Gallbladder metastasis of renal clear cell carcinoma 15 years after primary cancer excision: a case report

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Abstract

Background

Renal cell carcinoma is well-known for its propensity to metastasize to unusual sites. However, metastasis to the gallbladder has been rarely reported in the literature.

Case presentation

A 75-year-old Japanese (Asian) woman presented for further evaluation of a gallbladder polyp, 15 years after right radical nephrectomy for renal cell carcinoma. Computed tomography revealed a 12 mm enhancing pedunculated tumor in the gallbladder fundus. Open simple cholecystectomy was performed and the tumor was histologically confirmed as a metastasis of renal cell carcinoma to the gallbladder. Our patient is alive and has been disease-free for 3 years after cholecystectomy.

Conclusions

Although metastasis of renal cell carcinoma is a rare differential diagnosis of gallbladder tumors, simple cholecystectomy is likely to offer a chance of long-term survival for patients with gallbladder metastases of renal cell carcinoma.

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Most cited references 38

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Resection of metastatic renal cell carcinoma.

C Pavlovich, D Mastorakos, Emer Brady … (1998)

Resection of solitary metastases from renal cell carcinoma (RCC) is associated with a 5-year survival rate of 35% to 50%. Selection criteria are not well defined. We retrospectively analyzed our experience with 278 patients with recurrent RCC from 1980 to 1993. One hundred forty-one of 278 patients underwent a curative metastectomy for their first recurrence (44% 5-year overall survival [OS] rate), 70 patients underwent noncurative surgery (14% 5-year OS rate), and 67 patients were treated nonsurgically (11% 5-year OS rate). Favorable features for survival were a disease-free interval (DFI) greater than 12 months versus 12 months or less (55% v 9% 5-year OS rate; P < .0001), solitary versus multiple sites of metastases (54% v 29% 5-year OS rate; P < .001), and age younger than 60 years (49% v 35% 5-year OS rate; P < .05). Among 94 patients with a solitary metastasis, lung (n = 50; 54% 5-year OS rate) was more favorable than brain (n = 11; 18% 5-year OS rate; P < .05). Survival rates after curative resection of second and third metastases were not different compared with initial metastectomy (46% and 44%, respectively, v 43% 5-year OS rates; P = nonsignificant). Favorable predictors of survival by multivariate analysis included a single site of first recurrence, curative resection of first metastasis, a long DFI, a solitary site of first metastasis, and a metachronous presentation with recurrence. Selected patients with recurrent RCC who can undergo a curative resection of their disease have a good opportunity for long-term survival, particularly those with a single site of recurrence and/or a long DFI.

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Kidney cancer.

Robert W Stadler, N Vogelzang (1998)

In the USA, the incidence of kidney cancer has increased 43% since 1973. The risk of the disorder is higher in men than in women and increases with age. The von Hippel-Lindau tumour-suppressor gene is inactivated in over 75% of sporadic cases. Metastatic disease is present in 20-30% of patients at diagnosis. Early-stage kidney cancer is treated with a radical nephrectomy, but under certain circumstances a partial nephrectomy may be done. Tumour thrombus into the vena cava or right atrium requires thoracotomy and hypothermic circulatory arrest for successful removal of the tumour, but should not be done if extensive nodal or frank metastatic disease is present. Interleukin-2 is the systemic therapy of choice for metastatic disease at present, with long-term relapse-free survival of 5-8%. Several treatments including anti-angiogenesis drugs, cyclin-dependent kinase inhibitors, and differentiating agents are being actively investigated. Fluorouracil has a 10-15% response rate, and surgical excision of isolated metastases should always be considered. Therapy for metastatic renal cancer remains inadequate, but recent developments in basic and clinical research suggest future improvement.

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Renal cell carcinoma with metastases to the gallbladder: four cases from the National Cancer Institute (NCI) and review of the literature.

