Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
CORRESPONDENCE
Year : 2018  |  Volume : 14  |  Issue : 2  |  Page : 441-443

Disseminated cystic nodal metastasis in renal cell carcinoma mimicking systemic hydatidosis on imaging


Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India

Date of Web Publication8-Mar-2018

Correspondence Address:
Dr. Amit Nandan Dhar Dwivedi
Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.174526

Rights and Permissions
 > Abstract 


Cystic metastases in renal cell carcinoma (RCC) are very rare. Very few case reports can be found in literature. Retroperitoneal cystic nodal metastases have been reported in head and neck tumors. We present a very interesting case of RCC that had disseminated intraperitoneal and retroperitoneal cystic metastases that mimicked systemic hydatidosis. A detailed color Doppler sonography was followed by plain and contrast-enhanced computed tomography on a 64-slice multi-detector scanner. Imaging features were more in favor of right RCC with cystic lymph nodal metastasis. However, rare possibility of incidental hydatid disease with RCC could not be ruled out. Biopsy from left inguinal lymph nodes was taken, which confirmed metastatic deposits from RCC.

Keywords: Cystic metastasis, multi-detector computed tomography, oncology, renal cell carcinoma, systemic hydatidosis


How to cite this article:
Dwivedi AD, Mourya C. Disseminated cystic nodal metastasis in renal cell carcinoma mimicking systemic hydatidosis on imaging. J Can Res Ther 2018;14:441-3

How to cite this URL:
Dwivedi AD, Mourya C. Disseminated cystic nodal metastasis in renal cell carcinoma mimicking systemic hydatidosis on imaging. J Can Res Ther [serial online] 2018 [cited 2021 Dec 1];14:441-3. Available from: https://www.cancerjournal.net/text.asp?2018/14/2/441/174526




 > Introduction Top


Cystic metastasis is very rare in renal cell carcinoma (RCC). Few case reports have documented it.[1],[2],[3] RCC often produces nodal retroperitoneal metastases in the later stages. These metastatic lymph nodes are usually solid but can be infrequently cystic as well. The cystic nature of the nodes has been attributed to the tumor cells causing obstruction to the flow of the lymph resulting in cystic enlargement of the nodes. Diffuse cystic metastases in the peritoneal cavity from RCC have not been reported. RCC is a well-known malignancy with protean manifestation. Systemic hydatidosis is a benign condition which can have a similar picture on scanning as a differential diagnosis.


 > Case Report Top


A 55-year-old female patient presented to us in the outpatient clinic of surgery department with a total duration of illness of 3 months. She was asymptomatic 3 months back when she complained of diffuse abdominal pain and discomfort. She also noticed bilateral pedal edema. She had no history of fever, hematuria, urinary symptoms, rashes, postmenopausal bleed, or recent history of surgery. She had no history of cough with expectoration. Systemic examination revealed distended abdomen with multiple enlarged inguinal nodes. Gynecological examination was unremarkable. Transabdominal sonography with color flow showed multiple cystic lesions of variable size in pre- and para-aortic regions and bilateral common and external iliac regions with internal septations. Right kidney showed a highly vascular lesion arising from mid pole. Right renal vein and inferior vena cava were unremarkable. Detailed computed tomography scan (plain and postcontrast) showed an ill-defined heterogeneous mass lesion measuring 4.2 cm × 5.7 cm × 3.4 cm involving mid pole of the right kidney with enhancing solid component [Figure 1]. No evidence of extension into the renal pelvis or involvement of renal vein invasion was noted. Multiple well-defined, variable-sized, cystic lesions with internal enhancing septations involving peripancreatic, periportal regions, gastrohepatic ligament, retroperitoneum (pre-para aortic regions), bilateral common internal iliac and left inguinal region were noted [Figure 2]. Few lesions showed internal spoke wheel pattern of septations. Imaging features were reported in favor of right RCC with disseminated cystic lymph nodal metastasis. However, due to the rarity of disseminated metastasis and lack of any urinary symptoms, the possibility of incidental hydatid disease with RCC was also considered. Biopsy from left inguinal lymph nodes was taken, which showed presence of metastatic deposits from RCC. The patient could not be operated due to poor general condition and succumbed later during hospital stay due to multi-organ failure.
Figure 1: Coronal reformatted contrast-enhanced computed tomography scan showing enhancing right renal mass. Diffuse cystic nodal metastasis with septations can be seen

