Esophageal Squamous Cell Carcinoma Recurring as a Solitary Renal Mass

Do Hyoung Lim; Young-Hyuck Im; Sang Hoon Ji; Byeong-Bae Park; Mi Jung Oh; Jeeyun Lee; Keun Woo Park; Se-Hoon Lee; Joon-Oh Park; Kihyun Kim; Won Seog Kim; Chul Won Jung; Young Suk Park; Won Ki Kang; Mark H Lee; Kwanmien Kim; Young Mog Shim; Keunchil Park

doi:10.4143/crt.2004.36.4.271

Articles

Page Path: HOME > Cancer Res Treat > Volume 36(4); 2004 > Article

Case Report Esophageal Squamous Cell Carcinoma Recurring as a Solitary Renal Mass: Do Hyoung Lim, M.D.¹, Young-Hyuck Im, M.D.¹, Sang Hoon Ji, M.D.¹, Byeong-Bae Park, M.D.¹, Mi Jung Oh, M.D.¹, Jeeyun Lee, M.D.¹, Keun Woo Park, M.D.¹, Se-Hoon Lee, M.D.¹, Joon-Oh Park, M.D.¹, Kihyun Kim, M.D.¹, Won Seog Kim, M.D.¹, Chul Won Jung, M.D.¹, Young Suk Park, M.D.¹, Won Ki Kang, M.D.¹, Mark H Lee, M.D.¹, Kwanmien Kim, M.D.², Young Mog Shim, M.D.², Keunchil Park, M.D.¹; Cancer Research and Treatment : Official Journal of Korean Cancer Association 2004;36(4):271-274.
DOI: https://doi.org/10.4143/crt.2004.36.4.271
Published online: August 31, 2004

¹Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

²Division of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Correspondence: Young-Hyuck Im, Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea. (Tel) +82-2-3410-3445, (Fax) +82-2-3410-0041, imyh@smc.samsung.co.kr

• Received: June 21, 2004 • Accepted: August 2, 2004

9,812 Views
62 Download
14 Crossref

Full Article

Download PDF

Abstract

Herein, a case of solitary, unilateral renal metastasis in a patient with curatively resected thoracic esophageal carcinoma, who achieved a pathological complete remission after neoadjuvant concurrent chemoradiotherapy, is reported. The kidney is the 4^th or 5^th most common visceral metastasis site of a primary esophageal carcinoma. More than 50% of renal metastases typically show bilateral involvement. Solitary, unilateral renal metastasis is extremely rare. Renal metastases from a primary esophageal carcinoma are usually latent and its diagnosis is very unusual in a live patient. The solitary renal metastasis in this case was not accompanied by metastases to other sites. The value of a nephrectomy in solitary renal metastasis of esophageal cancer is not known due to the rarity of such cases. A nephrectomy could be justified in limited situations, such as with uncertainty of histological diagnosis, severe life-threatening hematuria, which cannot be controlled by embolization, or solitary renal metastasis with a long disease-free interval.
Key words: Esophageal carcinoma, Metastasis, Kidney

INTRODUCTION

An esophageal carcinoma is often diagnosed at an advanced stage and only a small number of patients can be considered for curative resection and thus, for long-term survival (1). Surgical resection remains the only curative treatment modality for an esophageal carcinoma without distant metastasis (2). Therefore, it is important to detect distant metastases in patients with an esophageal carcinoma, so that unwarranted surgery can be avoided. Despite the increase in radical surgery for esophageal carcinomas, about 43~63% of patients eventually experience a recurrent disease after surgery (3,4). Thirty to forty percent of recurrences are due to hematogenous spread, and common sites of recurrence are the liver, lung, bone and adrenal glands. The kidney is known to be the 4^th or 5^th most common visceral metastasis site of esophageal carcinomas (5~7). However, solitary renal metastasis of an esophageal squamous cell carcinoma has rarely been reported. Herein, a case of solitary, unilateral renal metastasis in a patient with curatively resected, thoracic esophageal carcinoma, who achieved a complete remission after preoperative concurrent chemoradiotherapy, is reported.

CASE REPORT

A 64-year-old man was admitted with an evaluation of progressive dysphagia in November, 2001. He had complained of dysphagia for the previous 2 months. An endoscopy showed a circular ulcerofungating mass measuring 4 cm in length, 32 cm from the incisor. A biopsy revealed a moderately differentiated, invasive squamous cell carcinoma. Staging work-up, including endoscopic ultrasonography, chest CT, abdominal CT and PET scan, showed a right high paratracheal lymph node enlargement, without distant metastasis. Under the diagnosis of locally advanced esophageal cancer, he received pre-operative concurrent chemoradiation therapy, consisting of 2 cycles of cisplatin (75 mg/m²) on day 1 and 5-fluorouracil (1,000 mg/m²) on days 1 to 4, which was repeated every 3 weeks. Radiation therapy was delivered in a total dose of 4,500 cGy in 25 fractions. He underwent an Ivor-Lewis operation, with 2-field lymph node dissection, on January 21, 2002. A histological examination showed no residual malignant cells or metastatic foci in 17 regional dissected lymph nodes, suggesting a pathologically complete remission after the preoperative chemoradiotherapy.

