonic mucosa infiltrated by nested groups of pleomorphic cells with abundant eosinophilic cytoplasm and slightly enlarged hyperchromatic nuclei. A second population of cells show abundant foamy and clear cytoplasm, H&E stain
Colonic mucosa infiltrated by nested groups of pleomorphic cells with abundant eosinophilic cytoplasm and slightly enlarged hyperchromatic nuclei. A second population of cells show abundant foamy and clear cytoplasm, H&E stain
Colonic mucosa infiltrated by nested groups of pleomorphic cells with abundant eosinophilic cytoplasm and slightly enlarged hyperchromatic nuclei. A second population of cells show abundant foamy and clear cytoplasm, H&E stain
Tumor cells with immunoreactivity for pancytokeratin stain
Tumor cells with immunoreactivity vimentin stain
Tumor cells wiht S100 nuclear staining
CD10 immunohistochemical stain (patchy staining)
Tumor cells negative for RCC and CDX2 immunohistochemical stains
Tumor cells negative for RCC and CDX2 immunohistochemical stains