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Year : 2019  |  Volume : 15  |  Issue : 1  |  Page : 250-251

Synchronous primary cancers: Renal cell carcinoma and rectal cancer

1 Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
2 Department of Pathology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

Date of Web Publication13-Mar-2019

Correspondence Address:
Dr. Vikas Asati
Room No. 214, PG Men's Hostel, Kidwai Memorial Institute of Oncology, Near NIMHANS, Bengaluru - 560 029, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.JCRT_45_17

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 > Abstract 

Although cancers of rectum and kidney are common malignancies, the occurrence of primary synchronous neoplasms of these organs has been reported rarely. Very few case reports are available in literature till date. The relationship between these two events remains unclear, probably because of the rarity of the association. In this report, we describe incidentally detected renal cell carcinoma in an elderly man, during staging workup of rectal adenocarcinoma and both malignancies were surgically managed simultaneously with curative intent.

Keywords: Clear cell carcinoma, double primary, multiple malignancies, renal cell carcinoma with rectal cancer

How to cite this article:
Babu M C, Asati V, Babu K G, Suma M N, Rajeev L K, Lokesh K N. Synchronous primary cancers: Renal cell carcinoma and rectal cancer. J Can Res Ther 2019;15:250-1

How to cite this URL:
Babu M C, Asati V, Babu K G, Suma M N, Rajeev L K, Lokesh K N. Synchronous primary cancers: Renal cell carcinoma and rectal cancer. J Can Res Ther [serial online] 2019 [cited 2020 Jun 5];15:250-1. Available from: http://www.cancerjournal.net/text.asp?2019/15/1/250/244461

 > Introduction Top

The presence of concomitant synchronous malignancies was first described by Warren and Gates.[1] It has been demonstrated that asymptomatic and clinically undetected kidney cancers are common findings in elderly patients with multiple malignancies.[2] The concomitant presence of renal cell carcinoma (RCC) with other primary malignancies including cancers of bladder, prostate, colorectum, lung, malignant melanoma, and non-Hodgkin's lymphoma has been reported.[3] Here, we report a rare case of synchronous malignancies of RCC with rectal cancer.

 > Case Report Top

A 62-year-old male presented with a complaint of painless rectal bleeding for the last 3 months. He lost 8 kg of weight during this period and felt tired even during daily routine household work. On physical examination, he was pale and systemic examination was normal. Per rectal examination revealed Grade 2 hemorrhoids. Colonoscopy showed a large cauliflower growth, seen at 15 cm from the anal verge, bleeds on touch, and involving the entire circumference and causing severe luminal narrowing. Biopsy was taken which revealed adenocarcinoma Grade 1. CT scan showed a circumferential asymmetric wall thickening involving rectosigmoid colon for a maximum thickness of 2.5 cm causing luminal narrowing extending for a length of 6.6 cm above with perirectal fat stranding and few enlarged regional lymph nodes. Apart from this, there was evidence of heterogeneous enhancing hypervascular mass involving the upper and mid-pole of right kidney infiltrating into the upper calyx and renal pelvis with increased pericapsular vasculature. The lesion showed washout on delayed phase, highly suggestive RCC. The patient underwent right radical nephrectomy with low anterior resection concomitantly. Histopathology of nephrectomy specimen confirmed clear cell carcinoma with perinephric fat extension, no renal vein invasion, and no lymph node involvement (pathological staging pT3aNoMo) [Figure 1]a and [Figure 1]b. Histopathological examination of rectal growth revealed Adenocarcinoma Grade 1, extending beyond the serosa, surgical margins were negative with one lymph node involvement by tumor cells (pathological staging pT4N1aMo) [Figure 1]c and [Figure 1]d. Adjuvant concurrent chemoradiation (5 FU and leucovorin with radiotherapy 45 Gy/25 fractions) was offered to the patient and currently receiving adjuvant chemotherapy (mFOLFOX-6) for 6 months.
Figure 1: (a and b) Low- (×100) and high-power view (×400) of renal cell carcinoma; (c and d) adenocarcinoma rectum Grade 1

