Journal of Clinical Oncology, Vol 21, Issue 12
(June), 2003: 2439-2440
© 2003 American Society for Clinical Oncology
Small-Cell Cancers, and an Unusual Reaction to Chemotherapy
CASE 2. SYNCHRONOUS RENAL CELL CARCINOMA AND LIMITED-STAGE SMALL-CELL LUNG CANCER
Suleiman Massarweh,
Michael Lewitton,
Uday Popat,
Garrett R. Lynch
Ben Taub General Hospital, Baylor College of Medicine, Houston, TX
A 54-year-old woman, who was a heavy smoker, presented with abdominal pain and weight loss of several months duration. A computed tomography (CT) scan revealed a heterogeneous right renal mass measuring 10 cm in diameter and consistent in appearance with renal cell carcinoma (Fig 1 ). Chest CT showed a left hilar node measuring 2.5 cm (Fig 2). Staging work-up disclosed no other abnormalities. Bronchoscopy was negative and was followed by left thoracotomy and biopsy of the hilar node seen on CT scan. Histopathologic examination revealed small-cell lung carcinoma (Fig 3). Because the radiologic appearance of the renal mass was that of renal cell carcinoma, she underwent radical nephrectomy, which revealed an 11-cm tumor with a gross renal vein thrombus. Histology was that of clear-cell carcinoma, Fuhrman’s grade 2 (Fig 4). After nephrectomy, she was treated with cisplatin 60 mg/m2 and etoposide 100 mg/m2 given every 4 weeks concomitant with thoracic irradiation (54 Gy) for her small-cell lung cancer. Restaging after therapy showed a left hilar node of less than 1 cm and no other evidence of disease. She was in complete remission, and her renal function remained normal.
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Fig 1. Abdominal CT scan. A 10 cm eterogeneous mass appears to be arising from the right kidney and is consistent in appearance with renal cell carcinoma.
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Fig 2. Chest CT scan. A 2.5 cm mass or lymph node is present in the left hilum with no evidence of pulmonary parenchymal lesions.
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Fig 3. Left hilar mass histology. Small malignant cells with prominent nuclei and frequent mitotic figures, appearance of which is consistent with small-cell carcinoma.
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Fig 4. Renal mass histology. Malignant cells with clear cytoplasm consistent with the clear cell variant of renal cell carcinoma.
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Synchronous occurrence of renal cell carcinoma and lung cancer is an uncommon event.1 Autopsy series have recognized that among multiple primary cancers, the lung and kidney were two of the five most common primary sites involved (the other three being colon, prostate, and stomach).2 However, the occurrence of small-cell lung cancer and renal cell carcinoma is an unusual event, and few anecdotal cases are reported in the literature.3–5 In view of the association between smoking with both small-cell and renal cell cancer (two relatively common cancers), it is intriguing that we do not see more patients with multiple primary carcinomas, such as in this present case. This kind of event is still quite rare despite the widespread use of advanced imaging techniques, which would have improved our ability to detect incidental multiple primary cancers. It is also interesting that multiple cancers are not more prevalent in view of commonly shared risk factors for cancer in general. We presume that cigarette smoking was the etiologic factor in our patient for development of both of her primary cancers. Von Hippel-Lindau disease is another situation, however, in which small-cell and renal cell carcinoma can present in the same patient.4 Deletions or mutations in a tumor suppressor gene mapped to the short arm of human chromosome 3 (3p25) have been implicated in the etiology of Von Hippel-Lindau syndrome.6 In addition, deletion of a segment of chromosome 3 short arm is a consistent finding in sporadic clear-cell carcinoma7 and in lung cancer.8
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