Metastatic cancer and back pain

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Papillary renal cell carcinoma pRCC is the second most common type of renal carcinoma. RCC usually metastasizes to the lungs, lymph nodes, bones, brain and liver.

Renal carcinoma dissemination to the ovaries is an exceptional occurrence. A year-old woman was ad­mit­ted in January due to acute back pain and ab­do­mi­nal discomfort.

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An abdominal computed to­mo­gra­phy CT scan with intravenous contrast revealed a solid mass with malignant features located on the left kidney, multiple enlarged lymph nodes, and pulmonary metastases — cT3N1M1 pul. The patient underwent radical left nephrectomy and para-aortic lymphadenectomy fol­lowed by treatment with pazopanib. The pathologic study revealed papillary renal cell carcinoma.

In Junethe patient presented with abdominal pain, postprandial bloa­ting, nausea, vomiting and abdominal distension ECOG 3.

CT imaging showed stable pulmonary metastases and left ovarian mass. An exploratory laparotomy was per­formed, revealing a 8x7 cm ovarian mass, followed by left adnexectomy. The histopathological report described metastatic cancer and back pain infiltration of the left ovary and fallopian tube, while the immunohistochemical staining could not clearly differentiate between a primary ovarian tumor metastatic cancer and back pain a metastasis.

Corroborating the histopathological and im­mu­no­his­to­che­mi­cal reports with the clinical status, the diagnosis of a synchronous primary ovarian tumor was decided. Carcinomul cu celule renale papilare pRCC este al doilea cel mai frecvent tip de carcinom re­nal.

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CCR metastazează de obicei metastatic cancer and back pain plămâni, ganglioni, oa­se, creier şi ficat. Diseminarea carcinomului renal la ova­re este o apariţie excepţională.

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O pacientă de 60 de ani a fost internată în ianuarie în urgenţă cu dureri de spate şi abdominale. Tomografia computerizată CT cu substanţă de contrast a relevat o masă solidă cu caracteristici maligne localizată pe rinichiul stâng şi multipli noduli limfatici invadaţi, precum şi noduli pul­mo­nari metastatici cT3N1M1.

Pacienta a suferit o ne­frec­tomie stângă radicală şi a urmat limfadenectomie para-aortică. A urmat tratament cu pazopanib. Exa­me­­­nul histologic a relevat carcinom cu celule renale pa­­pi­lare. Metastatic cancer and back pain iuniepacienta s-a prezentat cu durere ab­do­mi­nală, balonare postprandială, greaţă, vărsături şi distensie abdominală ECOG3.

Imagistica CT a arătat me­tas­taze pulmonare stabile şi o masă ovariană stângă. O laparotomie exploratorie a fost efectuată, relevând o masă ovariană de 8x7 cm care a fost rezecată. Raport his­to­patologic: tumoră carcinomatoasă a ovarului stâng şi trompei falopiene, în timp ce imunohistochimia nu a putut diferenţia în mod clar între o tumoră ova­ria­nă pri­ma­ră şi o metastază. Coroborând examenul his­to­pa­to­lo­­gic şi imunohistochimic cu starea clinică, diagnosticul unui cancer sincron ovarian a fost decis.

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It is considered the most lethal genitourinary vestibular papillomatosis thrush 2defined by an asymptomatic disease course, with late and uncharacteristic symptoms, leading to a poor survival prognosis 3.

Based on histological features, RRC is categorized into clear cell, papillary and cromophobe types. The classic triad of clinical symptoms — flank pain, palpable abdominal mass, and hematuria — is rare nowadays and is associated with locally advanced disease 4. Early diagnosis is rare, although the discovery of a renal mass can be incidental due to advances in imaging techniques.

A small percent of patients present with symptoms caused by metastatic disease. Renal cell carcinoma usually metastasizes to the lungs, lymph nodes, bones, brain and liver, and only very rarely to the ovary 23 cases known worldwide to date.

