| Abstract|| |
The simultaneous occurrence of two primary tumors in one patient is not uncommon, but one tumor metastasizing to another malignancy is a rare phenomenon. Tumor-to-tumor metastasis was first described by Berent in 1902. Since then fewer than 200 cases have been reported in the literature. In most of these cases renal cell carcinoma acted as a recipient tumor. In tumor-to-tumor metastasis renal cell carcinoma acting as a donor is exceedingly rare and there are no reported cases of adenocarcinoma of the esophagogastric junction acting as a recipient. We present a case of renal cell carcinoma metastasizing to an adenocarcinoma of esophagogastric junction. To our knowledge, this is the first reported case of such a combination.
Keywords: Adenocarcinoma, esophagogastric junction, renal cell carcinoma, tumor to tumor metastasis
|How to cite this article:|
Sukumaran R, Mathews A, Somanathan T, Kattoor J. Renal cell carcinoma metastasizing to adenocarcinoma of esophagogastric junction: A rare case of tumor-to-tumor metastasis. Indian J Pathol Microbiol 2012;55:525-7
|How to cite this URL:|
Sukumaran R, Mathews A, Somanathan T, Kattoor J. Renal cell carcinoma metastasizing to adenocarcinoma of esophagogastric junction: A rare case of tumor-to-tumor metastasis. Indian J Pathol Microbiol [serial online] 2012 [cited 2020 Feb 25];55:525-7. Available from: http://www.ijpmonline.org/text.asp?2012/55/4/525/107799
| Introduction|| |
Tumor-to-tumor metastasis is rare but interesting phenomenon. Most of the cases were discovered during autopsy studies. In majority of cases the recipient tumor was renal cell carcinoma followed by sarcoma, meningioma, and thyroid neoplasm, while the most common donor tumor was carcinoma lung followed by carcinomas of breast, gastrointestinal tract, prostate and thyroid. ,, Although it has the propensity to metastasize to unusual sites, renal cell carcinoma metastasizing to another malignant tumor is very rare. We report the first case of tumor-to-tumor metastasis where renal cell carcinoma acted as a donor and adenocarcinoma of the esophagogastric junction as a recipient.
| Case Report|| |
A 63-year-old man presented with dysphagia and loss of weight of 4-month duration. Imaging studies showed a mass lesion in the esophagogastric junction and another mass lesion in the lower pole of kidney. Biopsy of the growth in the esophagogastric junction showed moderately differentiated adenocarcinoma. With the clinical impression of two separate primaries, esophagogastrectomy and nephrectomy were done. Gross examination revealed an ulcerated growth in the esophagogastric junction measuring 4 × 3.5 × 2 cm and a nodular yellowish growth in the kidney measuring 2.8 × 2.5 cm. Histopathological examination of the renal mass revealed clear cell renal cell carcinoma [Figure 1]. Microscopy of the growth in the esophagogastric junction showed two population of tumor cells -- one was adenocarcinoma arising in esophagogastric junction while the other group of tumor cells showed the similar morphology of clear cell renal cell carcinoma [Figure 2], [Figure 3] and [Figure 4]. The adenocarcinoma component was CK7 positive [Figure 5] while the clear cell component showed CD10 positivity [Figure 6]. Immunohistochemically clear cell renal cell carcinoma is CD10 positive and CK7 negative whereas adenocarcinoma of the esophagogastric junction is CD10 negative and CK7 positive.
