A Rare Site of Metachronous Metastases from Renal Cell Carcinoma

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Abstract

Secondary metastatic involvement of the testis is a rare occurrence, particularly in cases of metastasis from renal cell carcinoma (RCC). We present a case of metachronous contralateral testicular metastasis from RCC in a 55-year-old man, occurring 2 years after radical nephrectomy. Following a thorough evaluation that ruled out systemic disease, the patient underwent a Chevassu procedure and right inguinal orchidectomy. Histopathological analysis confirmed metastatic involvement of the right testis by RCC. Metastasis to the testis from RCC is uncommon, with only a few cases reported in the literature. Isolated metachronous metastasis without systemic involvement is even rarer. This case highlights the importance of considering testicular metastasis in patients with a history of RCC, emphasizing the need for comprehensive evaluation and surgical resection when feasible, as it has been associated with prolonged survival.

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Most cited references 17

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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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Renal cell cancer stage migration: analysis of the National Cancer Data Base.

Christopher Kane, Katherine Mallin, Jamie Ritchey … (2008)

Evidence exists to suggest a pattern of increasing early diagnosis of renal cell carcinoma (RCC). The aim of the study was to analyze patterns of disease presentation and outcome of RCC by AJCC stage using data from the National Cancer Data Base (NCDB) over a 12-year period. The NCDB was queried for adults diagnosed between 1993 and 2004 presenting with ICD-O-2 of 3 renal cell tumors arising in the kidney. Cases were classified by demographics, 2002 AJCC stage (6th edition), and histology. The Cochran-Armitage Test for Trend was used to determine statistical significance of trends over time. Cox regression multivariate analysis was used to evaluate the impact of stage and histology on relative survival. SPSS 14.0 was used for analyses. Between 1993 and 2004 a total of 205,963 patients from the NCDB fit our case definition of RCC. Comparisons between 1993 and 2004 data show an increase in stage I disease and decrease in stage II, III, and IV disease (P < or = .001). The size of stage I tumors also decreased from a mean of 4.1 cm in 1993 to 3.6 cm in 2003. In multivariate analysis, stage, but not histology, predicted relative survival. A 3.3% increase in survival was found for patients diagnosed in 1998 compared with patients diagnosed in 1993. A greater proportion of newly diagnosed patients with RCC currently present with stage I disease compared with earlier years. Stage predicts relative survival for patients with kidney cancer. More recently diagnosed patients have improved relative survival. (Copyright) 2008 American Cancer Society.

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A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma.

Marcus Albrecht, Luigi Da Pozzo, Richard Sylvester … (2011)

Nephron-sparing surgery (NSS) can safely be performed with slightly higher complication rates than radical nephrectomy (RN), but proof of oncologic effectiveness is lacking. To compare overall survival (OS) and time to progression. From March 1992 to January 2003, when the study was prematurely closed because of poor accrual, 541 patients with small (≤5 cm), solitary, T1-T2 N0 M0 (Union Internationale Contre le Cancer [UICC] 1978) tumours suspicious for renal cell carcinoma (RCC) and a normal contralateral kidney were randomised to NSS or RN in European Organisation for Research and Treatment of Cancer Genito-Urinary Group (EORTC-GU) noninferiority phase 3 trial 30904. Patients were randomised to NSS (n=268) or RN (n=273) together with limited lymph node dissection (LND). Time to event end points was compared with log-rank test results. Median follow-up was 9.3 yr. The intention-to-treat (ITT) analysis showed 10-yr OS rates of 81.1% for RN and 75.7% for NSS. With a hazard ratio (HR) of 1.50 (95% confidence interval [CI], 1.03-2.16), the test for noninferiority is not significant (p=0.77), and test for superiority is significant (p=0.03). In RCC patients and clinically and pathologically eligible patients, the difference is less pronounced (HR=1.43 and HR=1.34, respectively), and the superiority test is no longer significant (p=0.07 and p=0.17, respectively). Only 12 of 117 deaths were the result of renal cancer (four RN and eight NSS). Twenty-one patients progressed (9 after RN and 12 after NSS). Quality of life and renal function outcomes have not been addressed. Both methods provide excellent oncologic results. In the ITT population, NSS seems to be significantly less effective than RN in terms of OS. However, in the targeted population of RCC patients, the trend in favour of RN is no longer significant. The small number of progressions and deaths from renal cancer cannot explain any possible OS differences between treatment types. Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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Journal

Journal ID (nlm-ta): J Kidney Cancer VHL

Journal ID (iso-abbrev): J Kidney Cancer VHL

Journal ID (publisher-id): JKCVHL

Title: Journal of Kidney Cancer and VHL

Publisher: Codon Publications

ISSN (Electronic): 2203-5826

Publication date (Electronic): 05 January 2024

Publication date Collection: 2024

Volume: 11

Issue: 1

Pages: 1-4

Affiliations

[1]Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India

Author notes

Author for correspondence: Anand Raja, Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India. Email: dranand@ 123456yahoo.com

Article

Publisher ID: JKCVHL-11-001

DOI: 10.15586/jkcvhl.v11i1.282

PMC ID: 10777059

SO-VID: 5e52fde8-2c34-4a96-8597-1f363c0e0a6e

License:

License: This open access article is licensed under Creative Commons Attribution 4.0 International (CC BY 4.0). http://creativecommons.org/licenses/by/4.0

A Rare Site of Metachronous Metastases from Renal Cell Carcinoma

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Karger: Oncology

Most cited references 17

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

Renal cell cancer stage migration: analysis of the National Cancer Data Base.

A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma.

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