Localized pleural metastasis without other organ metastases after nephrectomy for renal cell carcinoma

Our plain-English summary of Localized pleural metastasis without other organ metastases after nephrectomy for renal cell carcinoma, by Z. Saito, K. Hata, S. Nishioka, et al (Respiratory Medicine Case Reports, 2021).

The study

• Authors: Z. Saito, K. Hata, S. Nishioka, K. Tamura, N. Tamura, M. Yoshida, K. Kasa, J. Hirano, M. Masubuchi, K. Kuwano
• Journal: Respiratory Medicine Case Reports
• Published: 2021;33:101388
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We present a case of a 69-year-old man who had localized pleural metastasis without other organ metastases after nephrectomy for right renal cell carcinoma (RCC). He complained of respiratory symptoms for more than two years after the operation and was confirmed to have right pleural effusion and multiple pleural masses on computed tomography (CT). There were no abnormal findings in the other organs, but the pleural mass gradually increased in size on CT. We suspected malignant tumors such as malignant pleural mesothelioma and synovial sarcoma in addition to RCC metastasis. Finally, we performed surgical resection of the pleural mass under general anesthesia, and we diagnosed pathologically as metastasis from RCC. Distant metastases of RCC are common in the lungs, bones, brain, and liver. To our knowledge, localized pleural metastases from RCC is rare.

© 2021 The Authors.

In plain English

This case report described a 69-year-old man who had his right kidney removed (nephrectomy) in September 2017 for clear cell renal cell carcinoma (RCC), a kind of kidney cancer. CT scans every three months showed no recurrence until March 2020, when the patient came to the hospital with right chest pain and shortness of breath. CT then showed fluid around the right lung (pleural effusion) and multiple masses in the pleura, with no abnormal findings in other organs. The article states the patient had no asbestos exposure. The doctors considered spread from the kidney cancer, malignant pleural mesothelioma and synovial sarcoma. Two fluid tests before surgery found no cancer cells, and within a month the masses had clearly grown. Surgeons completely removed eight tumors, the largest 5.0 × 3.8 × 2.2 cm. Tissue examination diagnosed pleural metastasis from clear cell RCC. The patient was being treated with pembrolizumab plus axitinib. The authors tabulated 15 cases, including this one. The authors concluded that this pattern is extremely rare and that most cases have been treated with drugs rather than surgery.

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, with a table summarizing previously published similar cases
• Who was studied: One 69-year-old man who had undergone nephrectomy in September 2017 for right renal cell carcinoma (8.0 × 7.0 × 7.0 cm, clinical stage 3, clear cell type, grade 2) and later developed right pleural metastases
• Exposure: No asbestos exposure was reported for this patient. The article does not study an asbestos exposure; mesothelioma was only one of the diagnoses considered.
• Main results:
  • In March 2020, CT in this patient showed right pleural effusion and multiple pleural masses, with no abnormal findings in other organs
  • The doctors considered metastasis from RCC, malignant pleural mesothelioma and synovial sarcoma
  • Two pleural fluid tests before surgery gave class I cytology results (no malignant cells)
  • After one month, CT showed the pleural tumors had clearly grown
  • Eight tumors were completely resected, the largest measuring 5.0 × 3.8 × 2.2 cm
  • Tissue examination diagnosed pleural metastasis from clear cell type RCC
  • The patient was being treated with pembrolizumab plus axitinib at the time of the report
  • The authors summarized 15 cases of RCC with localized pleural metastasis, including this one
• The authors' conclusion: The authors concluded that a localized pleural mass from RCC is extremely rare and that most cases have been treated with interferon, interleukin and chemotherapy rather than surgery.

Topics

Medical terms in this study, explained in our Lexicon: Metastasis, Carcinoma, Pleural Effusion, Pleural Mesothelioma, Synovial Sarcoma, Surgical Resection.

Related studies

• Localized malignant pleural mesothelioma with renal metastasis — S.J. Zardawi, B.T. Li, et al. (2015)
• Pseudomesotheliomatous carcinoma due to pleural metastasis from renal pelvic cancer — Y. Katsuya, M. Fukusumi, et al. (2014)
• 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)

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