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| CORRESPONDENCE |
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| Year : 2018 | Volume
: 14
| Issue : 2 | Page : 441-443 |
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Disseminated cystic nodal metastasis in renal cell carcinoma mimicking systemic hydatidosis on imaging
Amit Nandan Dhar Dwivedi, Chandan Mourya
Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
| Date of Web Publication | 8-Mar-2018 |
Correspondence Address:
Dr. Amit Nandan Dhar Dwivedi
Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0973-1482.174526
Cystic metastases in renal cell carcinoma (RCC) are very rare. Very few case reports can be found in literature. Retroperitoneal cystic nodal metastases have been reported in head and neck tumors. We present a very interesting case of RCC that had disseminated intraperitoneal and retroperitoneal cystic metastases that mimicked systemic hydatidosis. A detailed color Doppler sonography was followed by plain and contrast-enhanced computed tomography on a 64-slice multi-detector scanner. Imaging features were more in favor of right RCC with cystic lymph nodal metastasis. However, rare possibility of incidental hydatid disease with RCC could not be ruled out. Biopsy from left inguinal lymph nodes was taken, which confirmed metastatic deposits from RCC.
Keywords: Cystic metastasis, multi-detector computed tomography, oncology, renal cell carcinoma, systemic hydatidosis
How to cite this article:
Dwivedi AD, Mourya C. Disseminated cystic nodal metastasis in renal cell carcinoma mimicking systemic hydatidosis on imaging. J Can Res Ther 2018;14:441-3 |
| > Introduction | |  |
Cystic metastasis is very rare in renal cell carcinoma (RCC). Few case reports have documented it.[1],[2],[3] RCC often produces nodal retroperitoneal metastases in the later stages. These metastatic lymph nodes are usually solid but can be infrequently cystic as well. The cystic nature of the nodes has been attributed to the tumor cells causing obstruction to the flow of the lymph resulting in cystic enlargement of the nodes. Diffuse cystic metastases in the peritoneal cavity from RCC have not been reported. RCC is a well-known malignancy with protean manifestation. Systemic hydatidosis is a benign condition which can have a similar picture on scanning as a differential diagnosis.
| > Case Report | | |
A 55-year-old female patient presented to us in the outpatient clinic of surgery department with a total duration of illness of 3 months. She was asymptomatic 3 months back when she complained of diffuse abdominal pain and discomfort. She also noticed bilateral pedal edema. She had no history of fever, hematuria, urinary symptoms, rashes, postmenopausal bleed, or recent history of surgery. She had no history of cough with expectoration. Systemic examination revealed distended abdomen with multiple enlarged inguinal nodes. Gynecological examination was unremarkable. Transabdominal sonography with color flow showed multiple cystic lesions of variable size in pre- and para-aortic regions and bilateral common and external iliac regions with internal septations. Right kidney showed a highly vascular lesion arising from mid pole. Right renal vein and inferior vena cava were unremarkable. Detailed computed tomography scan (plain and postcontrast) showed an ill-defined heterogeneous mass lesion measuring 4.2 cm × 5.7 cm × 3.4 cm involving mid pole of the right kidney with enhancing solid component [Figure 1]. No evidence of extension into the renal pelvis or involvement of renal vein invasion was noted. Multiple well-defined, variable-sized, cystic lesions with internal enhancing septations involving peripancreatic, periportal regions, gastrohepatic ligament, retroperitoneum (pre-para aortic regions), bilateral common internal iliac and left inguinal region were noted [Figure 2]. Few lesions showed internal spoke wheel pattern of septations. Imaging features were reported in favor of right RCC with disseminated cystic lymph nodal metastasis. However, due to the rarity of disseminated metastasis and lack of any urinary symptoms, the possibility of incidental hydatid disease with RCC was also considered. Biopsy from left inguinal lymph nodes was taken, which showed presence of metastatic deposits from RCC. The patient could not be operated due to poor general condition and succumbed later during hospital stay due to multi-organ failure. | Figure 1: Coronal reformatted contrast-enhanced computed tomography scan showing enhancing right renal mass. Diffuse cystic nodal metastasis with septations can be seen
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 | Figure 2: Diffuse and disseminated cystic nodal metastasis with septations seen in retroperitoneal and inguinal regions bilaterally
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| > Discussion | | |
RCC is the tenth leading cause of cancer deaths in males in the USA. In men, deaths from kidney cancer decreased by 3.9% between 1990 and 2005; in women, deaths decreased by 7.8% during the same period. Overall, 5-year relative survival increased from 51% to 67% between 1975–1977 and 1996–2004.[4] Except for stage I, these survival statistics have remained essentially unchanged for several decades. RCC is more common in people of Northern European ancestry (Scandinavians) and North Americans than in those of Asian or African descent. In the USA, its incidence is slightly higher among Negroes than Caucasians: 21.3 versus 19.2/100,000 population in men and 10.3 versus 9.9/100,000 populations in women.[5] Cystic retroperitoneal nodal metastases are seen in malignancies such as melanoma and bronchogenic carcinoma. However, cystic change is not rare in metastatic lymph nodes of squamous cell carcinoma of the head and neck organs, including tongue, tonsil, and nasopharynx.[6] This pattern of nodes with internal septations and spoke wheel configuration is also seen in systemic hydatidosis. The management of RCC with nodal metastasis is specific and has to be differentiated from an infective pathology such as hydatid disease which has a totally different management protocol. A study by Heng et al. found that progression-free survival at 3 and 6 months predicted overall survival among patients with metastatic RCC.[7] Patients with regional lymph node involvement or extracapsular extension have a survival rate of 12–25%. Although renal vein involvement does not have a markedly negative effect on prognosis, the 5-year survival rate for patients with stage IIIB RCC is 18%. In patients with effective surgical removal of the renal vein or inferior vena caval thrombus, the 5-year survival rate is 25–50%. Unfortunately, 5-year survival rates for patients with stage IV disease are low (0–20%).
| > Conclusion | | |
RCC is a well-known malignancy with protean manifestation. Systemic hydatidosis is a benign condition which can have a similar picture on scanning as a differential diagnosis. The above case highlights the diagnostic dilemma which can arise due to unusual presentation and imaging features of a common malignancy mimicking an infective pathology.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| > References | | |
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| 3. | Ishii N, Yonese J, Tsukamoto T, Maezawa T, Ishikawa Y, Fukui I. Retroperitoneal cystic metastasis from a small clear cell renal carcinoma. Int J Urol 2001;8:637-9. |
| 4. | Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009;59:225-49. |
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| 7. | Heng DY, Xie W, Bjarnason GA, Vaishampayan U, Tan MH, Knox J, et al. Progression-free survival as a predictor of overall survival in metastatic renal cell carcinoma treated swith contemporary targeted therapy. Cancer 2011;117:2637-42. |
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