During the regular post-operative follow-up as an outpatient, a solitary left kidney mass was detected in December, 2003. The patient was asymptomatic, with no abdominal discomfort, hematuria or any other urinary symptoms. A kidney CT scan revealed a heterogeneously attenuating mass lesion approximately 4.1×3.4 cm in size, with persistent weak enhancement on the anterior lip, mid-portion of the left kidney (Fig. 1). There were no other visceral metastases or lymphadenopathies in the CT scan. A PET scan (Fig. 1) also showed a single, abnormal increased uptake of the left kidney. He underwent a radical nephrectomy on January 14, 2004. A histological examination of the resected kidney showed a metastatic squamous cell carcinoma, which coincided with the histological findings of the previously resected esophageal carcinoma (Fig. 2). The follow-up abdominal CT scan revealed suspicious metastatic lymphadenopathy in the para-aortic space. The patient received palliative chemotherapy, consisting of cisplatin 75 mg/m² on day 1 and continuous infusion of 1,000 mg/m² 5-fluorouracil on days 1 to 4. After 3 cycles of chemotherapy, the size of the suspicious paraaortic lymphadenopathy had decreased in extent in the follow-up CT scan.

DISCUSSION

The incidence of distant metastases from a newly diagnosed esophageal carcinoma has been reported as approximately 18% (6). Several autopsy series reported that the common sites of spread as being abdominal lymph nodes (45%), followed by the liver (35%), lung (20%), cervical & supraclavicular lymph nodes (18%), bone (9%), adrenal glands (5%), peritoneum (2%) and brain (2%). Of these, the frequencies of visceral metastatic spread were as follows: lung, 22~52%; liver, 23~47%; adrenal glands, 6~20%; bone, 4~14%; kidney, 8~13% and central nervous system, 1~5% (5,8,9).

Because the renal blood flow accounts for approximately 20% of cardiac output, the kidneys are likely to be vulnerable to hematogenous metastases. More than 50% of renal metastases typically show bilateral involvement. The clinical manifestation of a metastatic renal tumor differs from that of primary renal cell carcinoma in several aspects. The majority of primary renal cell carcinomas are, on average, larger than metastatic renal tumor, with most primary tumors measuring over 6 cm at the time of presentation, compared with less than 4 cm for metastatic tumors. Second, metastases tend to be less exophytic and wedge-shaped than a primary renal cell carcinoma (10~12). Metastatic renal tumors are frequently observed in subcapsular location, which can be explained by a tumor seeding into the vascular renal cortex, with subsequent elongated growth being limited by the renal capsule, which produces a wedge shaped appearance.

The majority of patients with renal metastases are asymptomatic, despite extensive renal involvement. Hematuria and/or proteinuria occur in less than 20% of patients, and a cytologic examination infrequently shows malignant cells in the urine. Therefore, the diagnosis of renal metastases is very difficult, and often established accidentally (12~14). Renal metastasis from a primary esophageal carcinoma is commonly found in autopsy series, but is rarely diagnosed in live patients. Moreover, unilateral, solitary renal metastasis is extremely rare. Yokoi et al reported that G-CSF and CA19-9 may play a role in attaching the metastatic tumor cells to the glomerular endothelium (14). Further investigations are necessary to identify the molecules and cytokines involved in renal metastasis.

In this case, the patient achieved a pathologic complete remission after preoperative concurrent chemotherapy with irradiation. About 2 years after the curative resection, the patient recurred with a solitary renal metastasis. Since current diagnostic tools can not detect all the micrometastatic sites of a disease, the usefulness of curative nephrectomy cannot be determined in this clinical setting. A nephrectomy could be justified in limited situations, such as with the uncertainty of histological diagnosis, severe life-threatening hematuria which cannot be controlled by embolization, or solitary renal metastasis with a long disease free interval.

The median survival following the detection of a recurrent esophageal carcinoma is 5.0~7.0 months (1,2). The treatment outcome of a recurrent disease is disappointing, and the prognosis is notoriously poor. Therefore, molecular biological techniques for determining the tumor biology are needed to identify patients who will experience a recurrence. More early detection methods and effective systemic therapeutic modalities of esophageal carcinomas are also required.

