Concordant clear cell 'mesonephric' carcinoma of the bladder and lung adenocarcinoma with clear cell features – multiple primaries versus metastatic neoplasms: a case report

Autor: Joseph F. Tomashefski, Santhi Ganesan, Sarmad Jassim, Joram Sawady, Amer Khiyami, Jane K. Nguyen
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Pathology
Lung Neoplasms
medicine.medical_treatment
lcsh:Medicine
Case Report
Neoplasms
Multiple Primary
0302 clinical medicine
Carcinoembryonic antigen
biology
medicine.diagnostic_test
Bladder cancer
General Medicine
Middle Aged
Immunohistochemistry
Treatment Outcome
TTF-1
030220 oncology & carcinogenesis
Clear cell carcinoma
Adenocarcinoma
030211 gastroenterology & hepatology
Female
Lung cancer
medicine.medical_specialty
Salpingo-oophorectomy
Adenocarcinoma of Lung
Cystectomy
Hysterectomy
03 medical and health sciences
ARID2
medicine
Clear cells
Biomarkers
Tumor
Humans
Genetic Testing
Hematuria
business.industry
lcsh:R
medicine.disease
Transurethral biopsy
Urinary Bladder Neoplasms
biology.protein
Radiotherapy
Adjuvant
business
Tomography
X-Ray Computed
Clear cell
Adenocarcinoma
Clear Cell
Transcription Factors
Zdroj: Journal of Medical Case Reports
Journal of Medical Case Reports, Vol 11, Iss 1, Pp 1-6 (2017)
ISSN: 1752-1947
Popis: Background Clear cell carcinoma of the bladder is a rare variant of urinary bladder adenocarcinoma. We report a case of a patient with clear cell carcinoma of the bladder and a concordant right upper lobe pulmonary adenocarcinoma with clear cell features, and we address the role of immunohistochemistry and cytogenetic analysis in distinguishing the two primary malignancies. Case presentation Our patient was a 59-year-old African American woman who presented with hematuria. Her past medical history included invasive mammary carcinoma and end-stage renal disease treated with hemodialysis. A computed tomographic urogram revealed a 3-cm polypoid bladder mass. A follow-up chest computed tomographic scan revealed a 1-cm right upper lobe nodule. The patient underwent transurethral biopsy and subsequent radical cystectomy, as well as a transthoracic core needle biopsy of the lung nodule. Histologically, the bladder tumor consisted of flat, cuboidal to columnar cells with clear or eosinophilic cytoplasm and a hobnail appearance, organized in tubulocystic and papillary patterns. The neoplastic cells were diffusely positive for α-methylacyl-coenzyme A racemase, cancer antigen 125, and cytokeratin 7; focally positive for cytokeratin 20, P53, and carcinoembryonic antigen; and negative for thyroid transcription factor 1. The lung tumor demonstrated a glandular architecture with mucin production (positive for mucin with mucicarmine and periodic acid-Schiff with diastase stain). The neoplastic cells were diffusely positive for cytokeratin 7, napsin A, and thyroid transcription factor 1, and they were negative for cytokeratin 20 and cancer antigen 125. Genetic testing of the pulmonary neoplasm demonstrated ARID2 genomic alterations. Conclusions The presence of clear cell features in both neoplasms raised the possibility of lung metastasis from the primary bladder tumor. However, the glandular architecture of the lung neoplasm along with its distinctive immunohistochemical and genetic profiles confirmed the presence of two separate primaries.
Databáze: OpenAIRE
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