Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 24, 2020; 11(2): 103-109
Published online Feb 24, 2020. doi: 10.5306/wjco.v11.i2.103
Metastatic clear cell renal cell carcinoma in isolated retroperitoneal lymph node without evidence of primary tumor in kidneys: A case report
Lisa BE Shields, Arash Rezazadeh Kalebasty
Lisa BE Shields, Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, United States
Arash Rezazadeh Kalebasty, Norton Cancer Institute, Norton Healthcare, Louisville, KY 40202, United States
Author contributions: Shields LB and Kalebasty AR contributed to the conception, design, acquisition, analysis, and interpretation of data; Shields LB drafted the manuscript; Shields LB and Kalebasty AR critically revised the manuscript and gave final approval.
Informed consent statement: The patient gave written informed consent for the publication of this case.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Arash Rezazadeh Kalebasty, MD, Norton Cancer Institute, Norton Healthcare, 315 East Broadway, Louisville, KY 40202, United States. arash.rezazadehkalebasty@nortonhealthcare.org
Received: October 18, 2019
Peer-review started: October 18, 2019
First decision: November 5, 2019
Revised: November 8, 2019
Accepted: November 29, 2019
Article in press: November 29, 2019
Published online: February 24, 2020
Processing time: 128 Days and 6 Hours
Abstract
BACKGROUND

Retroperitoneal lymph node dissection (RPLND) plays a diagnostic, therapeutic, and prognostic role in myriad urologic malignancies, including testicular carcinoma, renal cell carcinoma (RCC), and upper urinary tract urothelial carcinoma. RCC represents 2% of all cancers with approximately 25% of patients presenting with advanced disease. Clear cell RCC (CCRCC) is the most common RCC, accounting for 75%-80% of all RCC.

CASE SUMMARY

A 71-year-old man presented with a history of benign prostatic hypertrophy. He was asymptomatic without any hematuria, pain, or other urinary symptoms. A computed tomography (CT) scan of the abdomen and pelvis showed a 1.8 cm left retroperitoneal lymph node. There was no evidence of renal pathology. A core biopsy was performed of the left para-aortic lymph node. Although the primary tumor site was unknown, the morphological and immunohistochemical features were most consistent with CCRCC. A RPLND was performed which revealed a single mass 5.5 cm in greatest dimension with extensive necrosis. The retroperitoneal lymph node was most compatible with CCRCC. A nephrectomy was not conducted as a renal mass had not been detected on any prior imaging studies. The patient did not receive any type of adjuvant therapy. The patient underwent surveillance with serial CT scans with contrast of the chest, abdomen, and pelvis for the next 5 years, all of which demonstrated no recurrent or metastatic disease and no evidence of retroperitoneal adenopathy.

CONCLUSION

Our unique case emphasizes the therapeutic role of metastasectomy in metastatic CCRCC even in the absence of primary tumor in the kidneys.

Keywords: Oncology; Renal cell carcinoma; Clear cell carcinoma; Lymph node dissection; Retroperitoneal; Metastasis; Nephrectomy without primary site; Case report

Core tip: Retroperitoneal lymph node dissection has important diagnostic, therapeutic, and prognostic functions in renal cell carcinoma (RCC). We present the first case of a solitary metastatic retroperitoneal lymph node with an unknown primary site but whose immunohistochemical features were consistent with clear cell RCC (CCRCC). A nephrectomy was not performed as a renal mass was not detected on any prior radiological examinations. Imaging studies for a subsequent 5 years demonstrated no recurrent or metastatic disease or retroperitoneal adenopathy. Our case highlights the therapeutic role of metastasectomy in metastatic CCRCC in the absence of a primary tumor in the kidneys.