Tumoră primară ovariană sau metastaze ale unui carcinom cu celule renale – prezentare de caz

Case report A year-old woman, with a history of stage 2 hypertension therapeutically controlled and with surgery for herniated disc in the lumbar region, was admitted in January due to acute back pain and abdominal discomfort. A computed tomography CT scan with intravenous contrast revealed a metastatic cancer and back pain mass with malignant features located on the left kidney, multiple enlarged lymph nodes, and pulmonary metastases — cT3N1M1 pul Figures 1 and 2.

The patient underwent radical left nephrectomy and para-aortic lymphadenectomy on January 17, Figure 3. The treatment was well tolerated, the patient presenting only grade 2 fatigue, with normal blood tests. In Junethe patient presents with abdominal pain, postprandial bloating, nausea, vomiting and abdominal distension ECOG 3. Contrast-enhanced chest-abdomen-pelvis CT showed stable pulmonary metastases and left ovarian mass Figure 4.

In Julyan exploratory laparotomy was performed, revealing chylous ascites and a 8x7 cm ovarian mass, followed by left adnexectomy. Corroborating the histopathological and immunohistochemical reports with the clinical status, the diagnosis of a synchronous primary ovarian tumor was decided.

The laboratory analyses revealed a biological inflammatory syndrome.

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Paracentesis was performed and 2. Subsequently, the symptomatic treatment had limited benefit. Figure 1. Contrast-enhanced chest CT showing multiple pulmonary metastases Figure 2.

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Therefore, the papillary subtype is the second most common type of renal carcinoma 7. Figure 3. Abdominal computed tomography Figure 4.

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Pelvic computed tomography showing left ovarian mass Renal carcinoma dissemination to the ovaries is an exceptional occurrence. The predominance of RCC in males 10the vascular sclerosis of the postmenopausal ovary, rare events of tumor emboli to the ovaries, as well as the misdiagnoses of certain metastases as primary ovarian neoplasms 11 can account for this low incidence. Therefore, the diagnosis may sometimes prove challenging. First, ovarian metastases laryngeal papillomatosis lymph nodes other organs are generally bilateral, whereas metastases from renal tumors to ovaries are typically unilateral due to the distinct metastatic cancer and back pain anatomy of renal-ovarian axis, the latter draining directly into the left renal vein 12consistent with our case.

In addition, its unilaterality could suggest the diagnosis of an ovarian primary tumor. Moreover, metastases from RCC involving the thyroid, liver and female genital tract are notably difficult to identify because of their histological similarities, each of these locations having their own clear cell and papillary tumors.

The immunohistochemical staining is used to ascertain the nature of the tumor in difficult cases. Furthermore, cytokeratin 7 CK7 tested positive, which is consistent with the immunoprofile of pRCC However, the inconclusive histopathological and immunohistochemical reports recommended correlating the results with the clinical context. As a result, the patient received platinum-based chemotherapy, carboplatin and paclitaxel, while continuing the treatment with the tyrosine kinase inhibitor, with clinical benefit after the first administration.

Due to drug interactions, a lower dose of paclitaxel was given. Conclusions Considering the major therapeutic and prognostic differences between ovarian metastases and ovarian primary tumor, it is critical to make a distinction between the two entities using primarily micro­scopic analysis with subsequent immunohistochemical study.

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Conflicts of interests: The authors declare no conflict of interests. Renal-cell carcinoma. N Engl J Med.

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Cases J. Metastases of renal clear cell carcinoma to ovary — case report and review of the literature.

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Eur J Gynaecol Oncol. Papillary renal cell carcinoma with synchronous ovarian metastasis: a rare entity. BMJ Case Rep. Metastasis from papillary renal cell carcinoma masquerading as primary ovarian clear cell tumor. Pathol Res Pract.

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Renal cell carcinoma metastatic to the ovary or fallopian tube: a clinicopathological study of 9 cases. Hum Pathol. CD10 expression in epithelial tissues and tumors of the gynecologic tract: a useful marker in the diagnosis of mesonephric, trophoblastic, and clear cell tumors.

Am J Surg Pathol. Int J Surg Pathol. Metastatic cancer and back pain HA. Pathol Oncol Res.

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