IMAGES
IN THE
MEDICAL SCIENCES
Metachronous Metastatic Renal Cell Carcinoma of the Gall Bladder Shun-Chien Cheng, MD, Chu-Hsin Chuang, MD and Chien-Ming Chao, MD* *Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan (E-mail: [email protected]) The authors have no financial or other conflicts of interest to disclose.
FIGURE 1
A
FIGURE 2
CLINICAL PRESENTATION
65-year-old man presented with right upper quadrant abdominal pain. He had the diagnosis of renal cell carcinoma (RCC) and received right nephrectomy 10 years ago. Physical examination was unremarkable except mild right upper quadrant tenderness. Computed tomography of the abdomen showed an enhanced polypoid nodule (arrow) over the gall bladder (Figure 1). He underwent cholecystectomy, and a polyp with the size of 3.5 3 2 3 1 cm near the neck of the gall bladder was found (Figure 2). The pathologic examination of the specimen confirmed the diagnosis of metastatic clear cell RCC, which was made up of sheet-like growth of clear cells possessing grade 1 small round uniform nuclei and presented with strong expression of epithelial membrane antigen, vimentin and CD10. The postoperative course was unremarkable, and he was referred to oncology for further management. RCC is associated with a great metastatic propensity, and the usual sites of metastatic RCC include lung, bone, liver and brain.1 In contrast, the gall bladder is an extremely rare site of RCC metastasis.2 In a recent review of 23 cases
58
with metastatic RCC of the gall bladder,2 17 cases presented with metachronous metastases with the interval ranging from 3 months to 27 years. Our patient had a similar presentation, which developed metastasis 10 years after the initial diagnosis of RCC. In such a rare clinical condition, RCC with metachronous gall bladder metastasis is difficult to diagnose because such patients usually present with nonspecific symptoms and signs or even incidental findings. Fortunately, contrast-enhanced computed tomography scan can provide useful diagnostic value with the characteristically hypervascular tumor in the gall bladder in this clinical entity, as in this case. Therefore, a hypervascular polypoid lesion in the gall bladder among patients with a history of RCC should be considered possible metastatic RCC. REFERENCES 1. Saitoh H. Distant metastasis of renal adenocarcinoma. Cancer 1981;48: 1487–91. 2. Jain D, Chopra P. Metastatic renal cell carcinoma of gall bladder. Saudi J Kidney Dis Transpl 2013;24:100–4.
The American Journal of the Medical Sciences
Volume 350, Number 1, July 2015
IN THE
MEDICAL SCIENCES
Metachronous Metastatic Renal Cell Carcinoma of the Gall Bladder Shun-Chien Cheng, MD, Chu-Hsin Chuang, MD and Chien-Ming Chao, MD* *Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan (E-mail: [email protected]) The authors have no financial or other conflicts of interest to disclose.
FIGURE 1
A
FIGURE 2
CLINICAL PRESENTATION
65-year-old man presented with right upper quadrant abdominal pain. He had the diagnosis of renal cell carcinoma (RCC) and received right nephrectomy 10 years ago. Physical examination was unremarkable except mild right upper quadrant tenderness. Computed tomography of the abdomen showed an enhanced polypoid nodule (arrow) over the gall bladder (Figure 1). He underwent cholecystectomy, and a polyp with the size of 3.5 3 2 3 1 cm near the neck of the gall bladder was found (Figure 2). The pathologic examination of the specimen confirmed the diagnosis of metastatic clear cell RCC, which was made up of sheet-like growth of clear cells possessing grade 1 small round uniform nuclei and presented with strong expression of epithelial membrane antigen, vimentin and CD10. The postoperative course was unremarkable, and he was referred to oncology for further management. RCC is associated with a great metastatic propensity, and the usual sites of metastatic RCC include lung, bone, liver and brain.1 In contrast, the gall bladder is an extremely rare site of RCC metastasis.2 In a recent review of 23 cases
58
with metastatic RCC of the gall bladder,2 17 cases presented with metachronous metastases with the interval ranging from 3 months to 27 years. Our patient had a similar presentation, which developed metastasis 10 years after the initial diagnosis of RCC. In such a rare clinical condition, RCC with metachronous gall bladder metastasis is difficult to diagnose because such patients usually present with nonspecific symptoms and signs or even incidental findings. Fortunately, contrast-enhanced computed tomography scan can provide useful diagnostic value with the characteristically hypervascular tumor in the gall bladder in this clinical entity, as in this case. Therefore, a hypervascular polypoid lesion in the gall bladder among patients with a history of RCC should be considered possible metastatic RCC. REFERENCES 1. Saitoh H. Distant metastasis of renal adenocarcinoma. Cancer 1981;48: 1487–91. 2. Jain D, Chopra P. Metastatic renal cell carcinoma of gall bladder. Saudi J Kidney Dis Transpl 2013;24:100–4.
The American Journal of the Medical Sciences
Volume 350, Number 1, July 2015
