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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
CASE REPORT  
Year : 2013  |  Volume : 24  |  Issue : 5  |  Page : 988-990
Primary renal carcinoid tumor


1 Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, Dr. H. L. Trivedi Institute of Transplantation Sciences - Smt Gulabben Rasiklal Doshi and Smt Kamlaben Mafatlal Mehta Institute of Kidney Diseases and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
2 Department of Nephrology and Clinical Transplantation, Dr. H. L. Trivedi Institute of Transplantation Sciences - Smt Gulabben Rasiklal Doshi and Smt Kamlaben Mafatlal Mehta Institute of Kidney Diseases and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
3 Department of Urology and Clinical Transplantation, Dr. H. L. Trivedi Institute of Transplantation Sciences - Smt Gulabben Rasiklal Doshi and Smt Kamlaben Mafatlal Mehta Institute of Kidney Diseases and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India

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Date of Web Publication12-Sep-2013
 

   Abstract 

Primary renal carcinoid tumor is extremely rare and, therefore, its pathogenesis and prognosis is not well known. We report a primary renal carcinoid in a 26-year-old man treated by radical nephrectomy.

How to cite this article:
Kanodia K V, Vanikar A V, Patel R D, Suthar K S, Kute V B, Modi P R, Trivedi H L. Primary renal carcinoid tumor . Saudi J Kidney Dis Transpl 2013;24:988-90

How to cite this URL:
Kanodia K V, Vanikar A V, Patel R D, Suthar K S, Kute V B, Modi P R, Trivedi H L. Primary renal carcinoid tumor . Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2019 Nov 16];24:988-90. Available from: http://www.sjkdt.org/text.asp?2013/24/5/988/118095

   Introduction Top


Carcinoid tumors are low-grade malignant neoplasms that arise from neuroendocrine cells. Although common in the respiratory and gastrointestinal organs, carcinoid is rarely encountered in the urogenital system. Primary renal carcinoid is extremely rare, with only 50 cases reported in the medical literature. [1]

We herein report a young man who had a primary renal carcinoid tumor without any evidence of metastasis or carcinoid syndrome.


   Case Report Top


A 26-year-old man presented with a complaint of pain in the left flank and left iliac fossa, frequent vomiting and low-grade fever for five days. There was no history of hematuria or pyuria. Abdominal examination revealed a nontender large mass about 15 cm × 15 cm size in the left hypochondriac region extending up to the midline.

Ultrasonography and computed tomography of the abdomen revealed a large malignant mass arising from the left kidney with extension to the renal hilum and a tumor thrombus in the left renal vein and the inferior vena cava [Figure 1] and [Figure 2]. On investigations, urine examination showed +3 albuminuria and two to three red blood cells/high-power field. His serum creatinine was 1.42 mg%, hemoglobin was 13.4 g/dL and total leucocyte count was 12,700/mm 3 . The liver function tests were within normal limits.

A left radical nephrectomy with inferior vena cava (IVC) thrombectomy was performed. The pathological gross examination of the nephrectomized kidney revealed a kidney weighing 2400 g and measuring 22 cm × 18 cm × 16 cm in size. The outer surface was greyish brown, irregular and covered with perinephric fat. The cut-surface showed that most of the renal parenchyma was replaced by the tumor mass with normal renal parenchyma visible at one pole measuring 5 cm × 3 cm and the tumor mass measuring 17 cm × 9 cm in size. Tumor mass variegated in appearance with intervening areas of hemorrhage and necrosis. There was a separately elongated thrombosed tumor mass from the vein measuring 17 cm × 4 cm in size. The microscopic examination revealed small round basophilic tumor cells arranged in a nest and trabeculae pattern, and they had large basophilic nuceli surrounded by a thin cytoplasmic rim [Figure 3] and [Figure 4].
Figure 1. CT of the abdomen revealed a large malignant mass arising from the left kidney with extension to the renal hilum and direct tumor thrombus in the left renal vein and inferior vena cava.

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Figure 2. A close-up view of the tumor on CT scan.

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Figure 3. Carcinoid tumor cells appear pleomorphic and are arranged in trabecular pattern (H&E, 200).

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Figure 4. Immunohistochemical staining demonstrates positive chromogranintumor cells (Chromogranin, 200).

