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Solitary renal tumours are often primary clear cell carcinoma. A 48-year-old man with chronic hepatitis, hepatocellular carcinoma (HCC), and orthotropic liver transplant 6 years ago presented with a solitary left renal mass. Histology revealed metastatic HCC of the left kidney with extensive reactive changes in lymph nodes. Interestingly, biopsy of the transplanted liver showed no evidence of HCC recurrence. Metastatic disease to the kidney often disseminate locally through transcelomic spread, or hematogenous affecting both kidneys. It is important to recognize extrahepatic HCC metastases to the contralateral kidney, especially in patients with active hepatitis, and radical lymph node clearance is needed.
A 48-year-old man presented with lethargy and weight loss. He had orthotropic liver transplant 6 years ago for hepatocellular carcinoma (HCC) secondary to chronic hepatitis B and hepatitis C. Postoperatively he was immunosuppressed with tacrolimus and azathioprine, and received tenofovir for chronic hepatitis B. Blood showed microcytic anemia (hemoglobin 98 g/L), and hepatitis C viral load was 803,279 IU/mL. Computer tomography showed a 7.9 × 7.8 cm left renal mass in the upper pole (Fig. 1) with significant perirenal and para-aortic lymphadenopathy that was not present in the magnetic resonance imaging 5 years ago. A biopsy of the transplanted liver showed no HCC recurrence.
Figure 1Coronal contrast-enhanced computer tomography showing 79 cm × 78 cm solitary heterogeneous enhanced left renal mass in the upper pole (arrow), with perirenal and para-aortic lymphadenopathy. Left adrenal is not visualized separate from the renal tumor. Liver, right kidney, pancreas, and spleen were unremarkable.
After laparoscopic left radical nephrectomy, immunohistochemistry showed positive Heppar 1, Ck18, vimentin, E-cadherin, and racemase, and negative for RCC, CK7, CDX2, and CK20, consistent with metastatic HCC with extensive reactive changes in 20 lymph nodes (Fig. 2). He remains well 2 years postnephrectomy.
Figure 2Histopathology examination showing metastatic renal hepatocellular carcinoma with trabecular growth pattern (hematoxylin and eosin ×40).
It is important to recognize extrahepatic HCC metastases to contralateral kidney, especially in patients with active hepatitis, and radical lymph node clearance is needed.
References
Gordon S.C.
Moonka D.
Brown K.A.
et al.
Risk for renal cell carcinoma in chronic hepatitis C infection.
Cancer Epidemiol Biomarkers Prev.2010; 19: 1066-1073
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