Intermixed medullary and papillary thyroid cancer in a patient with renal cell carcinoma

Summary We report a rare case of concurrent medullary thyroid cancer (MTC) and papillary thyroid cancer (PTC) with intermixed disease in several of the lymph node (LN) metastases in a patient who was subsequently diagnosed with clear cell renal cell carcinoma (RCC). A 56 year old female presented with dysphagia and was found to have a left thyroid nodule and left superior cervical LN with suspicious sonographic features. Fine needle aspiration biopsy (FNAB) demonstrated PTC in the left thyroid nodule and MTC in the left cervical LN. Histopathology demonstrated multifocal PTC with 3/21 LNs positive for metastatic PTC. One LN in the left lateral neck dissection exhibited features of both MTC and PTC within the same node. In the right lobe, a 0.3 cm focus of MTC with extra-thyroidal extension was noted. Given persistent calcitonin elevation, a follow-up ultrasound displayed an abnormal left level 4 LN. FNAB showed features of both PTC and MTC on the cytopathology itself. The patient underwent repeat central and left radical neck dissection with 3/6 LNs positive for PTC in the central neck and 2/6 LNs positive for intermixed PTC and MTC in the left neck. There was no evidence of distant metastases on computed tomography and whole body scintigraphy, however a 1.9 x 2.5 cm enhancing mass within the right inter-polar kidney was discovered. This lesion was highly suspicious for RCC. Surgical pathology revealed a 2.5 cm clear cell RCC, Fuhrman grade 2/4, with negative surgical margins. She continues to be observed with stable imaging of her triple malignancies. Learning points: Mixed medullary-papillary thyroid neoplasm is characterized by the presence of morphological and immunohistochemical features of both medullary and papillary thyroid cancers within the same lesion. Simultaneous occurrence of these carcinomas has been previously reported, but a mixed disease within the same lymph node is an infrequent phenomenon. Prognosis of mixed medullary-papillary thyroid carcinomas is determined by the medullary component. Therefore, when PTC and MTC occur concurrently, the priority should be given to the management of MTC, which involves total thyroidectomy and central lymph node dissection. Patients with thyroid cancer, predominantly PTC, have shown higher than expected rates of RCC. To our knowledge, this is the first report describing the combination of MTC, PTC, and RCC in a single patient.

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Abstract #1001: Extremely Aggressive Papillary Thyroid Cancer (PTC) with Widespread Metastases Including Spleen and Clear Cell Renal Cell Carcinoma (RCC) in one Patient: An Unknown Syndromic Entity or Manifestation of Familial PTC?

Endocrine Practice ◽

10.1016/s1530-891x(20)44123-0 ◽

2017 ◽

Vol 23 ◽

pp. 210

Author(s):

Shilpi Singh ◽

Anh-Thu Nguyen ◽

Robert Anderson

Keyword(s):

Renal Cell Carcinoma ◽

Thyroid Cancer ◽

Cell Carcinoma ◽

Papillary Thyroid Cancer ◽

Renal Cell ◽

Clear Cell ◽

Papillary Thyroid ◽

Cell Renal Cell Carcinoma

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Metastatic renal cell carcinoma of unknown primary site. Clinical follow-up

Modern Oncology ◽

10.26442/18151434.2020.3.200301 ◽

2020 ◽

Vol 22 (3) ◽

pp. 149-153

Author(s):

N. A. Ognerubov ◽

T. S. Antipova ◽

G. E. Gumareva

Keyword(s):

Computed Tomography ◽

Renal Cell Carcinoma ◽

Adrenal Gland ◽

Cell Carcinoma ◽

Renal Cell ◽

Clear Cell ◽

Cell Cancer ◽

Primary Site ◽

The Right

Renal cell cancer metastases without evidence of a primary tumor are extremely rare. These variants are usually showed as a spontaneous description of single clinical cases. Aim.This contribution is a clinical follow-up of synchronous renal cell cancer metastases of unknown primary site. Results.A 52-year-old patient U. with a history of increased blood pressure, up to 170/100 mmHg for the last 5 years, who had undergone many instrumental examinations, including ultrasound examination, because of this disease. The computed tomography of the abdomen showed a 4975 mm heterogeneous tumor in the right adrenal gland in October 2017. The combined positron emission and X-ray computed tomography showed a 795441 mm mass in the right adrenal gland, associated with elevated fluorodeoxyglucose metabolic activity SUVmax 7.25. Focal accumulation of the radiopharmaceutical SUVmax 4.31 in a 171124 mm mass was detected in the space of bifurcation in the mediastinum. The lytic lesion (1015 mm) was found in right superior L3 articular process. The patient underwent retroperitoneoscopic adrenalectomy and thoracoscopic removal of mediastinal tumor in November 2017 because of the oligometastatic nature of the process. The histological study identified clear-cell carcinoma with areas of papillary structure in the right adrenal gland. The immunohistochemical study showed carcinoma cells intensively expressing CD10, and some other cells RCC. The immune phenotype of the tumor was identified as clear-cell renal cell carcinoma. The immunohistological and immunohistochemical analysis reviled the metastases of the same variant of renal cell carcinoma in one of 9 lymph nodes. The patient was treated with pazopanib. The primary renal tumor was not detected during the dynamic observation, including the application of annual combined positron emission and X-ray computed tomography. The patient is alive without disease progression with a follow-up of 32 months. Conclusion.Metastases of clear-cell renal cell carcinoma, including adrenal gland, without evidence of a primary site are extremely rare. The main method of treatment is a combination of surgery and targeted therapy, providing long-term local control of the course of the disease.

