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Neuroendocrine breast carcinoma metastatic to renal cell carcinoma and ipsilateral adrenal gland

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Abstract

We report on a 60-year-old woman with neuroendocrine carcinoma of the left breast metastasizing to renal cell carcinoma (RCC) of the left kidney and to adrenal gland. A yellow, well-circumscribed tumor, 11 cm in largest diameter and limited to the kidney, was found. Histopathology revealed RCC with foci of neuroendocrine differentiation. Solid sheets of hyperchromatic epithelioid cells with high mitotic activity were found between typical clear cells of RCC. These cells were CAM5,2 and E-cadherin focally positive, synaptophysin and NSE weakly positive, CK19 moderately positive, and AE1-AE3 and EMA strongly positive. Chromogranin A, CD10, CK 14, CK 20, HER2 (score 1+), vimentin, and HMB45 were negative. The left adrenal gland contained multiple, separate foci of a tumor composed of neuroendocrine components. Because of the biphasic tumor in the kidney, extensive clinical examination and further analyses were recommended. Tumor in the left breast was revealed. Two months later, the patient underwent mastectomy with axillary lymph node dissection. The tumor was histologically and immunohistochemically similar to the neuroendocrine component within RCC. All axillary nodes were positive.

To our knowledge, this is the first case of neuroendocrine breast carcinoma with metastasis to renal cell carcinoma and ipsilateral adrenal gland.

Introduction

Breast cancer is the most common malignant tumor and the main cause of tumor-related death in women. Its occurrence with other primary malignances, in particular renal cell carcinoma, is not a rare event. However, tumor metastatic to another neoplasm is rare. Four cases of breast cancer metastasis to renal cell carcinoma have been described in the literature [7], [15], [17], [18]. We report the first case of breast carcinoma showing neuroendocrine differentiation with metastasis to renal cell carcinoma and ipsilateral adrenal gland.

Section snippets

Clinical history

A 60-year-old woman presented with painless macrohematuria persisting for several months. Clinical examination including ultrasound, intravenous pyelography, and CT scan showed a well-circumscribed tumor on the upper pole of the left kidney. The tumor of the left breast was also found. Nephrectomy with ureterectomy was performed. During the same operation, the left adrenal gland and spleen were removed. The patient underwent mastectomy with axillary lymph node dissection 2 months later.

The

Materials and methods

Specimens were fixed in 10% buffered formalin, embedded in paraffin, cut at 5 μm thickness, and routinely stained with hematoxylin and eosin. Immunohistochemical staining was performed following the microwave streptavidin immunoperoxidase (MSIP) protocol on DAKO TechMate Horizon automated immunostainer using the following primary antibodies: CK7, CK19, CK20, AE1-AE3, EMA, synaptophysin, S-100, chromogranin A, vimentin, HMB45, Ki-67, ER, PR and HER2 (DAKO), CK14 (Novocastra), and CAM5.2 (Becton

Results

Grossly, the kidney showed a yellow, well-circumscribed tumor, 11 cm in largest diameter, with an elevated capsule but limited to the kidney (Fig. 1A). Histopathologic diagnosis revealed typical renal cell carcinoma (RCC) with foci of solid sheets of hyperchromatic epithelioid cells with high mitotic activity and apoptosis (Fig. 1B and C). Small foci of necrosis were observed within the hyperchromatic epithelioid component. The RCC component was composed of atypical epithelial cells with clear

Discussion

The occurrence of multiple primary malignances is a rare but well-known phenomenon. It has been reported in 2.3% of clinical and in 8.1% of autopsy series [10]. RCC is the tumor most commonly found to co-exist with other malignancies [1], [10], [12], [13], [14]. In different studies, the incidence of second primary malignancy associated with RCC was reported to be 12–27.4% [1], [10], [11], [14]. About 19% of these tumors appeared synchronously [1]. Other primary malignant tumors most often

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