Tumor-to-tumor metastasis is a rare phenomenon. From our review of the international literature, around 150 cases have been reported since it was first documented by Campbel in 1868. Renal clear cell carcinoma is well known to be the most common recipient of tumor-to-tumor metastasis in all tumors. However, renal chromophobe cell carcinoma has not been reported to be a recipient. Here, we report a first case of colorectal carcinoma metastatic to chromophobe renal cell carcinoma

Kan, Tomoko

Mimata, Hiromitsu

Sato, Fuminori

Shin, Toshitaka

English

PubMed

Tumor-to-tumor metastasis is a rare phenomenon. From our review of the international literature, around 150 cases have been reported since it was first documented by Campbel in 1868. Renal clear cell carcinoma is well known to be the most common recipient of tumor-to-tumor metastasis in all tumors. However, renal chromophobe cell carcinoma has not been reported to be a recipient. Here, we report a first case of colorectal carcinoma metastatic to chromophobe renal cell carcinoma.</jats:p

Toshitaka Shin

Tomoko Kan

Fuminori Sato

Hiromitsu Mimata

Crossref

Hindawi Publishing CorporationCase Reports in UrologyVolume 2011, Article ID 520839, 3 pagesdoi:10.1155/2011/520839Case ReportTumor-to-Tumor Metastasis to Chromophobe Renal CellCarcinoma: A First ReportToshitaka Shin, Tomoko Kan, Fuminori Sato, and Hiromitsu MimataDepartment of Urology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, JapanCorrespondence should be addressed to Toshitaka Shin, shintosh@oita-u.ac.jpReceived 25 June 2011; Accepted 10 August 2011Academic Editors: E. Casciani, H. Y. Choi, and C. LiaoCopyright © 2011 Toshitaka Shin et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Tumor-to-tumor metastasis is a rare phenomenon. From our review of the international literature, around 150 cases have beenreported since it was first documented by Campbel in 1868. Renal clear cell carcinoma is well known to be the most commonrecipient of tumor-to-tumor metastasis in all tumors. However, renal chromophobe cell carcinoma has not been reported to be arecipient. Here, we report a first case of colorectal carcinoma metastatic to chromophobe renal cell carcinoma.1. IntroductionThe occurrence of various cancers metastasizing to diﬀerentrecipient host tumors is extremely rare [1, 2]. Renal clear cellcarcinoma is themost common recipient tumor ofmetastasiswhile chromophobe cell carcinoma has not been reportedto be a recipient [3, 4]. We present a case of colorectal car-cinoma metastatic to chromophobe renal cell carcinoma anda brief review of the relevant literature.2. Case ReportA 82-year-old woman was referred to our hospital for evalu-ation and treatment of the left renal mass. She has a historyof simultaneous ascending colon and rectal adenocarcinoma,which were both resected and fecal diversion was placed.Single liver metastasis was also resected at the same time.Next year, left lobectomy was performed to resect a newsingle lung metastasis. After 2 years from the first operation,computed tomography (CT) scan showed an enlargingheterogenous left renal mass 35mm in diameter (Figure 1).In contrast enhancement (CE) CT, the tumor was graduallyenhanced, at peripheral lesion in particular. Therefore, thistumor was thought likely to be a primary renal cell carcinomaor metastatic carcinoma. Retroperitoneoscopic left nephrec-tomy was performed. Sectioning revealed a light yellow well-circumscribed mass in the middle portion of the kidney,measuring 3.5× 3.8 cm (Figure 2). The tumor contained thehemorrage or necrosis at inside. Microscopically, the tumorwas composed largely of two patterns of small oxyphilicgranular cells and larger light translucent cells when using thehematoxylin and eosin (HE) staining (Figure 3 upper). Thesefeatures are consistent with chromophobe cell carcinomaof the kidney. However, within the chromophobe renal cellcarcinoma, there were another foci of atypical cells arrangedin high-columnar pattern (Figure 3 lower). These cells grewwith the production of viscous liquid and the necrosis. Thesefindings were as same as those of the previous colorectaladenocarcinoma. Thus, pathological diagnosis was colorectalcarcinoma metastatic to chromophobe renal cell carcinoma.Then, the patient was merely put under followup and is stillwithout evidence of disease, 8 months after the nephrectomy.3. DiscussionAlthough the coexistence of 2 or more primary neoplasmsin the same patient is sometimes observed, tumor-to-tumormetastasis is a rare phenomenon [1–4]. Documentation oftumor-to-tumor metastasis must meet certain criteria. Ac-cording to Campbell et al. [1] these criteria are the following[2, 3]: (1) more than 1 primary tumor must exist; (2) therecipient tumor is a true benign or malignant neoplasm; (3)the metastatic neoplasm is a true metastasis with establishedgrowth in the host tumor, not the result of contiguous2 Case Reports in UrologySimple(a)CE+(b)Figure 1: Computed tomography at the time of diagnosis. It showed a heterogeneously enhanced left renal mass 35mm in diameter.Figure 2: A gross pathologic specimen. Sectioning revealed a lightyellow well-circumscribedmass in themiddle portion of the kidney,measuring 3.5 × 3.8 cm. The tumor contained the hemorrhage ornecrosis at inside.