Paul Chung, Ramaprasad Srinivasan, W Linehan … (2012)

We evaluate presentation and outcome of patients with metastatic RCC to the gallbladder from our institution and published literature. Patients with a history of gallbladder metastasis from RCC were selected from our institution's prospective database. A systematic PubMed search was performed to identify articles describing patients with metastatic RCC to the gallbladder. The final cohort included 33 patients: 4 from our institution and 29 from 28 previously published cases. Survival analysis was conducted using log-rank Kaplan-Meier analysis. Median patient age was 63 years and the majority of patients were male. Most patients were asymptomatic and diagnosed with gallbladder metastasis on imaging performed for surveillance or staging. The median time to gallbladder metastasis following nephrectomy was 4 years. Metastasis to the gallbladder occurred both synchronously (33%) and metachronously (67%). Of the patients with available histology, all had clear cell RCC (n = 28). Of all patients, 13 (39%) had metastasis only to the gallbladder, while 20 (61%) had additional sites of metastasis. The most common sites of additional metastasis were contralateral kidney (30%), pancreas (21%), lung (18%), adrenal (18%), and lymph nodes (9%). All patients underwent cholecystectomy. At a median follow up time of 1.5 years after cholecystectomy, 54% of patients had no evidence of disease, 14% were alive with metastasis, 23% had died from metastatic RCC, and 9% died from causes unrelated to their cancer. Gallbladder metastasis from RCC is a rare event that may occur synchronously or metachronously with most patients being asymptomatic. Clear cell carcinoma appears to be the primary pathology associated with gallbladder metastasis. High rates of bilateral RCC and pancreatic metastasis suggest novel associations in patients with RCC and gallbladder metastasis. Published by Elsevier Inc.

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Author and article information

Contributors

Yasufumi Saito: ngywc515@ybb.ne.jp

Hiroshi Okuda: hokuda.2nd-s@go5.enjoy.ne.jp

Makoto Yoshida: Cay@excite.co.jp

Seiji Okimasa: roadman1963@gmail.com

Toshikatsu Fukuda: tsktfukuda@fch.ne.jp

Masatsugu Yano: yamasa63@mopera.net

Makoto Ochi: ochimako@triton.ocn.ne.jp

Yuzo Okamoto: okamotouzo@msi.biglobe.ne.jp

Hirofumi Nakayama: nakayamhsurgpathol1@yahoo.co.jp

Eiji Ono: eiji-ono@jrhh.or.jp

Hideki Ohdan: hohdan@hiroshima-u.ac.jp

Journal

Journal ID (nlm-ta): J Med Case Rep

Journal ID (iso-abbrev): J Med Case Rep

Title: Journal of Medical Case Reports

Publisher: BioMed Central (London )

ISSN (Electronic): 1752-1947

Publication date (Electronic): 31 May 2018

Publication date PMC-release: 31 May 2018

Publication date Collection: 2018

Volume: 12

Electronic Location Identifier: 162

Affiliations

[1 ]Department of Surgery, Medical Corporation JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima, 732-0057 Japan

[2 ]ISNI 0000 0004 0604 7643, GRID grid.416874.8, Department of Surgery, , Onomichi General Hospital, ; Onomichi, Hiroshima Japan

[3 ]Department of Palliative Care, Medical Corporation JR Hiroshima Hospital, Hiroshima, Japan

[4 ]Department of Dialysis Surgery, Medical Corporation JR Hiroshima Hospital, Hiroshima, Japan

[5 ]Department of Pathology and Laboratory Medicine, Medical Corporation JR Hiroshima Hospital, Hiroshima, Japan

[6 ]ISNI 0000 0000 8711 3200, GRID grid.257022.0, Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, , Institute of Biomedical & Health Sciences, Hiroshima University, ; Hiroshima, Japan

Article

Publisher ID: 1569

DOI: 10.1186/s13256-018-1569-3

PMC ID: 5977495

PubMed ID: 29855393

SO-VID: a1903cc0-9bcf-4099-a52e-b669d3e60ce6

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 11 July 2017

Date accepted : 10 January 2018

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ScienceOpen disciplines: Medicine

Keywords: renal cell carcinoma,metastasis,gallbladder

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ScienceOpen disciplines: Medicine

Keywords: renal cell carcinoma, metastasis, gallbladder

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Gallbladder metastasis of renal clear cell carcinoma 15 years after primary cancer excision: a case report

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Abstract

Background

Case presentation

Conclusions

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Karger: Oncology

Most cited references 38

Resection of metastatic renal cell carcinoma.

Kidney cancer.

Renal cell carcinoma with metastases to the gallbladder: four cases from the National Cancer Institute (NCI) and review of the literature.

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Contributors

Journal

Affiliations

Article

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Cited by 4

Most referenced authors 340