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Case Report

Metachronous metastasis of renal cell carcinoma to bilateral testis

Sameer Nain , Suman Kharkwal , Onkar Kaur 2
1
1
1 Department of Surgery, ESI PGIMSR Hospital , Basaidarapur, New Delhi 110015, India.
2
Department of Pathology, ESI PGIMSR Hospital, Basaidarapur, New Delhi 110015, India.
Correspondence to: Dr. Sameer Nain , Department of Surgery, ESI PGIMSR Hospital, Basaidarapur, New Delhi 110015, India.
E-mail: sameer.nain@gmail.com

ABSTRACT
Unusual site metastasis as a presenting complaint of renal cell carcinoma (RCC) has been reported previously in the literature.
RCC is a tumor with notoriously unpredictable behavior. The authors report an unusual case of metachronous bilateral testicular
metastasis in a patient who operated for RCC. The case highlights the unique behavior of RCC with an unusual site of metastasis.
A 72-year-old patient presented with bilateral scrotal swelling of 1-month duration. There was a history of left radical nephrectomy
for RCC 4 years prior. He underwent a bilateral high inguinal orchidectomy and diagnosis of chromophobe RCC was made on
histopathological examination.
Key words: Metachronous metastasis, renal cell carcinoma, testis

Introduction 10 cm × 6 cm on the left side, extending to epididymis, with
absent testicular sensation. Examination of the abdomen
Renal cell carcinoma (RCC) is a relatively rare adult solid did not reveal any abnormality. Blood samples for serum
tumor accounting for 3.0% of malignancies worldwide. It lactate dehydrogenase,  human chorionic gonadotropin,
is an unpredictable entity due to its atypical metastatic and serum alpha fetal protein were sent, which were
profi le at presentation. Thirty percent of these tumors found to be within normal limits. Metastatic workup
may be accompanied by synchronous metastatic disease was done : contrast-enhanced computed tomography of
at diagnosis. The organs most affected by metastatic whole abdomen and pelvis was within normal limits.
[1]
spread are: lung, bone, liver, brain, and lymph nodes. [2]
Ultrasound of testis showed bilateral homogenous
However, other structures can also be affected by enlargement of testis size 10 cm × 5 cm × 3 cm on right
RCC metastases: eyes, mouth, neck and thyroid, side and 10 cm × 5 cm × 3 cm on left side extending
heart, breast, rectum abdominal muscle, intra-scrotal to epididymis, with focal areas of necrosis suggestive
structures, and vagina. Although metastatic foci are of testicular malignancy. After all routine hematological
[3]
present in about 30.0% of RCCs at the time of primary and biochemical investigations, he was consented
diagnosis (synchronous), metastatic disease can develop and undertook a bilateral high inguinal orchidectomy.
as part of the latency of the tumor, with delayed Post-operative period was uneventful.
development of metastases, especially if the tumor is Biopsy fi nding
well-differentiated.
On gross examination: right testicular mass of
Case Report 13 cm × 8 cm × 6 cm with cut surface showing a

A 72-year-old smoker presented to surgical outpatient solid variegated appearance. Left testicular mass
department (OPD) with a complaint of a progressively of 10 cm × 8 cm × 6 cm with cut surface showing a
increasing bilateral scrotal swelling of 1-month duration. solid variegated appearance. Microscopy revealed
There was a history of left radical nephrectomy for RCC malignant tumor cells arranged in large islands and
4 years prior. His general physical examination was nests in the interstitium. The tumor cells were large
unremarkable. Local examination showed bilateral hard with clear cytoplasm in a fair number of cells, and
testicular masses, 12 cm × 5 cm on the right side and eosinophilic cytoplasm in other cells with moderate
nuclear pleomorphism along with some mitotic
fi gures [Figure 1a]. The seminiferous tubules and
Access this article online epididymis were pushed to one side [Figure 1b], but
Quick Response Code: all the margins were free and testicular vein was not
Website: involved on either side.
www.jcmtjournal.com
Immunohistochemistry was done epithelial membrane
antigen positive and cytokeratin pan, S100, CD10 were
DOI:
10.4103/2394-4722.153913 negative. A diagnosis of chromophobe variety of RCC
was made.

Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 1 ¦ April 15, 2015 ¦ 39