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Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 835-836
Metastatic adenoid cystic carcinoma of kidney masquerading as renal cell carcinoma


1 Department of General Surgery, G. S. V. M. Medical College, Kanpur, Uttar Pradesh, India
2 Department of Pathology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh, India

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Date of Web Publication27-Oct-2010
 

How to cite this article:
Kala S, Pantola C, Agarwal A. Metastatic adenoid cystic carcinoma of kidney masquerading as renal cell carcinoma. Indian J Pathol Microbiol 2010;53:835-6

How to cite this URL:
Kala S, Pantola C, Agarwal A. Metastatic adenoid cystic carcinoma of kidney masquerading as renal cell carcinoma. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Nov 23];53:835-6. Available from: https://www.ijpmonline.org/text.asp?2010/53/4/835/72072


A 35-year-old female presented with pain and heaviness over the right lumbar region and hematuria of 1 month duration. There was past history of salivary gland adenoid cystic carcinoma 8 years back, for which she was operated and received chemotherapy and radiation therapy. Her ultrasound and computed tomography (CT) scan revealed approximately 63 × 55 cm mass in the upper pole of right kidney [Figure 1]. Ultrasound guided FNAC of kidney suggested renal cell carcinoma (poorly differentiated). Her X-ray chest was normal. On the ground of these investigations, diagnosis of renal cell carcinoma was made, for which the patient underwent right nephrectomy. Gross examination showed a single approximately 6 × 5.5 cm mass at the upper pole of kidney [Figure 2]. On histopathological examination, it was found to be adenoid cystic carcinoma showing cribriform pattern [Figure 3].
Figure 1: CT scan of patient showing single mass in the right kidney

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Figure 2: Cut section showing tumor mass with yellowish areas and normal kidney pushed at lower pole

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Figure 3: Cribriform pattern of adenoid cystic carcinoma of kidney with normal renal tissue at right upper quadrant (H and E, ×100)

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On the basis of clinical, radiological and peroperative findings, tumor was considered as renal cell carcinoma because a solitary tumor mass was situated in upper pole, almost replacing the normal kidney; margins of tumors were well defined; on cut section yellowish areas were seen, which were again consistent with gross appearance of renal cell carcinoma, the most common malignant primary renal tumor of adult kidney. The features favoring the primary nature of tumor were a single large mass replacing most of the renal tissue and the typical pattern of renal metastases consisting of multiple small nodules that are often clinically silent was absent (although they can lead to hematuria or flank pain in exceptional cases). [1] However, to our great surprise, on microscopic examination, it turned out to be adenoid cystic carcinoma of kidney. From all of the above information, it was concluded that actually it was a case of sole metastatic adenoid cystic carcinoma kidney, masquerading as renal cell carcinoma, with probable primary being the salivary gland which was treated in remote past.

Renal tumors can be benign or malignant. With the exception of oncocytoma, the benign tumors rarely cause clinical problems. Malignant tumors, on the other hand, are of great importance clinically, the most common being renal cell carcinoma followed by Wilm's tumor. However, here is a very rare secondary renal tumor, i.e., adenoid cystic carcinoma replacing almost whole of the kidney and mimicking as renal cell carcinoma.

Adenoid cystic carcinoma, formerly known as cylindroma, is relatively uncommon but highly malignant neoplasm with a remarkable capacity for recurrence. 50% of cases have been found in minor salivary glands but are also reported in nose, sinuses, upper airway, lacrimal glands and breast. [2] Those affected are in the age group 20-84 years (mean 52 years). Adenoid cystic carcinoma frequently metastasizes to lung. Lymph node metastasis is rare and to some extent represents the direct extension from perinodal soft tissue. Here, we are presenting a rare case of adenoid cystic carcinoma metastasizing to kidney and masquerading clinically, radiologically and preoperatively as primary renal cell carcinoma.

Adenoid cystic carcinoma, a slow growing but highly malignant neoplasm, is the most common malignant tumor of minor salivary gland. Microscopically, it has cribriform pattern - nests and columns of cells are arranged concentrically around gland like spaces (pseudocyst). Small true glandular lumina are also found. Tumor frequently invades perineural spaces. [3]

Adenoid cystic carcinoma frequently metastasizes to lung and patient may live in symbiosis with these secondaries for years together. Lymph node metastasis is uncommon and metastasis to kidney is very rare. Awakura et al. in 2001 [4] diagnosed metastatic adenoid cystic carcinoma of kidney, 5 years after parotidectomy for adenoid cystic carcinoma parotid. Four years after left renal nephrectomy, multiple metastases were demonstrated on the other side kidney, liver, lungs and brain. Similarly, Herzberg et al. in 1991 [5] reported metastatic adenoid cystic carcinoma of kidney after 12 years of mastectomy for adenoid cystic carcinoma of breast.

 
   References Top

1.Bryant DA, Scheinfield AG, Russo P, Gaudin PB, Reuter VE. Conventional renal cell carcinomas: A clinicopathologic study of 183 cases from 1991 to 1994. Mod Pathol 1998;11:77A.  Back to cited text no. 1
    
2.Percin KH, Gullone P, Clairmant AC. Adenoid cystic carcinoma arising in salivary glands. A correlation of histologic features and clinical course. Cancer 1978;42:265-82.   Back to cited text no. 2
    
3.Spiro RH, Huvas AG, Strong EW. Adenoid cystic carcinoma of salivary gland origin. A clinico pathologic study of 242 cases. Am J Surg 1974;128:512-29.   Back to cited text no. 3
    
4.Awakura Y, Nonomura M, Fukuyama T, Okamoto E. Metastatic renal cancer, arising from adenoid cystic carcinoma of parotid gland, a case report. Hinyokika Kiyo 2001;47:785-7.  Back to cited text no. 4
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5.Herzberg AJ, Bossen EH, Walther PJ. Adenoid cystic carcinoma of the breast metastatic to the kidney. A clinically symptomatic lesion requiring surgical management. Cancer 1991;68:1015-20.  Back to cited text no. 5
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Correspondence Address:
Sanjay Kala
L-21, G S V M Medical College Campus, Kanpur - 208 002, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72072

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