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 > Discussion Top

Warren and Gates criteria to identify synchronous tumors state that each tumor must present with a definite picture of malignancy, each must be distinct, pathologically proven, and the possibility of one being the metastasis of the other must be excluded.[1] Synchronous colon and renal primary tumors have been described in Lynch II syndrome. The latter is characterized by hereditary nonpolyposis colorectal cancer (HNPCC) associated with neoplasms of other organs (endometrium, stomach, ovary, small bowel, pancreas, ureter, breast, and kidney). Mutations in one of the four mismatch repair genes MSH2, MLH1, PMS1, and PMS2 have been found in about 70% of HNPCC kindreds.[4] Interestingly, many of the literature cases of associated colon and renal cancer did not show a family history of malignancies.[5] Papalampros et al.[6] suggested microsatellite instability testing may be used in all patients presenting with colorectal and urological cancers for detecting a common genetic aberration between malignancies.

Lee et al.[7] identified 2.6% patients (217/8368) of colorectal cancer had synchronous another primary tumor, and curative resection is still a valid option in these patients. Two-regional resection is preferable than extensive resection.

Beisland et al.[8] used the National Cancer Registry of Norway to determine the rates association of RCC in conjunction with other cancers. They found the rate of multiple primary malignancies associated with RCC was 16.1% (287 out of 1425 patients), supporting previous studies reporting prostate, breast, colorectal, bladder, non-Hodgkin's lymphoma, and lung cancer to be the most common primary cancers in patients with RCC. Of them, 25 out of 287 had colonic cancer and 14 others had rectal cancer. They also reported 3.7% (53 patients) of newly diagnosed RCC patients presented with another synchronous tumor.

Sato et al. studied survival rate in malignancies seen concomitantly with RCC. According to their report, the presence of other primary tumors concomitant with RCC (at the time of nephrectomy) is an independent predictive factor for postoperative survival rate.[9]

 > Conclusion Top

During evaluation of one primary malignant tumor, the possibility of finding another primary tumor always to be kept in mind and the aim of management in cancer patients should always be curative even in the presence of multiple malignancies.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

 > References Top

Warren S, Gates O. Multiple primary malignant tumors: A survey of the literature and a statistical study. Am J Cancer 1932;16:1358.  Back to cited text no. 1
Hajdu SI, Berg JW, Foote FW Jr. Clinically unrecognized, silent renal-cell carcinoma in elderly cancer patients. J Am Geriatr Soc 1970;18:443-9.  Back to cited text no. 2
Rabbani F, Grimaldi G, Russo P. Multiple primary malignancies in renal cell carcinoma. J Urol 1998;160:1255-9.  Back to cited text no. 3
Lynch HT, Lemon SJ, Karr B, Franklin B, Lynch JF, Watson P, et al. Etiology, natural history, management and molecular genetics of hereditary nonpolyposis colorectal cancer (Lynch syndromes): Genetic counseling implications. Cancer Epidemiol Biomarkers Prev 1997;6:987-91.  Back to cited text no. 4
O'Boyle KP, Kemeny N. Synchronous colon and renal cancers: Six cases of a clinical entity. Am J Med 1989;87:691-3.  Back to cited text no. 5
Papalampros AE, Petrou AS, Mantonakis EI, Evangelou KI, Giannopoulos LA, Marinos GG, et al. Coexistence of a colon carcinoma with two distinct renal cell carcinomas: A case report. J Med Case Rep 2011;5:134.  Back to cited text no. 6
Lee BC, Yu CS, Kim J, Lee JL, Kim CW, Yoon YS, et al. Clinicopathological features and surgical options for synchronous colorectal cancer. Medicine (Baltimore) 2017;96:e6224.  Back to cited text no. 7
Beisland C, Talleraas O, Bakke A, Norstein J. Multiple primary malignancies in patients with renal cell carcinoma: A national population-based cohort study. BJU Int 2006;97:698-702.  Back to cited text no. 8
Sato S, Shinohara N, Suzuki S, Harabayashi T, Koyanagi T. Multiple primary malignancies in Japanese patients with renal cell carcinoma. Int J Urol 2004;11:269-75.  Back to cited text no. 9


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