REFERENCES

1. Mariette C, Fabre S, Balon JM, Finzi L, Triboulet JP. Factors predictive of complete resection of operable esophageal cancer: review of 746 patients. Gastroenterol Clin Biol. 2002;26:454–462. PMID: 12122354PubMed
2. Roth J, Putnam J Jr., Rich T, Forastiere A. . In: Devita VT., Hellman S, Rosenberg SA, editors. Cancer of the Esophagus. Cancer. Principles and Practice of Oncology. 2001. 6th edition. New York: Lippincott-Raven, Inc.; p. 1051–1091.
3. Mariette C, Balon JM, Piessen G, Fabre S, Van Seuningen I, Triboulet JP. Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease. Cancer. 2003;97:1616–1623. PMID: 12655517Article PubMed
4. Nakagawa S, Kanda T, Kosugi S, Ohashi M, Suzuki T, Hatakeyama K. Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg. 2004;198:205–211. PMID: 14759776Article PubMed
5. Chan KW, Chan EY, Chan CW. Carcinoma of the esophagus. An autopsy study of 231 cases. Pathology. 1986;18:400–405. PMID: 3822518Article PubMed
6. Quint LE, Hepburn LM, Francis IR, Whyte RI, Orringer MB. Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma. Cancer. 1995;76:1120–1125. PMID: 8630886Article PubMed
7. Marsan RE, Baker DA, Morin ME. Esophageal carcinoma presenting as a primary renal tumor. J Urol. 1979;121:90–91. PMID: 759652Article PubMed
8. Chan KW, Chan EY, Chan CW. Carcinoma of the esophagus. An autopsy study of 231 cases. Pathology. 1986;18:400–405. PMID: 3822518Article PubMed
9. Mandard AM, Chasle J, Marnay J, Villedieu B, Bianco C, Roussel A, Elie H, Vernhes JC. Autopsy findings in 111 cases of esophageal cancer. Cancer. 1981;48:329–335. PMID: 6453643Article PubMed
10. Choyke PL, White EM, Zeman RK, Jaffe MH, Clark LR. Renal metastases: clinicopathologic and radiologic correlation. Radiology. 1987;162:359–363. PMID: 3797648Article PubMed
11. Heitala SO, Wahlqvist L. Metastatic tumors to the kidney: a postmortem, radiologic and clinical investigation. Acta Radiol Diagn (Stockh). 1982;23:585–591. PMID: 7171026Article PubMed
12. Wada T, Ichikawa T, Okuzono T, Okuzono Y, Naito K. Renal metastasis from squamous cell carcinoma of the hypopharynx. Urol Int. 2002;68:132–134. PMID: 11834907Article PubMed
13. Yokoi H, Nakata M, Sawai K, Yoshida T, Koshikawa M, Joyama S, Tanaka A, Goto M, Ueda S, Senzaki H, Sugawara A, Kuwahara T. Intraglomerular metastasis from pancreatic cancer. Am J Kidney Dis. 2001;37:1299–1303. PMID: 11382703Article PubMed
14. Bosch A, Frias Z, Caldwell WL, Jaeschke WH. Autopsy findings in carcinoma of the esophagus. Acta Radiol Oncol Radiat Phys Biol. 1979;18:103–112. PMID: 495189Article PubMed

Fig. 1

CT scan of the kidney and a whole body FDG-PET scan of the patient. (A), (B) About 4.1×3.4 cm sized heterogeneous attenuating mass was detected on the anterior lip of the left kidney. (C), (D) A mass with high FDG uptake was seen on the lateral cortex area of the left kidney. The mass corresponded to the mass detected at the CT scan of the kidney.

Fig. 2

Gross and microscopic pathology of the kidney mass. A subcapsular protruding mass was found at the mid-portion of the left kidney. (A) Microscopic examination of the resected kidney showed a metastatic squamous cell carcinoma, which coincided with the histological findings of the previously resected esophageal carcinoma (H & E stain, B: ×200).

