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      Metastasis of renal cell carcinoma to the parathyroid gland 12 years after radical nephrectomy

      case-report

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          Abstract

          Renal cell carcinoma (RCC) accounts for 2–3% of all malignant tumors in adults. RCC is well-known for its propensity to metastasize to unusual sites, and late metastasis, even after several years, is common. Involvement of the parathyroid gland has only four reported cases in literature. A 62-year-old Caucasian man was referred to our department due to an enlarging cervical mass. The patient’s relevant past medical history included a left nephrectomy for RCC 12 years ago. After right thyroid lobectomy and isthmectomy, histopathology revealed an intrathyroidal nodule corresponding to the parathyroid gland with metastatic RCC. Approximately one-third of RCC subjects with apparently localized disease will develop metastasis, even several years after nephrectomy. The literature is sparse regarding the most appropriate follow-up approach for these patients. We describe a rare case of nodular goiter of the thyroid gland concurrent with metastatic RCC to an intrathyroidal parathyroid gland, without disseminated systemic metastasis.

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          Epidemiologic and socioeconomic burden of metastatic renal cell carcinoma (mRCC): a literature review.

          Kiran B. Gupta, Jeffrey Miller, Jim Li … (2008)
          Renal cell carcinoma (RCC), the most common form of kidney cancer, initially has an asymptomatic clinical course; 25-30% of patients present with metastatic disease at time of diagnosis. Worldwide incidence and mortality rates are rising at a rate of approximately 2-3% per decade. Metastatic RCC (mRCC) is one of the most treatment-resistant malignancies; outcomes are generally poor and median survival after diagnosis is less than one year. Surgery and chemotherapy have limited or no effect, leaving mRCC patients underserved in the realm of cancer treatment. As the world's population ages and the prevalence of risk factors (obesity, hypertension) increases, the burden of mRCC is predicted to increase significantly. With a shift in treatment of mRCC to novel therapies, such as molecularly targeted therapies (MTTs) (e.g., sorafenib and sunitinib), clinicians, payers, and other healthcare decision-makers must re-evaluate the optimal role for new treatments. Timely understanding of the burden of mRCC on individuals and society clearly is needed at this juncture. Using a comprehensive literature review, we assessed the epidemiologic, economic, and health-related quality of life (HRQOL) burdens of mRCC. The annual incidence of mRCC in major European countries, the US, and Japan ranges from 1500 to 8600 cases. However, prevalence data were lacking. The estimated economic burden of mRCC is large; $107-$556 million (2006 USD) in the US and $446 million-$1.6 billion (2006 USD) collectively in select countries worldwide. MTTs have potential to reduce the burden of mRCC and provide substantial value beyond their clinical effectiveness.
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            The changing natural history of renal cell carcinoma.

            A Pantuck, A Zisman, A Belldegrun (2001)
            Our understanding of the natural history of renal cell carcinoma, the role of nephrectomy, the benefits of immunotherapy and the possibilities of new technologies are evolving and being integrated with advances in classification and staging. We reviewed the relevant literature to clarify these pertinent questions and provide a current review of the changes in the epidemiology, treatment and prognosis of patients with renal cell carcinoma. We comprehensively reviewed the peer reviewed literature on the current management of and results of treatment for renal cell carcinoma. The incidence of and mortality from renal cell carcinoma have continuously increased during the last 50 years. Despite this increase in the number of new patients and consequently the number of deaths yearly the percent of those surviving for 5 years has notably improved. Factors related to improved survival include advances in renal imaging, earlier diagnosis, improved staging, better understanding of prognostic indicators, refinement in surgical technique and the introduction of immunotherapy approaches for advanced disease. Currently patients with localized and metastatic renal cell carcinoma have had improvements in outlook and the therapeutic options available have expanded.
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              Immunohistochemical distinction of renal cell carcinoma from other carcinomas with clear-cell histomorphology: utility of CD10 and CA-125 in addition to PAX-2, PAX-8, RCCma, and adipophilin.

              Mark Mentrikoski, Scott M Wendroth, Mark R Wick (2014)
              Clear-cell renal cell carcinoma (CC-RCC) is the most common primary kidney malignancy, yet this morphology is not unique to renal primary tumors, as clear-cell variants of numerous nonrenal carcinomas of varying lineages exist. Therefore, because of CC-RCC's ability to metastasize to nearly any anatomic location, ancillary studies such as immunohistochemistry are often needed to establish the diagnosis. Despite CD10 and renal cell carcinoma monoclonal antibody (RCCma) being touted as sensitive and specific markers, some have suggested that more recent stains including PAX-2, PAX-8, or adipophilin (ADP) are more robust markers of CC-RCC. In this study, 26 cases of CC-RCC, and 51 nonrenal carcinomas with clear-cell histomorphology (CCM) were stained with CD10, RCCma, PAX-2, PAX-8, and ADP. CA-125 was also included to help distinguish CC-RCC from Müllerian clear-cell carcinomas, due the known expression of PAX-2 and PAX-8 in both these entities. RCCma highlighted 77% of CC-RCC and 27% of the CCM group, whereas CD10 was positive in 85% and 25%, respectively. ADP highlighted all CC-RCC and 45% of CCMs. PAX-2 was positive in 81% of CC-RCC and 24% of CCM, whereas PAX-8 stained 100% of CC-RCC and 39% of CCM. Müllerian-derived tumors (clear-cell carcinomas of the ovary, vagina, and cervix) were positive with PAX-2 and PAX-8 in 69% and 100% of cases, respectively. No cases of CC-RCC stained with CA-125, whereas 88% of the Müllerian-derived tumors were positive. In summary, although new markers such as PAX-2 and PAX-8 tend to be more sensitive markers of CC-RCC, they lose specificity when Müllerian tumors are included. Inclusion of a classic renal marker such as CD10 or RCCma in the immunohistochemical panel, as well as CA-125 obviates this difficulty.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Surg Case Rep
                Journal ID (iso-abbrev): J Surg Case Rep
                Journal ID (publisher-id): jscr
                Title: Journal of Surgical Case Reports
                Publisher: Oxford University Press
                ISSN (Electronic): 2042-8812
                Publication date Collection: February 2019
                Publication date (Electronic): 19 February 2019
                Publication date PMC-release: 19 February 2019
                Volume: 2019
                Issue: 2
                Electronic Location Identifier: rjz032
                Affiliations
                [1 ]General Surgery Department, Unidade Local de Saúde do Baixo Alentejo, Beja 7801-849, Portugal
                [2 ]Department of Pathology, Hospital Espiríto Santo, 7000 Évora, Portugal
                Author notes
                Correspondence address. General Surgery Department, Unidade Local de Saúde do Baixo Alentejo, Beja 7801-849, Portugal. Tel: +351-96-330-4401; E-mail: debora.melo@ 123456ulsba.min-saude.pt
                Author information
                http://orcid.org/0000-0002-1149-5809
                Article
                Publisher ID: rjz032
                DOI: 10.1093/jscr/rjz032
                PMC ID: 6380075
                SO-VID: 0a9c17d4-e6fa-4887-9284-550625e7614b
                Copyright © Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2019.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@ 123456oup.com

                History
                Date received : 25 November 2018
                Date revision received : 15 January 2019
                Date accepted : 22 January 2019
                Page count
                Pages: 3
                Categories
                Subject: Case Report

                Data availability:

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