Journal of Obstetrics and Gynaecology
ISSN: 0144-3615 (Print) 1364-6893 (Online) Journal homepage: http://www.tandfonline.com/loi/ijog20
A case of renal cell carcinoma with solitary metastasis to the ovary M. Dolanbay, M. S. Kutuk, S. Uludag, M. T. Ozgun, F. Ozturk & B. Ozcelik To cite this article: M. Dolanbay, M. S. Kutuk, S. Uludag, M. T. Ozgun, F. Ozturk & B. Ozcelik (2015) A case of renal cell carcinoma with solitary metastasis to the ovary, Journal of Obstetrics and Gynaecology, 35:2, 218-219, DOI: 10.3109/01443615.2014.948814 To link to this article: http://dx.doi.org/10.3109/01443615.2014.948814
Published online: 20 Aug 2014.
Submit your article to this journal
Article views: 12
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ijog20 Download by: [Texas A & M International University]
Date: 05 November 2015, At: 16:49
218
Gynaecology Case Reports
Downloaded by [Texas A & M International University] at 16:49 05 November 2015
Majmudar B, Henderson PH 3rd, Semple E. 1983. Salpingitis isthmica nodosa: a high-risk factor for tubal pregnancy. Obstetrics and Gynecology 62:73–78. Saracoglu FO, Mungan T, Tanzer F. 1992. Salpingitis isthmica nodosa in infertility and ectopic pregnancy. Gynecologic and Obstetric Investigation 34:202–205. Seeber BE, Barnhart KT. 2008. Ectopic pregnancy. In: Gibbs RS, Karlan BY, Haney AF et al., editors. Danforth’s obstetrics and gynecology. Philadelphia: Lippincott, Williams and Wilkins. p 69–87. Skibsted L, Sperling L, Hansen U et al. 1991. Salpingitis isthmica nodosa in female infertility and tubal diseases. Human Reproduction 6:828–831. Stock RJ. 1990. Histopathology of fallopian tubes with recurrent tubal pregnancy. Obstetrics and Gynecology 75:9–14. Stovall TG. 2007. Early pregnancy loss and ectopic pregnancy. In: Berek JS, editor. Berek and Novak’s gynecology. Philadelphia: Lippincott, Williams and Wilkins. p 601–637.
A case of renal cell carcinoma with solitary metastasis to the ovary M. Dolanbay1, M. S. Kutuk1, S. Uludag1, M. T. Ozgun1, F. Ozturk2 & B. Ozcelik1 Departments of 1Obstetrics and Gynecology and 2Pathology, Faculty of Medicine, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey Correspondence: M. Dolanbay, Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Gevher Nesibe Hospital, 38039 Kayseri, Turkey. E-mail: [email protected] DOI: 10.3109/01443615.2014.948814
Here, we present a case of metastatic ovarian carcinoma from renal carcinoma in a postmenopausal woman and briefly review the relevant literature.
Case report A 55-year-old postmenopausal woman with a solid mass in the lower abdomen, was referred to the gynaecology department. She had a history of left partial lower pole nephrectomy for stage 2 clear cell renal carcinoma 4 years previously. In bimanual examination, a solid, fixed mass with an irregular boundary on the left adnexal region was palpated. Transvaginal ultrasonography showed: 13 ⫻ 12 ⫻ 9 cm partially solid, predominantly cystic mass on the left ovary, minimal free pelvic fluid and a normal uterus and right ovary. Magnetic resonance imaging scans of the abdomen and chest revealed a 13 cm solidcystic mass, with minimal free fluid in the pelvis and no renal or lung recurrence. Her CA125 level was mildly elevated (49 ml/dl, normal range: 5–30 ml/dl) and routine laboratory tests were normal. At laparotomy, minimal pelvic free fluid and a left irregular surfaced, fixed mass were noted. There was no peritoneal implant. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Frozen section was reported as metastatic carcinoma showing clear cell histology. She was discharged from the hospital at day 7 post-operation, feeling well. No additional therapy was given and, no recurrence was detected after 14 months’ follow-up. At pathological examination, the tumour was irregularly surfaced with haemorrhagic and cystic spaces, and maroon/beige in colour. Microscopic examination showed large multicystic areas limited by solid cell cords, surrounded by fibrous stroma. Epithelial cells had oval, pyknotic nucleus and transparent cytoplasm. Immunohistochemically, tumour cells had immunoreactivity for CD10 and vimentin (Figure 1), and were negative for CK.
