Complete Spontaneous Regression Of A Primary Renal Cell Carcinoma. Report Of A Pathological Proven Case And Review Of The Literature

Freih-Fraih, A. 2022Kidney cancer

Freih-Fraih, A., Celada-Luis, G., Ranchal, T., Lagana, C., Canca-Velasco, A., & Jiménez-Heffernan, J. A. (2022). Complete spontaneous regression of a primary renal cell carcinoma. Report of a pathological proven case and review of the literature. Revista espanola de patologia : publicacion oficial de la Sociedad Espanola de Anatomia Patologica y de la Sociedad Espanola de Citologia, 55 Suppl 1, S69–S73. https://doi.org/10.1016/j.patol.2019.09.002

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Abstract

Regression of primary renal cell carcinoma (RCC) is a rare phenomenon and for several reasons many of the reported cases have been questioned. We present a case that can be considered a true spontaneous and complete regression of a primary RCC. A 79-year-old female underwent nephrectomy because a renal tumor. At the time of surgery image studies showed a small para-aortic lymph node. The tumor measured 3cm and was analyzed completely. Histology showed a fibro-inflammatory lesion with necrosis, foamy macrophages and inflammatory cells. No neoplastic cells were observed and the lesion was interpreted as a localized type of xanthogranulomatous pyelonephritis. One year later a CT control scan, showed that the para-aortic lymph node had increased in size to 4cm. Fine needle aspiration revealed features of clear RCC. Metastatic dissemination was limited so surgical removal of the para-aortic lymph node was performed and the cytologic diagnosis confirmed.

Case Details

Disease Location

Kidney

Personal Characteristics

79-year-old female

Clinical Characteristics

Consulted because of hematuria. Renal ultrasonography and computed tomography revealed a 3cm solid tumor in the cortical area of the lower pole of the left kidney. The lesion was described as a well-defined, hypodense lesion with partial extension to perirenal fat. Left radical nephrectomy was performed, and the specimen was submitted for pathologic analysis. Microscopically, the lesion was fibro-inflammatory with areas of necrosis and accumulation of foamy macrophages. Lymphocytes, siderophages, and occasional multinucleated giant cells were also present. A diagnosis of non-neoplastic fibro-inflammatory lesion, most probably xanthogranulomatous pyelonephritis (localized type) was given. One year later a CT control scan, showed that the lymph node in the para-aortic area had increased in size to 4cm. Image guided fine needle aspiration was performed. Cytology showed numerous neoplastic cells most of which formed cohesive groups. Several of the cellular groups were accompanied by vascular structures and basement membrane-type material. Suggestive of renal clear cell carcinoma.

Remission Characteristics

At the light of this result, a review of the previous nephrectomy specimen was conducted, but failed to show viable neoplastic cells. With all of these findings, we interpreted the nephrectomy specimen as an example of complete spontaneous necrosis of a primary renal carcinoma.