|Figure 2: Adenocarcinoma of the esophagogastric junction (H and E, ×100)|
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|Figure 3: Two populations of tumor cells in esophagogastric junction tumor-adenocarcinoma component and clear cell carcinoma component (H and E, ×100)|
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|Figure 4: Photomicrograph highlighting the two populations of tumor cells in the esophagogastric junction tumor (H and E, ×400)|
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|Figure 5: CK7 positivity in adenocarcinoma component and negativity in clear cell carcinoma component of the esophagogastric junction tumor (IHC, ×200)|
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|Figure 6: CD10 positivity in the clear cell carcinoma component of the esophagogastric junction tumor (IHC, ×200)|
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| Discussion|| |
Tumor-to-tumor metastasis was first described by Berent in 1902.  In1968, Campbell reviewed the cases of tumor-to-tumor metastasis and made strict criteria for the diagnosis of this uncommon phenomenon which include the following: (1) More than one primary tumor must exist. (2) The recipient tumor must be a true malignant or benign neoplasm. (3) The metastatic neoplasm is a true neoplasm with established growth in the host tumor and not the result of contiguous growth or embolization of tumor cells. (4) The tumors that metastasized to the lymphatic system where lymphoreticular malignant tumors already exist are to be excluded.  Our case of clear cell renal cell carcinoma metastasizing to adenocarcinoma of the esophagogastric junction meets all these criteria of a true tumor-to-tumor metastasis.
There are two theories which will explain why the renal tumors act as the most common recipients in tumor-to-tumor metastasis. According to the mechanical theory, the rich vasculature of renal tumors renders it more accessible to metastatic tumor cells in the circulating blood. The seed and soil theory explains this phenomenon by the presence of high lipid and glycogen content in clear cell renal cell carcinoma which may provide a nutrient rich microenvironment for metastasizing tumor cells. ,
The mechanisms which cause renal cell tumors to be the donor in tumor-to-tumor metastasis are still unclear. Of the 10 reported cases of renal cell carcinoma metastasizing to other tumors, the recipient tumor was meningioma in 4 cases, thyroid neoplasms in 3 cases, glioblastoma in 1 case, pheochromocytoma in 1 case, and solitary fibrous tumor of the pleura in 1 case. ,,,,
The occurrence of this rare phenomenon should be kept in mind while encountering a bimodal population of cells in a tumor. The identification of the tumor metastasis will help in the treatment and prognostication of patients. This also highlights the importance of thorough sampling of each specimen because in most of the reported cases the metastatic tumor was present in small foci within the primary tumor.
| References|| |
|1.||Berent W. Seltene metastasenbildung. Zentralbl Allg Pathol 1902;13:406-10. |
|2.||Campbell LV Jr, Gilbert E, Chamberlain CR Jr, Watne AL. Metastases of cancer to cancer. Cancer 1968;22:635-43. |
|3.||Petraki C, Vaslamatzis M, Argyrakos T, Petraki K, Strataki M, Alexopoulos C, et al. Tumor to tumor metastasis: Report of two cases and review of the literature. Int J Surg Pathol 2003;11:127-35. |
|4.||Ricketts R, Tamboli P, Czerniak B, Guo CC. Tumor to tumor metastasis: Report of two cases of metastatic carcinoma to angiomyolipoma of the kidney. Arch Pathol Lab Med 2008;132:1016-20. |
|5.||Kragel C, Wei S. Renal cell carcinoma metastasizing to solitary fibrous tumor of the pleura. J Med Case Rep 2011;5:248-50. |
|6.||Ozenc A, Ruacan S, Baykal A. Renal cell carcinoma and ipsilateral pheochromocytoma with neoplasm-to-neoplasm metastasis. J Urol 1997;157:1831-2. |
|7.||Ryska A, Cap J. Tumor-to-tumor metastasis of renal cell carcinoma into oncocytic carcinoma of the thyroid: Report of a case and review of literature. Pathol Res Pract 2003;199:101-6 |
|8.||Kimiwada T, Motohashi O, Kumabe T, Watanabe M, Tominaga T. Lipomatous meningioma of the brain harboring metastatic renal cell carcinoma: A case report. Brain Tumor Pathol 2004;21:47-52. |
|9.||Franke FE, Altmannberger M, Schachenmayr W. Metastasis of renal carcinoma colliding with glioblastoma. Carcinoma to glioma: An event only rarely detected. Acta Neuropathol 1990;80:448-52. |
Department of Pathology, Regional Cancer Centre, Medical college campus, Trivandrum
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]