Introduction Ovaries are the frequent sites for metastasis for almost all intraabdominal cancers. Metastatic tumours to the ovary constitute nearly 6% of all ovarian cancer, and usually arise from carcinomas of the colorectum, breast, endometrium, stomach, cervix, pancreas, appendix and lymphoma (Scully et al. 1998). However, ovarian metastasis from renal cell carcinoma (RCC) is a very rare entity and only 21 cases have been reported (Vorder Bruegge et al. 1957).
Discussion Renal cell carcinoma is a relatively rare tumour, which is mostly seen in the 6th and 7th decades of life. The tumour is known for its different invasion/metastasis characteristics, which include haematogenous, lymphatic and endovascular spread. It is reported that 23% of RCC present with distant metastasis and 25% of remaining cases develop distant metastasis within 5 years of initial diagnosis (Ritchie
Figure 1. Left ovary: immunohistochemically, tumour cells had immunoreactivity for (A) CD10 and (B) vimentin (H&E ⫻ 100).
Downloaded by [Texas A & M International University] at 16:49 05 November 2015
Gynaecology Case Reports 219 and deKernion 1987). The most common sites of metastasis include the lung parenchyma (60%), bone (40%) and liver (40%). The average survival of metastatic RCC is about 4 months and only 10% survive for 1 year (Thyavihally et al. 2005). The ovarian metastasis of RCC is extremely rare and only 21 cases have been reported in the English literature. The mean age of the cases was 52 years (range: 17–73 years). The interval between primer diagnosis and the emergence of ovarian metastasis range from 4 months to 14 years. Though bilateral involvement of the ovaries is pathognomonic for metastatic tumours, metastasis from RCC to the ovary is usually unilateral (80%) and predominantly involve the left ovary (72%). Despite the fact that RCC can spread via a variety of routes, evidence suggests that metastasis to the ovary occurs by means of retrograde venous embolisation through the renal vein to the ovarian vessels. Given the fact that the left ovarian vein drains directly into the left renal vein, this mechanism can explain the high rate of left-sided ovarian involvement in RCC (Young and Hart 1992). Differential diagnosis of primary ovarian clear cell carcinoma and RCC metastasis may be crucial, especially in cases presenting with ovarian metastasis. Clear cells with a tubulocystic pattern, with the characteristic ‘hob-nail’ appearance of the lining epithelium and extracellular mucin are more typical of clear cell carcinoma of the ovary (Vara et al. 1998). Additionally, CA125 and cytokeratin 7, which are expressed by epithelial ovarian carcinomas, are negative in renal cell carcinomas (Toquero et al. 2009). Favourable prognostic factors for survival in metastatic RCC were suggested by Thyavihally et al. (2005), and include: (a) a disease free interval of more than 1 year before development of solitary metastasis; (b) early primary tumour stage; and (c) low tumour grade (Thyavihally et al. 2005). Several studies have shown that metastasectomy for resectable RCC can improve survival compared with no surgery. Additionally,
Motzer et al. (1996) reported that immunotherapy with interleukins or interferon is the most effective therapeutic option for primary renal cell carcinomas and metastasis after resection. In conclusion, the ovary may be the target organ for renal carcinoma metastasis. Therefore, the possibility of metastasis from renal cell carcinoma should be kept in mind in the differential diagnosis of clear cell carcinoma of the ovary. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Motzer RJ, Bander NH, Nanus DM. 1996. Renal cell carcinoma. New England Journal of Medicine 335:865–866. Ritchie AW, de Kernion JB. 1987. The natural history and clinical features of renal carcinoma. Seminars in Nephrology 7:131–139. Scully RE, Young RH, Clement PB. 1998. Tumors of the ovary, maldeveloped gonads, fallopian tube and broad ligament. In: Atlas of tumor pathology. 3rd Series. Washington, DC: Armed Forces Institute of Pathology. p 335–372. Thyavihally Y, Mahantshetty U, Chamarajanagar R et al. 2005. Management of renal cell carcinoma with solitary metastasis. World Journal of Surgical Oncology 3:48. Toquero L, Aboumarzouk OM, Abbasi Z. 2009. Renal cell carcinoma metastasis to the ovary: a case report. Cases Journal 2:7472. Vara A, Madrigal B, Veiga M et al. 1998. Bilateral ovarian metastasis from renal cell carcinoma. Acta Oncologica 37:379–380. Vorder Bruegge CF, Hobbs JE, Wegner CR et al. 1957. Bilateral ovarian metastasis from renal adenocarcinoma. Report of a case and discussion of pathogenesis. Obstetrics and Gynecology 9:198–205. Young RH, Hart WR. 1992. Renal cell carcinoma metastatic to ovary: a report of three cases emphasizing possible confusion with ovarian clear cell adenocarcinoma. International Journal of Gynecological Pathology 11:96–104.
