Dyspnea as the First Manifestation of Silent Renal Cell Carcinoma

Our plain-English summary of Dyspnea as the First Manifestation of Silent Renal Cell Carcinoma, by A. Khorsand-Rahimzadeh, F. Khatami, S. Sefidbakht, et al (Iranian Journal of Pathology, 2019).

The study

• Authors: A. Khorsand-Rahimzadeh, F. Khatami, S. Sefidbakht, H. Saffar, S.M. Tavangar
• Journal: Iranian Journal of Pathology
• Published: 2019;14(1):87-93
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Renal cell carcinoma (RCC) accounts for only 3% of adult malignancies, and the lung is the most common site of metastasis of this tumor, which may be accompanied by pleural metastasis. However, solitary pleural involvement is very rare and its presentation with dyspnea as the first manifestation of RCC is extremely rare. We describe a 39-year-old male with episodes of dyspnea dating back 6 months prior to hospital admission. During paraclinical investigations, chest computed tomography (CT) demonstrated pleural effusion and multiple pulmonary nodules, raising the question of primary mesothelioma or metastasis from distant focus. Histopathology and immuno- histochemical examinations of pleural biopsy provided evidence of metastatic RCC of the clear cell type. Therefore, an abdominal contrast computed tomography (CT) was performed, revealing a 3 cm right renal mass, which was then removed by partial nephrectomy. Physicians and pathologists should be aware of unusual presentations of RCC with no symptoms attributable to the kidneys, including dyspnea as in our case.

In plain English

This article is a case report of one patient, a 39-year-old man, whose kidney cancer (renal cell carcinoma) first came to attention through shortness of breath. The article does not discuss asbestos; mesothelioma was considered as a possible diagnosis and ruled out. The patient had episodes of breathlessness for 6 months before hospital admission. A chest CT scan showed multiple lung nodules and fluid around both lungs, and the fluid was bloody. A pleural biopsy showed large tumor cells with clear cytoplasm. Staining tests were positive for markers including CD10 and carbonic anhydrase IX. They were negative for others, including calretinin and WT1, which the authors tested to exclude mesothelioma. The tumor was diagnosed as metastatic clear cell renal cell carcinoma. An abdominal CT then found a 3 cm mass in the right kidney. It was removed by partial nephrectomy and confirmed as clear cell renal cell carcinoma. The authors concluded that awareness of rare presentations like this one may lead to proper diagnosis and successful treatment.

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
• Who was studied: One 39-year-old man with episodes of dyspnea (shortness of breath) for 6 months before hospital admission, with unremarkable past medical and family histories
• Exposure: Not applicable: the article reports no asbestos or other exposure history; it concerns renal cell carcinoma spreading to the pleura, where mesothelioma was considered in the differential diagnosis
• Main results:
  • Chest CT showed multiple pulmonary nodules in a diffuse pattern with bilateral pleural effusion; the aspirated fluid was bloody and was an exudate
  • The pleural biopsy showed a neoplasm of large cells with round to oval nuclei and clear cytoplasm
  • Immunohistochemistry: tumor cells were strongly positive for CD10, carbonic anhydrase IX, EMA and Pan CK, and negative for CK7, CK20, NapsinA, TTF1, calretinin, WT1, CDX2, inhibin and PSA; calretinin and WT1 were used to exclude mesothelioma
  • The pleural tumor was diagnosed as compatible with metastatic renal cell carcinoma of the clear cell type
  • Abdominal contrast CT showed a 3 cm right renal mass, which was removed by partial nephrectomy and found to be clear cell renal cell carcinoma
• The authors' conclusion: The authors concluded that renal cell carcinoma can first present in rare ways, including pleural involvement, and that awareness of solitary pleural involvement may lead to proper diagnosis and successful treatment.

Topics

Medical terms in this study, explained in our Lexicon: Dyspnea, Carcinoma, Metastasis, Pleural Effusion, Mesothelioma, Histopathology, Pleural Biopsy.

Related studies

• The epidemiology of renal cell carcinoma — L. Lipworth, R.E. Tarone, et al. (2006)
• Occupational risk factors for renal cell carcinoma: agent-specific results from a case-control study in Germany. MURC Study Group. Multicenter urothelial and renal cancer study — B. Pesch, J. Haerting, et al. (2000)
• A comparative immunohistochemical study of malignant mesothelioma and renal cell carcinoma: the diagnostic utility of Leu-M1, Ber EP4, Tamm-Horsfall protein and thrombomodulin — R.L. Attanoos, H. Goddard, et al. (1995)
• Value of PAX8, PAX2, napsin A, carbonic anhydrase IX, and claudin-4 immunostaining in distinguishing pleural epithelioid mesothelioma from metastatic renal cell carcinoma — N.G. Ordóñez (2013)
• Renal cell carcinoma development in the rat independent of alterations at the VHL gene locus — C. Walker, Y.T. Ahn, et al. (1996)
• Metastatic renal cell carcinoma mimicking pleural mesothelioma — D.R. Taylor, W. Page, et al. (1987)

Browse return to medical research.