Renal Cancer Hepatitis and Solitary Left Renal Mass: Renal Hepatocellular Carcinoma Kenneth Chan, Jamil Al-Roubaie, Soha El Sheikh, and Faiz Mumtaz Solitary renal tumours are often primary clear cell carcinoma. A 48-year-old man with chronic hepatitis, hepatocellular carcinoma (HCC), and orthotropic liver transplant 6 years ago presented with a solitary left renal mass. Histology revealed metastatic HCC of the left kidney with extensive reactive changes in lymph nodes. Interestingly, biopsy of the transplanted liver showed no evidence of HCC recurrence. Metastatic disease to the kidney often disseminate locally through transcelomic spread, or hematogenous affecting both kidneys. It is important to recognize extrahepatic HCC metastases to the contralateral kidney, especially in patients with active hepatitis, and radical lymph node clearance is needed. UROLOGY 96: 114–115, 2016. © 2016 Elsevier Inc.
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48-year-old man presented with lethargy and weight loss. He had orthotropic liver transplant 6 years ago for hepatocellular carcinoma (HCC) secondary to chronic hepatitis B and hepatitis C. Postoperatively he was immunosuppressed with tacrolimus and azathioprine, and received tenofovir for chronic hepatitis B. Blood showed microcytic anemia (hemoglobin 98 g/ L), and hepatitis C viral load was 803,279 IU/mL. Computer tomography showed a 7.9 × 7.8 cm left renal mass in the upper pole (Fig. 1) with significant perirenal and paraaortic lymphadenopathy that was not present in the magnetic resonance imaging 5 years ago. A biopsy of the transplanted liver showed no HCC recurrence. After laparoscopic left radical nephrectomy, immunohistochemistry showed positive Heppar 1, Ck18, vimentin, E-cadherin, and racemase, and negative for RCC, CK7, CDX2, and CK20, consistent with metastatic HCC with extensive reactive changes in 20 lymph nodes (Fig. 2). He remains well 2 years postnephrectomy. Chronic hepatitis is known to increase the risk of renal cell carcinoma, the most common cause of solitary renal tumors.1 Metastases often disseminate locally through transcelomic spread, or hematogenous affecting both kidneys.2,3 It is important to recognize extrahepatic HCC metastases to contralateral kidney, especially in patients with active hepatitis, and radical lymph node clearance is needed.
Financial Disclosure: The authors declare that they have no relevant financial interests. From the Royal Free NHS Foundation Trust, London, United Kingdom Address correspondence to: Kenneth Chan, M.B.B.S., Royal Free NHS Foundation Trust, London NW3 2QG, United Kingdom. E-mail:
[email protected] Submitted: May 28, 2016, accepted (with revisions): July 11, 2016
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Figure 1. Coronal contrast-enhanced computer tomography showing 79 cm × 78 cm solitary heterogeneous enhanced left renal mass in the upper pole (arrow), with perirenal and para-aortic lymphadenopathy. Left adrenal is not visualized separate from the renal tumor. Liver, right kidney, pancreas, and spleen were unremarkable.
Figure 2. Histopathology examination showing metastatic renal hepatocellular carcinoma with trabecular growth pattern (hematoxylin and eosin ×40). http://dx.doi.org/10.1016/j.urology.2016.07.008 0090-4295
References 1. Gordon SC, Moonka D, Brown KA, et al. Risk for renal cell carcinoma in chronic hepatitis C infection. Cancer Epidemiol Biomarkers Prev. 2010;19:1066-1073.
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2. Aron M, Nair M, Hemal AK. Renal metastasis from primary hepatocellular carcinoma. A case report and review of the literature. Urol Int. 2004;73:89-91. 3. D’Antonio A, Caleo A, Caleo O, Addesso M, Boscaino A. Hepatocellular carcinoma metastatic to the kidney mimicking renal oncocytoma. HBPD INT. 2010;9:550-552.
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