TEACHING CASESNeuroendocrine breast carcinoma metastatic 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.
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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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