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The tumor was well encapsulated and extended up to the renal vein and the IVC in the form of an embolus. The adjacent renal parenchyma showed changes ofacute tubular necrosis.

Immunohistochemistry was positive for neuron-specific enolase, S100, chromogranin and synaptophysin, while it was negative for CD4, CD20, vimentin and desmin.


   Discussion Top


Primary renal carcinoid tumor is an exceedingly rare neoplasm. [2] Rensick and colleagues reported the first case in 1966. [3] The majority of patients are presented with abdominal/flank pain and/or hematuria. Primary renal carcinoid tumor is frequently associated with horseshoe kidneys. [4],[5],[6] It may also arise from a mature teratoma of the kidney. [7] Their pathogenesisof this diseasis uncertain because neuroendocrine cells are not found in normal renal parenchyma, pelvis and ureter, [8] and pre-existing hyperplasia of neuroendocrine cells found within the foci of metaplastic or teratomatous epithelium is the most likely pathogenesis of the disease. Others have hypothesized that the tumor is derived from misplaced neural crest tissue in the hilar aspect of the kidneys during embryogenesis. There is a positive correlation between the size of the primary tumor and the incidence of metastasis. [9] In our case, there was a large-sized tumor with renal vein thrombus, but liver and lymph nodes metastasis was not detected.

Radical nephrectomy or partial nephrectomy is the primary treatment of renal carcinoid and is curative for localized disease. [10] There are no reports of chemotherapy for primary renal carcinoid tumors. Prognosis of renal carcinoid tumors is better than that for other renal neoplasms.

We conclude that the incidence of primary renal carcinoid tumor is extremely rare and nephrectomy is curative in localized disease and recommended even in the presence of metastasis.

 
   References Top

1.Romero FR, Rais-Bahrami S, Permpongkosol S, Fine SW, Kohanim S, Jarrett TW. Primary carcinoid tumors of the kidney. J Urol 2006; 176:2359-66.  Back to cited text no. 1
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2.Chung HY, Lau WH, Chu SM, Collins RJ, Tam PC. Carcinoid tumor of the kidney in a Chinese woman presenting with loin pain. Hong Kong Med J 2007;13:406-8.  Back to cited text no. 2
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3.Resnick ME, Unterberger H, McLoughlin PT. Renal carcinoid producing the carcinoid syndrome. Med Times 1966;94:895-96.  Back to cited text no. 3
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4.Isobe H, Takashima H, Higashi N, et al. Primary carcinoid tumor in a horseshoe kidney. Int J Urol 2000;7:184-8.  Back to cited text no. 4
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5.Begin LR. Guy L, Jacobson SA, Aprikian AG. Renal carcinoid and horseshoe kidney: A frequent association of two rare entities - a case report and review of the literature. J Surg Oncol 1998;68:113-9.  Back to cited text no. 5
    
6.Krishnan B, Truong LD, Saleh G, Sirbasku DM, Slawin KM. Horseshoe kidney is associated with an increased relative risk of primary renal carcinoid tumor. J Urol 1997; 157:2059-66.  Back to cited text no. 6
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7.Yoo J, Park S, Jung Lee H, Jin Kang S, Kee Kim B. Primary carcinoid tumor arising in a mature teratoma of the kidney: A case report and review of the literature. Arch Pathol Lab Med 2002;126:979-81.  Back to cited text no. 7
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8.Shurtleff BT, Shvarts O, Rajfer J. Carcinoid tumor of the kidney; Case report and review of literature. Rev Urol 2005;7:229-33.  Back to cited text no. 8
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9.Kawajiri H, Onoda N, Ohira M, et al. Carcinoid tumor of the kidney presenting as a large abdominal mass: Report of a case. Surg Today 2004;34:86-9.  Back to cited text no. 9
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10.Lane BR, Chery F, Jour G, et al. Renal neuroendocrine tumors: A clinicopathological study. BJU Int 2007;100:1030-5.  Back to cited text no. 10
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Top
Correspondence Address:
K V Kanodia
Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, Dr. H. L. Trivedi Institute of Transplantation Sciences - Smt Gulabben Rasiklal Doshi and Smt Kamlaben Mafatlal Mehta Institute of Kidney Diseases and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad 380016, Gujarat
India
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DOI: 10.4103/1319-2442.118095

PMID: 24029267

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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    Abstract
   Introduction
   Case Report
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    References
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