ISSN: 0144-3615 (Print) 1364-6893 (Online) Journal homepage: http://www.tandfonline.com/loi/ijog20
A case of renal cell carcinoma with solitary metastasis to the ovary M. Dolanbay, M. S. Kutuk, S. Uludag, M. T. Ozgun, F. Ozturk & B. Ozcelik To cite this article: M. Dolanbay, M. S. Kutuk, S. Uludag, M. T. Ozgun, F. Ozturk & B. Ozcelik (2015) A case of renal cell carcinoma with solitary metastasis to the ovary, Journal of Obstetrics and Gynaecology, 35:2, 218-219, DOI: 10.3109/01443615.2014.948814 To link to this article: http://dx.doi.org/10.3109/01443615.2014.948814
Published online: 20 Aug 2014.
Submit your article to this journal
Article views: 12
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ijog20 Download by: [Texas A & M International University]
Date: 05 November 2015, At: 16:49
218
Gynaecology Case Reports
Downloaded by [Texas A & M International University] at 16:49 05 November 2015
Majmudar B, Henderson PH 3rd, Semple E. 1983. Salpingitis isthmica nodosa: a high-risk factor for tubal pregnancy. Obstetrics and Gynecology 62:73–78. Saracoglu FO, Mungan T, Tanzer F. 1992. Salpingitis isthmica nodosa in infertility and ectopic pregnancy. Gynecologic and Obstetric Investigation 34:202–205. Seeber BE, Barnhart KT. 2008. Ectopic pregnancy. In: Gibbs RS, Karlan BY, Haney AF et al., editors. Danforth’s obstetrics and gynecology. Philadelphia: Lippincott, Williams and Wilkins. p 69–87. Skibsted L, Sperling L, Hansen U et al. 1991. Salpingitis isthmica nodosa in female infertility and tubal diseases. Human Reproduction 6:828–831. Stock RJ. 1990. Histopathology of fallopian tubes with recurrent tubal pregnancy. Obstetrics and Gynecology 75:9–14. Stovall TG. 2007. Early pregnancy loss and ectopic pregnancy. In: Berek JS, editor. Berek and Novak’s gynecology. Philadelphia: Lippincott, Williams and Wilkins. p 601–637.
A case of renal cell carcinoma with solitary metastasis to the ovary M. Dolanbay1, M. S. Kutuk1, S. Uludag1, M. T. Ozgun1, F. Ozturk2 & B. Ozcelik1 Departments of 1Obstetrics and Gynecology and 2Pathology, Faculty of Medicine, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey Correspondence: M. Dolanbay, Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Gevher Nesibe Hospital, 38039 Kayseri, Turkey. E-mail: [email protected] DOI: 10.3109/01443615.2014.948814
Here, we present a case of metastatic ovarian carcinoma from renal carcinoma in a postmenopausal woman and briefly review the relevant literature.
Case report A 55-year-old postmenopausal woman with a solid mass in the lower abdomen, was referred to the gynaecology department. She had a history of left partial lower pole nephrectomy for stage 2 clear cell renal carcinoma 4 years previously. In bimanual examination, a solid, fixed mass with an irregular boundary on the left adnexal region was palpated. Transvaginal ultrasonography showed: 13 ⫻ 12 ⫻ 9 cm partially solid, predominantly cystic mass on the left ovary, minimal free pelvic fluid and a normal uterus and right ovary. Magnetic resonance imaging scans of the abdomen and chest revealed a 13 cm solidcystic mass, with minimal free fluid in the pelvis and no renal or lung recurrence. Her CA125 level was mildly elevated (49 ml/dl, normal range: 5–30 ml/dl) and routine laboratory tests were normal. At laparotomy, minimal pelvic free fluid and a left irregular surfaced, fixed mass were noted. There was no peritoneal implant. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Frozen section was reported as metastatic carcinoma showing clear cell histology. She was discharged from the hospital at day 7 post-operation, feeling well. No additional therapy was given and, no recurrence was detected after 14 months’ follow-up. At pathological examination, the tumour was irregularly surfaced with haemorrhagic and cystic spaces, and maroon/beige in colour. Microscopic examination showed large multicystic areas limited by solid cell cords, surrounded by fibrous stroma. Epithelial cells had oval, pyknotic nucleus and transparent cytoplasm. Immunohistochemically, tumour cells had immunoreactivity for CD10 and vimentin (Figure 1), and were negative for CK.