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Faculty Opinions recommendation of Lymph node dissection at the time of radical nephrectomy for high-risk clear cell renal cell carcinoma: indications and recommendations for surgical templates.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.7827956.8165054 ◽

2011 ◽

Author(s):

Levent Turkeri ◽

Ilker Tinay

Keyword(s):

Renal Cell Carcinoma ◽

Lymph Node ◽

High Risk ◽

Cell Carcinoma ◽

Renal Cell ◽

Radical Nephrectomy ◽

Clear Cell ◽

Node Dissection ◽

Cell Renal Cell Carcinoma ◽

Surgical Templates

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Association of Tumor Size with Risk of Lymph Node Metastasis in Clear Cell Renal Cell Carcinoma: A Population-Based Study

Journal of Oncology ◽

10.1155/2020/8887782 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Yunlai Zhi ◽

Xiao Li ◽

Feng Qi ◽

Xin Hu ◽

Wenbo Xu

Keyword(s):

Renal Cell Carcinoma ◽

Lymph Node ◽

Cell Carcinoma ◽

Tumor Size ◽

Renal Cell ◽

Clear Cell ◽

Personal Characteristics ◽

Survival Outcomes ◽

Cell Renal Cell Carcinoma ◽

Increased Risk

The purpose of this article was to explore the association of tumor size with lymph node metastases (LNM) risk in patients with clear cell renal cell carcinoma (ccRCC). Based on the Surveillance, Epidemiology, and End Result (SEER) database, patients diagnosed with ccRCC from 1988 to 2015 were included in this study. For each patient, personal characteristics, clinicopathological data, and survival outcomes were, respectively, collected. Subsequently, the odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to investigate the potential risk factors for LNM in ccRCC. Finally, Kaplan-Meier (KM) survival plots of overall survival (OS) and ccRCC-specific survival (CSS) were evaluated on the basis of different tumor sizes. A total of 8,292 patients were finally enrolled in the study, 1,170 of whom (14.11%) had LNM. According to the heatmap, we could intuitively interpret that larger tumor size was related to an increased risk of LNM obviously. The risk of LNM was evidently greater for larger tumor size (4-7 cm: OR = 2.415, 95% CI = 1.708–3.415; 7–10 cm: OR = 3.746, 95% CI = 2.677–5.242; and >10 cm: OR = 4.617, 95% CI = 3.302–6.457) compared with smaller tumor size (≤4 cm). According to the KM survival plots of OS and CSS, we observed a gradual decline in survival with increasing tumor size, while the smallest tumor size had the best survival outcomes. These results indicated the positive relationship of tumor size with risk of LNM in ccRCC. And we also noticed continual decrease survival rates of OS and CSS with increasing tumor size.

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A rare case of renal cell carcinoma with hematogenous extension into the right atrium discovered incidentally on echocardiogram

The Southwest Respiratory and Critical Care Chronicles ◽

10.12746/swrccc.v8i34.655 ◽

2020 ◽

Vol 8 (34) ◽

pp. 52-55

Author(s):

Ryan Dean ◽

Ganesh Maniam ◽

Thien Vo

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Right Atrium ◽

Renal Cell ◽

Renal Vein ◽

Clear Cell ◽

Right Atrial ◽

Atrial Mass ◽

Right Atrial Mass ◽

The Right

While hematogenous spread of renal cell carcinoma (RCC) is common, isolated extension into the renal vein and inferior vena cava (IVC) is rare and extension to the right atrium is even less likely. In the case, a 62-year-old Hispanic female was admitted for a suspected inferior myocardial infarction, and her echocardiogram revealed a right atrial mass consistent with the appearance of an atrial myxoma. Following cardiac catheterization, a histopathological examination of the mass revealed a clear cell tumor consistent with metastatic clear cell RCC. Following a CABG with excision of the atrial mas, the CT demonstrated a 5 cm right lower pole renal mass with hilar involvement, as well as filling defects in the IVC extending into the right renal vein; these findings were consistent with RCC tumor thrombus extension into the renal vein, IVC, and right atrium. The radical nephrectomy necessary for tumor removal could not be performed at this hospital, so the patient was discharged to a higher level of care. The incidence rate for RCC with extension into the right atrium is quite low, but clinicians should understand the lethality of RCC warrants immediate clinical investigation upon diagnosis. The increased utilization of sophisticated imaging modalities will likely continue to increase the rate of incidental discovery of such neoplasms, and physicians should keep RCC on the differential when a right atrial mass is discovered incidentally on echocardiogram.

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