Cystic renal cell carcinoma: arose as a simple cyst, recurred repeatedly as a multicystic mass and finally presented as a solid mass

Our plain-English summary of Cystic renal cell carcinoma: arose as a simple cyst, recurred repeatedly as a multicystic mass and finally presented as a solid mass, by Y. Shishikura, M. Furusato, S. Aizawa (Pathology International, 1998).

The study

• Authors: Y. Shishikura, M. Furusato, S. Aizawa
• Journal: Pathology International
• Published: 1998;48(8):623-8
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

An unusual case of cystic renal cell carcinoma in a 70-year-old Japanese male is reported. He had had a simple renal cyst removed 1 year ago. On presentation the right kidney was surrounded by multiple translucent cysts, which varied in size from 1 to 50 mm. The cyst walls were lined by single-layered cuboidal epithelium. The differential diagnosis included cystic mesothelioma, cystic lymphangioma and multicystic dysplastic kidney. An immunohistochemical and ultrastructural study and flow cytometric analysis of DNA ploidy were performed. The tumor was differentiated to such an extent that it was difficult to diagnose as carcinoma; however, it recurred repeatedly. Three and a half years after initial presentation the tumor had invaded the ileum with the pathological change to be almost solid when viewed grossly and, microscopically, showed tubulo-papillary structures in addition to a cystic pattern. The DNA ploidy pattern revealed a near-diploid aneuploid in the early specimen and a polyploid aneuploid in the last specimen.

In plain English

This case report described one patient, a Japanese man, with cystic renal cell carcinoma, a kidney cancer. The article does not discuss asbestos. Cystic mesothelioma appeared only as one of the conditions the authors considered when making the diagnosis. In 1988, at age 69, the patient had a kidney cyst removed at another hospital, and it was diagnosed as a simple cyst with no malignancy. In 1989 many thin-walled cysts, 1 to 50 mm across, were found around the right kidney and removed with the kidney. The growth kept returning, requiring operations in 1991 and 1993. By 1993 it was partly solid, had invaded the ileum (part of the small intestine), and showed severe cell abnormality under the microscope. DNA analysis found abnormal DNA content in the 1989 specimen (DNA index 1.11) and the 1993 specimen (DNA index 1.26). The patient died in 1994, and no autopsy was done. The authors concluded that the tumor was probably malignant from the start and that its spread may have come from seeding during the first operation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient), with pathology, immunohistochemistry, electron microscopy and DNA flow cytometry of surgical specimens
• Who was studied: one Japanese male patient, aged 69 at his first operation in 1988, treated at Jikei University School of Medicine, Tokyo, from 1989 until his death in 1994
• Main results:
  • The cyst removed in 1988 at another hospital was diagnosed as a simple cyst with no malignancy.
  • The 1989 (second operation) specimen consisted of multiple translucent cysts measuring 1 to 50 mm.
  • The fourth operation specimen (1993) contained solid areas with tubular, papillary and alveolar structures and severe cellular atypia. The tumor had invaded the subcutaneous tissue and the ileum.
  • Tumor cells stained positive for cytokeratin, vimentin and EMA and negative for CEA and Ber-EP4. The authors stated that these antibodies did not help determine where the tumor cells came from.
  • The second surgical specimen showed near-diploid aneuploidy with a DNA index of 1.11 and a CV% of 4.4. Normal kidney tissue was diploid with a CV% of 3.5.
  • The fourth surgical specimen showed aneuploidy with a DNA index of 1.26 and a CV% of 4.7.
  • The patient died the month after the final admission in October 1994. The authors attributed the death to invasion of the ileum and metastasis to the liver, an inguinal lymph node and a vertebra.
• The authors' conclusion: The authors considered that the tumor was malignant from the start, and that its spread around the kidney and in the abdomen was due to seeding during the 1988 operation. They also stated that the earlier multicystic lesion should have been suspected of malignancy potential despite being well differentiated.

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Epithelium, Differential Diagnosis, Mesothelioma, Tubulopapillary.

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