Introduction Ovaries are the frequent sites for metastasis for almost all intraabdominal cancers. Metastatic tumours to the ovary constitute nearly 6% of all ovarian cancer, and usually arise from carcinomas of the colorectum, breast, endometrium, stomach, cervix, pancreas, appendix and lymphoma (Scully et al. 1998). However, ovarian metastasis from renal cell carcinoma (RCC) is a very rare entity and only 21 cases have been reported (Vorder Bruegge et al. 1957).
Discussion Renal cell carcinoma is a relatively rare tumour, which is mostly seen in the 6th and 7th decades of life. The tumour is known for its different invasion/metastasis characteristics, which include haematogenous, lymphatic and endovascular spread. It is reported that 23% of RCC present with distant metastasis and 25% of remaining cases develop distant metastasis within 5 years of initial diagnosis (Ritchie
Figure 1. Left ovary: immunohistochemically, tumour cells had immunoreactivity for (A) CD10 and (B) vimentin (H&E ⫻ 100).
Downloaded by [Texas A & M International University] at 16:49 05 November 2015
Gynaecology Case Reports 219 and deKernion 1987). The most common sites of metastasis include the lung parenchyma (60%), bone (40%) and liver (40%). The average survival of metastatic RCC is about 4 months and only 10% survive for 1 year (Thyavihally et al. 2005). The ovarian metastasis of RCC is extremely rare and only 21 cases have been reported in the English literature. The mean age of the cases was 52 years (range: 17–73 years). The interval between primer diagnosis and the emergence of ovarian metastasis range from 4 months to 14 years. Though bilateral involvement of the ovaries is pathognomonic for metastatic tumours, metastasis from RCC to the ovary is usually unilateral (80%) and predominantly involve the left ovary (72%). Despite the fact that RCC can spread via a variety of routes, evidence suggests that metastasis to the ovary occurs by means of retrograde venous embolisation through the renal vein to the ovarian vessels. Given the fact that the left ovarian vein drains directly into the left renal vein, this mechanism can explain the high rate of left-sided ovarian involvement in RCC (Young and Hart 1992). Differential diagnosis of primary ovarian clear cell carcinoma and RCC metastasis may be crucial, especially in cases presenting with ovarian metastasis. Clear cells with a tubulocystic pattern, with the characteristic ‘hob-nail’ appearance of the lining epithelium and extracellular mucin are more typical of clear cell carcinoma of the ovary (Vara et al. 1998). Additionally, CA125 and cytokeratin 7, which are expressed by epithelial ovarian carcinomas, are negative in renal cell carcinomas (Toquero et al. 2009). Favourable prognostic factors for survival in metastatic RCC were suggested by Thyavihally et al. (2005), and include: (a) a disease free interval of more than 1 year before development of solitary metastasis; (b) early primary tumour stage; and (c) low tumour grade (Thyavihally et al. 2005). Several studies have shown that metastasectomy for resectable RCC can improve survival compared with no surgery. Additionally,
Motzer et al. (1996) reported that immunotherapy with interleukins or interferon is the most effective therapeutic option for primary renal cell carcinomas and metastasis after resection. In conclusion, the ovary may be the target organ for renal carcinoma metastasis. Therefore, the possibility of metastasis from renal cell carcinoma should be kept in mind in the differential diagnosis of clear cell carcinoma of the ovary. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Motzer RJ, Bander NH, Nanus DM. 1996. Renal cell carcinoma. New England Journal of Medicine 335:865–866. Ritchie AW, de Kernion JB. 1987. The natural history and clinical features of renal carcinoma. Seminars in Nephrology 7:131–139. Scully RE, Young RH, Clement PB. 1998. Tumors of the ovary, maldeveloped gonads, fallopian tube and broad ligament. In: Atlas of tumor pathology. 3rd Series. Washington, DC: Armed Forces Institute of Pathology. p 335–372. Thyavihally Y, Mahantshetty U, Chamarajanagar R et al. 2005. Management of renal cell carcinoma with solitary metastasis. World Journal of Surgical Oncology 3:48. Toquero L, Aboumarzouk OM, Abbasi Z. 2009. Renal cell carcinoma metastasis to the ovary: a case report. Cases Journal 2:7472. Vara A, Madrigal B, Veiga M et al. 1998. Bilateral ovarian metastasis from renal cell carcinoma. Acta Oncologica 37:379–380. Vorder Bruegge CF, Hobbs JE, Wegner CR et al. 1957. Bilateral ovarian metastasis from renal adenocarcinoma. Report of a case and discussion of pathogenesis. Obstetrics and Gynecology 9:198–205. Young RH, Hart WR. 1992. Renal cell carcinoma metastatic to ovary: a report of three cases emphasizing possible confusion with ovarian clear cell adenocarcinoma. International Journal of Gynecological Pathology 11:96–104.
