Published online Feb 24, 2020. doi: 10.5306/wjco.v11.i2.103
Peer-review started: October 18, 2019
First decision: November 5, 2019
Revised: November 8, 2019
Accepted: November 29, 2019
Article in press: November 29, 2019
Published online: February 24, 2020
Processing time: 128 Days and 6 Hours
Retroperitoneal lymph node dissection (RPLND) plays a diagnostic, therapeutic, and prognostic role in myriad urologic malignancies, including testicular carcinoma, renal cell carcinoma (RCC), and upper urinary tract urothelial carcinoma. RCC represents 2% of all cancers with approximately 25% of patients presenting with advanced disease. Clear cell RCC (CCRCC) is the most common RCC, accounting for 75%-80% of all RCC.
A 71-year-old man presented with a history of benign prostatic hypertrophy. He was asymptomatic without any hematuria, pain, or other urinary symptoms. A computed tomography (CT) scan of the abdomen and pelvis showed a 1.8 cm left retroperitoneal lymph node. There was no evidence of renal pathology. A core biopsy was performed of the left para-aortic lymph node. Although the primary tumor site was unknown, the morphological and immunohistochemical features were most consistent with CCRCC. A RPLND was performed which revealed a single mass 5.5 cm in greatest dimension with extensive necrosis. The retroperitoneal lymph node was most compatible with CCRCC. A nephrectomy was not conducted as a renal mass had not been detected on any prior imaging studies. The patient did not receive any type of adjuvant therapy. The patient underwent surveillance with serial CT scans with contrast of the chest, abdomen, and pelvis for the next 5 years, all of which demonstrated no recurrent or metastatic disease and no evidence of retroperitoneal adenopathy.
Our unique case emphasizes the therapeutic role of metastasectomy in metastatic CCRCC even in the absence of primary tumor in the kidneys.
Core tip: Retroperitoneal lymph node dissection has important diagnostic, therapeutic, and prognostic functions in renal cell carcinoma (RCC). We present the first case of a solitary metastatic retroperitoneal lymph node with an unknown primary site but whose immunohistochemical features were consistent with clear cell RCC (CCRCC). A nephrectomy was not performed as a renal mass was not detected on any prior radiological examinations. Imaging studies for a subsequent 5 years demonstrated no recurrent or metastatic disease or retroperitoneal adenopathy. Our case highlights the therapeutic role of metastasectomy in metastatic CCRCC in the absence of a primary tumor in the kidneys.