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Metastatic chromophobe renal cell carcinoma to the brain
1Cleveland Clinic, Department of Anatomic Pathology, L25, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Abstract:
Metastases represent the most common tumors of the central nervous system, with clear cell renal cell carcinomas showing a particular predilection to involve the brain. This report documents an unusual case of a patient with a chromophobe renal cell carcinoma presenting with a brain metastasis. A 58-year-old man presented with stroke-like symptomatology, including expressive aphasia, right side facial weakness, headaches and vomiting. CT imaging demonstrated a 4.7 cm left frontal lobe hemorrhagic mass. He underwent surgery with excision of the mass, which was marked by sheets of large cells with lightly eosinophilic to clear cytoplasm. PAX8 staining was positive and a diagnosis of clear cell carcinoma of probably renal origin was rendered. Subsequently, CT imaging of the abdomen revealed a 12.9 cm left renal mass. The patient underwent a left nephrectomy and a diagnosis of chromophobe renal cell carcinoma was made. The tumor was noted to extend into the perirenal fat and to have involved a paraaortic lymph node. Re-review of the frontal lobe lesion confirmed the tumor was the same. Chromophobe renal cell carcinomas are far less common than clear cell tumors, are less likely to metastasize, and generally have a more favorable overall prognosis. When they metastasize, they most commonly involve the liver, lung and lymph nodes, in contrast to the more common clear cell carcinomas that typically spread to the lungs, bone and brain.
Insights
This case report details an unusual brain metastasis from a chromophobe renal cell carcinoma (chRCC). While chRCC rarely spreads to the brain, this finding highlights the importance of considering rare metastatic patterns in central nervous system lesions.
Area of Science:
- Oncology
- Neurology
- Pathology
Background:
- Metastases are the most common central nervous system (CNS) tumors.
- Clear cell renal cell carcinoma (ccRCC) frequently metastasizes to the brain.
- Chromophobe renal cell carcinoma (chRCC) is a rare subtype with a lower metastatic potential.
Observation:
- A 58-year-old man presented with stroke-like symptoms and a left frontal lobe hemorrhagic mass.
- Initial biopsy suggested clear cell carcinoma of probable renal origin.
- Subsequent abdominal imaging revealed a large left renal mass, confirmed as chRCC after nephrectomy.
Findings:
- The frontal lobe mass was histopathologically identical to the primary renal chromophobe cell carcinoma.
- This represents an unusual presentation of chRCC with brain metastasis.
- chRCC typically metastasizes to the liver, lungs, and lymph nodes, unlike ccRCC which commonly spreads to the brain.
Implications:
- This case underscores the importance of considering rare metastatic origins for CNS lesions.
- It highlights that even rare renal tumor subtypes like chRCC can present with atypical metastatic sites.
- Accurate diagnosis is crucial for appropriate patient management and prognosis, even in unusual presentations.