Click here to view
Figure 2: Diffuse and disseminated cystic nodal metastasis with septations seen in retroperitoneal and inguinal regions bilaterally

Click here to view



 > Discussion Top


RCC is the tenth leading cause of cancer deaths in males in the USA. In men, deaths from kidney cancer decreased by 3.9% between 1990 and 2005; in women, deaths decreased by 7.8% during the same period. Overall, 5-year relative survival increased from 51% to 67% between 1975–1977 and 1996–2004.[4] Except for stage I, these survival statistics have remained essentially unchanged for several decades. RCC is more common in people of Northern European ancestry (Scandinavians) and North Americans than in those of Asian or African descent. In the USA, its incidence is slightly higher among Negroes than Caucasians: 21.3 versus 19.2/100,000 population in men and 10.3 versus 9.9/100,000 populations in women.[5] Cystic retroperitoneal nodal metastases are seen in malignancies such as melanoma and bronchogenic carcinoma. However, cystic change is not rare in metastatic lymph nodes of squamous cell carcinoma of the head and neck organs, including tongue, tonsil, and nasopharynx.[6] This pattern of nodes with internal septations and spoke wheel configuration is also seen in systemic hydatidosis. The management of RCC with nodal metastasis is specific and has to be differentiated from an infective pathology such as hydatid disease which has a totally different management protocol. A study by Heng et al. found that progression-free survival at 3 and 6 months predicted overall survival among patients with metastatic RCC.[7] Patients with regional lymph node involvement or extracapsular extension have a survival rate of 12–25%. Although renal vein involvement does not have a markedly negative effect on prognosis, the 5-year survival rate for patients with stage IIIB RCC is 18%. In patients with effective surgical removal of the renal vein or inferior vena caval thrombus, the 5-year survival rate is 25–50%. Unfortunately, 5-year survival rates for patients with stage IV disease are low (0–20%).


 > Conclusion Top


RCC is a well-known malignancy with protean manifestation. Systemic hydatidosis is a benign condition which can have a similar picture on scanning as a differential diagnosis. The above case highlights the diagnostic dilemma which can arise due to unusual presentation and imaging features of a common malignancy mimicking an infective pathology.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Arai T, Tanaka M, Noto K, Sakamoto Y, Kawachi Y. Cystic lymph node metastasis caused by a Bellini duct carcinoma. Br J Urol 1997;79:135-6.  Back to cited text no. 1
    
2.
Rastogi R. Retroperitoneal cystic metastases from renal cell carcinoma. Saudi J Kidney Dis Transpl 2008;19:244-6.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Ishii N, Yonese J, Tsukamoto T, Maezawa T, Ishikawa Y, Fukui I. Retroperitoneal cystic metastasis from a small clear cell renal carcinoma. Int J Urol 2001;8:637-9.  Back to cited text no. 3
    
4.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009;59:225-49.  Back to cited text no. 4
    
5.
Surveillance Epidemiology and End Results. SEER Stat Fact Sheets. National Cancer Institute. Available from: http://www.seer.cancer.gov/statfacts/html/kidrp.html. [Last accessed on 2014 Apr 05].  Back to cited text no. 5
    
6.
Micheau C, Cachin Y, Caillou B. Cystic metastases in the neck revealing occult carcinoma of the tonsil. A report of six cases. Cancer 1974;33:228-33.  Back to cited text no. 6
    
7.
Heng DY, Xie W, Bjarnason GA, Vaishampayan U, Tan MH, Knox J, et al. Progression-free survival as a predictor of overall survival in metastatic renal cell carcinoma treated swith contemporary targeted therapy. Cancer 2011;117:2637-42.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  >Abstract>Introduction>Case Report>Discussion>Conclusion>Article Figures
  In this article
>References

 Article Access Statistics
    Viewed1771    
    Printed79    
    Emailed0    
    PDF Downloaded85    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]