Latest news with #renal cell carcinoma
Medscape
2 days ago
- Health
- Medscape
Clinical Case: Kidney Cancer Hides in 6-mm Breast Lesion
A 54-year-old woman with a history of renal cell carcinoma (RCC) developed a metastatic lesion in her breast 6 years after radical nephrectomy. The lesion, initially detected via routine imaging, was confirmed as RCC by histopathology and immunohistochemistry. This case report by Aman Saswat Sahoo, a fourth-year Medicine & Surgery undergraduate at the University of Central Lancashire, School of Medicine and Dentistry, Preston, England, and colleagues, highlighted the need for meticulous diagnostic evaluation to distinguish between primary breast carcinoma and metastatic disease, particularly in patients with a history of RCC. The Patient and Her History The patient had a history of RCC that was initially treated with radical nephrectomy and no chemotherapy. She had undergone regular CT imaging since her surgery 3 years ago, and routine CT identified a 4-mm lesion in the lower outer quadrant of the right breast. No other relevant preexisting medical conditions were reported. Her medical, family, travel, allergy, social, and drug histories were unremarkable. Findings and Diagnosis A clinical examination revealed no palpable abnormalities in both breasts. Mammography revealed a 6-mm nodule in the posterolateral region of the right breast, which was absent on a prior mammogram conducted 4 years earlier. Ultrasound imaging confirmed the presence of a solid nodule measuring approximately 5 mm in size. Ultrasound evaluation correlated these findings with a 5-mm benign-appearing nodule. A core biopsy was performed, and histopathologic evaluation showed an inflammatory lesion, characterised by cells with clear cytoplasm and macrophages. Considering the initial diagnosis, immunohistochemical staining provided crucial diagnostic clarity, with positive results for PAX8, CD10, and MNF116 markers, confirming metastatic RCC. Given the patient's history, these findings confirmed the presence of metastatic RCC in the right breast. The patient was informed of the diagnosis of metastatic RCC in the right breast. Further assessment of distant sites and the potential for systemic therapy were discussed at this stage; however, it was later decided that no systemic interventions would be pursued. Although the lesion was considered minor in terms of surgical intervention, its identification is crucial as an indicator of metastatic disease. Wide local excision was performed after tagging the lesion with a radiofrequency identification tag located 3 mm inferior to the original site; no axillary surgery was performed. Postoperative histopathologic evaluation revealed a 5-mm well-circumscribed metastatic RCC. No vascular invasion, ductal carcinoma in situ, or lobular carcinoma in situ was identified. Discussion Although RCC is prominent in its ability to spread haematogenously, metastasis to the breast is extremely uncommon. The route for metastasis usually includes the migration of tumour cells from the kidneys through the inferior vena cava to the right ventricle of the heart. From here on, they enter the pulmonary circulation and eventually reach the breast. Breast metastasis from RCC is exceedingly rare, with fewer than 60 cases documented in the literature. Although the risk for RCC recurrence is highest within the first 2 years following treatment, metastases to uncommon sites, such as the breast, have been reported even a decade after the initial diagnosis and surgical intervention. 'The limited information available in the literature regarding optimal treatment strategies and patient outcomes for RCC metastasis to the breast highlights the need for further studies to better understand this condition,' the authors wrote.
Medscape
16-07-2025
- Health
- Medscape
Rapid Review Quiz: Advanced and Metastatic Renal Cell Carcinoma
Advanced and metastatic renal cell carcinoma (RCC) remains a complex and clinically significant disease that often presents diagnostic and therapeutic challenges. Whereas early-stage RCC can be curable with surgery, advanced RCC frequently carries a poor prognosis and demands nuanced, multidisciplinary management. Rapid advancements in systemic therapies, particularly immunotherapy and targeted agents, have transformed the treatment landscape, making ongoing clinical familiarity essential. Understanding current approaches to diagnosis, prognostication, and treatment selection is critical for optimizing outcomes in this evolving field. Patients with metastatic RCC have a 5-year survival rate of 17.4%. This contrasts greatly with the 5-year survival rate of 92.9% among patients with localized RCC. The overall 5-year survival rate in RCC is 78.6%, highlighting the dramatic impact of disease stage on long-term outcomes. Learn more about prognosis of RCC. The most common type of bone metastasis in RCC is osteolytic, resulting from bone resorption due to osteoclast activity. These lesions lead to bone destruction and are frequently associated with complications such as fractures. Osteoblastic lesions, characterized by excessive bone deposition, are associated with other types of cancer but are not commonly seen in RCC. Osteoblastic lesions are a type of sclerotic lesion. Learn more about imaging in RCC. A robust T-cell-mediated antitumor response requires activation of the local interferon gamma signaling pathway within the tumor microenvironment. Adaptive resistance to ICI therapy in RCC is largely attributed to an impaired response to interferon gamma, a key cytokine in anti-tumor immunity. The release of immunosuppressive cytokines can also contribute to resistance by dampening T-cell activity. However, resistance is not caused by a lack of immunosuppressive cells in the tumor microenvironment. On the contrary, regulatory T cells and myeloid-derived suppressor cells often accumulate in the tumor microenvironment and inhibit effective immune responses. Learn more about PD-1/PD-L1 inhibitors for RCC. CAR-T therapy has reshaped therapeutic approaches in several hematologic cancers, but its effectiveness in solid tumors such as RCC remains limited. This relatively reduced effectiveness is largely due to poor CAR T-cell infiltration into solid tumors and an immunosuppressive tumor microenvironment that impairs CAR-T activity. CAR-T therapies are still investigational in RCC, with no FDA-approved treatments currently available. Cytokine release syndrome (CRS) is one of the most common and clinically significant toxicities associated with CAR-T therapy. It is caused by elevated levels of inflammatory cytokines and may present with fever, myalgia, and arthralgia. In severe cases, CRS can lead to endothelial activation and disruption of the blood-brain barrier. Learn more about experimental therapeutic approaches for RCC. NCCN guidelines recommend initiating systemic therapy in patients with either extensive distant metastases or tumors containing a substantial sarcomatoid component before considering cytoreductive nephrectomy. Thermal ablation is typically reserved for select patients with stage T1 disease. Stereotactic body radiation therapy, another form of ablative therapy, may be appropriate for localized (stage I, II, or III) renal cancer in patients who are not ideal candidates for surgery. Current guidelines from the American Society of Clinical Oncology are aligned with these NCCN recommendations, stating that first-line treatment for patients with metastatic RCC exhibiting sarcomatoid features should be systemic therapy, specifically an ICI-based combination. This therapy may consist of ipilimumab plus nivolumab, or alternatively, an ICI paired with a tyrosine kinase inhibitor. Learn more about radiation therapy for RCC.