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

Rapidly Rising Serum Creatinine in a Patient With Colorectal Adenocarcinoma and Eosinophilia: A Quiz
Athiphat Banjongjit, Vorachai Ratanatharathorn, Piyanut Mahanupap, Winyou Mitarnun
American Journal of Kidney Diseases.2024; 83(2): A14. CrossRef
Esophageal squamous cell carcinoma metastases to kidney and renal hilar lymph nodes through epithelial-mesenchymal transition: a case report and literature review
Nai-Jun Fan
American Journal of Translational Research.2024; 16(5): 1825. CrossRef
Secondary Tumors of the Kidney: A Comprehensive Clinicopathologic Analysis
Faisal Saeed, Adeboye O. Osunkoya
Advances in Anatomic Pathology.2022; 29(4): 241. CrossRef
Surgery for metachronous oligometastatic esophageal cancer: Is there enough evidence?
Dimitrios Schizas, Michail Vailas, Maria Sotiropoulou, Ioannis A. Ziogas, Konstantinos S. Mylonas, Ioannis Katsaros, Alkistis Kapelouzou, Theodore Liakakos
Cirugía Española.2021; 99(7): 490. CrossRef
Surgery for metachronous oligometastatic esophageal cancer: Is there enough evidence?
Dimitrios Schizas, Michail Vailas, Maria Sotiropoulou, Ioannis A. Ziogas, Konstantinos S. Mylonas, Ioannis Katsaros, Alkistis Kapelouzou, Theodore Liakakos
Cirugía Española (English Edition).2021; 99(7): 490. CrossRef
The role of surgical treatment in isolated organ recurrence of esophageal cancer—a systematic review of the literature
Dimitrios Schizas, Ioannis I. Lazaridis, Demetrios Moris, Aikaterini Mastoraki, Lazaros-Dimitrios Lazaridis, Diamantis I. Tsilimigras, Nikolaos Charalampakis, Theodore Liakakos
World Journal of Surgical Oncology.2018;[Epub] CrossRef
Esophageal Cancer with Solitary Renal Metastasis Treated with Multidisciplinary Therapy: A Case Report and Mini Review of the Literature
Kyoung Sik Nam, Kyoungwon Jung, Moo In Park, Seun Ja Park, Won Moon, Sung Eun Kim, Jae Hyun Kim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2017; 17(1): 39. CrossRef
Esophageal Cancer Metastases to Unexpected Sites: A Systematic Review
Osama Shaheen, Abdulaziz Ghibour, Bayan Alsaid
Gastroenterology Research and Practice.2017; 2017: 1. CrossRef
FDG PET/CT in 2 Cases of Renal Metastasis From Esophageal Squamous Cell Carcinoma
Qian Zhao, Aisheng Dong, Bo Yang, Yang Wang, Changjing Zuo
Clinical Nuclear Medicine.2017; 42(11): 896. CrossRef
Solitary renal metastasis of esophageal squamous cell carcinoma mimicking primary renal neoplasm – A case report and literature review
Kai-Po Chang, Chi-Ping Huang, Han Chang
BioMedicine.2016;[Epub] CrossRef
Unilateral renal metastases after definitive chemoradiation in squamous cell carcinoma of esophagus: A case report and review literature
Kapil Dev, Jaiprakash Gurawalia, Sandeep Nayak, Balu Sadasivan
Asian Journal of Oncology.2016; 02: 046. CrossRef
Renal metastasis after esophagectomy of esophageal squamous cell carcinoma: a case report and literature review
Yan Sun, Xinmin Yu, Yiping Zhang
World Journal of Surgical Oncology.2014;[Epub] CrossRef
Esophageal Adenocarcinoma with Solitary Renal Metastasis
Thomas D. Willson, Matthew J. Blecha, Mark M. Connolly, Francis J. Podbielski
Journal of Gastrointestinal Cancer.2013; 44(3): 351. CrossRef
Synchronous Squamous Cell Carcinomas of the Esophagus and Renal Pelvis
Te-Chun Hsieh, Yu-Chin Wu, Shung-Shung Sun, I-Ping Chiang, Chun-Fan Yang, Kuo-Yang Yen, Chia-Hung Kao
Clinical Nuclear Medicine.2011; 36(11): e171. CrossRef

PubReader
ePub Link

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Esophageal Squamous Cell Carcinoma Recurring as a Solitary Renal Mass

Cancer Res Treat. 2004;36(4):271-274. Published online August 31, 2004

DOI: https://doi.org/10.4143/crt.2004.36.4.271

XML Download

Abstract
INTRODUCTION
CASE REPORT
DISCUSSION
REFERENCES

Neoadjuvant Nivolumab Therapy for Esophageal Squamous Cell Carcinoma: A Single-Arm, Phase II Study

Esophageal Squamous Cell Carcinoma Recurring as a Solitary Renal Mass

Fig. 1 CT scan of the kidney and a whole body FDG-PET scan of the patient. (A), (B) About 4.1×3.4 cm sized heterogeneous attenuating mass was detected on the anterior lip of the left kidney. (C), (D) A mass with high FDG uptake was seen on the lateral cortex area of the left kidney. The mass corresponded to the mass detected at the CT scan of the kidney.

Fig. 2 Gross and microscopic pathology of the kidney mass. A subcapsular protruding mass was found at the mid-portion of the left kidney. (A) Microscopic examination of the resected kidney showed a metastatic squamous cell carcinoma, which coincided with the histological findings of the previously resected esophageal carcinoma (H & E stain, B: ×200).

Fig. 1

Fig. 2

Esophageal Squamous Cell Carcinoma Recurring as a Solitary Renal Mass