×40×400Figure 3: Histologic appearance of junction between metastaticpoorly diﬀerentiated adenocarcinoma (upper) and chromophoberenal cell carcinoma (lower), HE staining.growth (collision tumor) or embolization of tumor cells;(4) tumors that have metastasized to the lymphatic system,where lymphoreticular malignant tumors already exist, areexcluded.Many of the cases reported previously were discoveredonly at autopsy. In this phenomenon, the most frequentrecipient is clear cell carcinoma of the kidney, followed bysarcomas, meningiomas, and thyroid neoplasms, while themost common donor is carcinoma of the lung, followed bycarcinoma of the breast, gastrointestinal tract, prostate, andthyroid [2]. Two factors may contribute to the preferentialhoming of metastatic cancer to renal clear cell carcinoma[2, 3, 5, 6]. One is the rich vascularization of clearcell carcinomas, which renders them more accessible tometastatic tumor cells in the circulating blood. This theoryis called “mechanical theory.” The other is the high lipid andglycogen content in clear cell carcinoma, which may providea nutrient-richmicroenvironment formetastatic tumor cells.This theory is called “seed and soil theory.”However, chromophobe cell carcinoma does not havethese special features and other unknown mechanismsmight work for this phenomenon. Chromophobe renal cellcarcinoma is an uncommon variant of renal cell carcinoma,accounting for approximately 3–5% of renal cancer [7].Chromophobe cell carcinoma has distinct biologic andclinical characteristics compared with clear cell carcinoma.The typical cytological findings are a light translucent, butnot empty cytoplasm when using the hematoxylin and eosinstaining [7]. The cells are usually voluminous with pro-nounced cell boundaries. Clinically, chromophobe cell car-cinoma is considered to have a good prognosis.To our knowledge, this is the first reported case of tumor-to-tumor metastasis to chromophobe cell carcinoma.Although tumor-to-tumor metastasis occurs infre-quently, this possibility should always be considered whenan unusual dimorphic pattern appears in a tumor. Thephenomenon may become more frequent because of theimproving prognosis and survival of patients with malignan-cies.Case Reports in Urology 3References[1] L. V. Campbell, E. Gilbert, C. R. Chamberlain, and A. L. Watne,“Metastases of cancer to cancer,” Cancer, vol. 22, no. 3, pp. 635–643, 1968.[2] E. O. Singh, R. C. Benson Jr., and L. E. Wold, “Cancer-to-cancermetastasis,” Journal of Urology, vol. 132, no. 2, pp. 340–342,1984.[3] A. Sella and J. Y. Ro, “Renal cell cancer: best recipient of tumor-to-tumor metastasis,” Urology, vol. 30, no. 1, pp. 35–38, 1987.[4] C. Petraki, M. Vaslamatzis, T. Argyrakos et al., “Tumor to tumormetastasis: report of two cases and review of the literature,”International Journal of Surgical Pathology, vol. 11, no. 2, pp.127–135, 2003.[5] R. Ricketts, P. Tamboli, B. Czerniak, and C. C. Guo, “Tumor-to-tumor metastasis: report of 2 cases of metastatic carcinomato angiomyolipoma of the kidney,” Archives of Pathology &Laboratory Medicine, vol. 132, no. 6, pp. 1016–1020, 2008.[6] K. Honma, K. Hara, and T. Sawai, “Tumour-to-tumour metas-tasis: a report of two unusual autopsy cases,” Virchows Archiv,vol. 416, no. 2, pp. 153–157, 1989.[7] T. Klatte, K. R. Han, J. W. Said et al., “Pathobiology andprognosis of chromophobe renal cell carcinoma,” UrologicOncology, vol. 26, no. 6, pp. 604–609, 2008.Submit your manuscripts athttp://www.hindawi.comStem CellsInternationalHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014MEDIATORSINFLAMMATIONofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Behavioural NeurologyEndocrinologyInternational Journal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Disease MarkersHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014BioMed Research InternationalOncologyJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Oxidative Medicine and Cellular LongevityHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014PPAR ResearchThe Scientific World JournalHindawi Publishing Corporation http://www.hindawi.com Volume 2014Immunology ResearchHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Journal ofObesityJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014 Computational and  Mathematical Methods in MedicineOphthalmologyJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Diabetes ResearchJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Research and TreatmentAIDSHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Gastroenterology Research and PracticeHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Parkinson’s DiseaseEvidence-Based Complementary and Alternative MedicineVolume 2014Hindawi Publishing Corporationhttp://www.hindawi.com

Case Reports in Urology

Tumor-to-Tumor Metastasis to Chromophobe Renal Cell Carcinoma: A First Report

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Tumor-to-Tumor Metastasis to Chromophobe Renal Cell Carcinoma: A First Report

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