Urology Annals
About UA | Search | Ahead of print | Current Issue | Archives | Instructions | Online submissionLogin 
Urology Annals
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 1738   Home Print this page  Email this page Small font size Default font size Increase font size


 
Table of Contents
CASE REPORT
Year : 2013  |  Volume : 5  |  Issue : 2  |  Page : 122-123  

Simultaneous renal clear cell carcinoma and gastrointestinal stromal tumor in one case


Department of Urology, PeKing Union Medical College Hospital, Chinese Academy of Medical Sciences and PeKing Union Medical College, Beijing, China

Date of Submission20-May-2011
Date of Acceptance06-Aug-2011
Date of Web Publication3-Apr-2013

Correspondence Address:
Han-Zhong Li
Department of Urology, PeKing Union Medical College Hospital, Chinese Academy of Medical Sciences and PeKing Union Medical College, Beijing - 100 730
China
Login to access the Email id


DOI: 10.4103/0974-7796.110013

PMID: 23798873

Rights and Permissions
   Abstract 

Renal cell carcinoma is a tumor in kidney, while gastrointestinal stromal tumors are localized in the stomach and small intestine. They seldom occur simultaneously in sporadic case, both of which were suspective to sunitinib, a tyrosine kinases (RTKs) inhibitor. Our current case is novel in that concurrent RTK-related tumors are involved in one case. One possible explanation is the presence of some activating mutations.

Keywords: Gastrointestinal stromal tumor, receptor tyrosine kinase, sunitinib


How to cite this article:
Wen J, Li HZ, Ji ZG, Gang-Yan W, Shi BB. Simultaneous renal clear cell carcinoma and gastrointestinal stromal tumor in one case. Urol Ann 2013;5:122-3

How to cite this URL:
Wen J, Li HZ, Ji ZG, Gang-Yan W, Shi BB. Simultaneous renal clear cell carcinoma and gastrointestinal stromal tumor in one case. Urol Ann [serial online] 2013 [cited 2020 Jan 20];5:122-3. Available from: http://www.urologyannals.com/text.asp?2013/5/2/122/110013


   Introduction Top


Renal cell carcinoma (RCC) is a common tumor in kidney, which accounts for 2-3% of all adult malignancies. [1] Gastrointestinal stromal tumors (GISTs) originate from the interstitial cells, which control gastrointestinal peristalsis. GISTs arise most commonly from the stomach. [2] The occurrence of them simultaneously remains an issue of great interest to surgeons and oncologists. Little is known about the genetic basis of any such associations. We present a case of concurrent a RCC and a GIST of stomach, both of which were suspective to sunitinib, a tyrosine kinases (RTKs) inhibitor.


   Case Report Top


A 65-year-old man presented to PeKing Union Medical College Hospital (PUMCH) with a four-month history of weakness, anorexia, upper abdominal discomfort, and weight loss of 3 kg. A 64-spiral computed tomography (CT) scanning of the abdomen demonstrated the presence of a 5 cm × 5 cm × 4 cm left renal mass and 10 cm × 9 cm × 8 cm gastric mass [Figure 1], [Figure 2] and [Figure 3]. There were no metastases seen in the liver or lung. The patient underwent surgical resection with radical nephrectomy and partial gastrectomy. Histological appraisal of the specimens revealed a clear cell type Fuhrman grade 2 renal cell carcinoma and a gastrointestinal stromal tumor (GIST). All resection margins were clear of tumor and the GIST was positive for c-KIT and DOG-1. The patient was treated with sunitinib at a standard dose postoperatively (50 mg daily, 4 wk on, 2 wk off).
Figure 1: A 64-spiral computed tomography (CT) scanning of the abdomen demonstrated the presence of a 10 cm × 9 cm × 8 cm gastric mass

Click here to view
Figure 2: A 64-spiral CT scanning of the abdomen demonstrated the presence of a 5 cm × 5 cm × 4 cm left renal mass

Click here to view
Figure 3: A 64-spiral CT scanning of the abdomen demonstrated the presence of a 5 cm × 5 cm × 4 cm left renal mass and 10 cm × 9 cm × 8 cm gastric mass

Click here to view



   Discussion Top


The occurrence of two neoplasms in a single patient is an unusual occurrence.

The etiology of multiple primary tumors is quite complex, with genetic, environmental, hormonal, medical treatment-related, and gender-specific factors. [3] Both RCC and GIST may occur as recurrent familial tumors, related to mutations in the genes c-MET and c-KIT. [4] These are both RTKs. However, such germline mutations are rarely found in sporadic cases.

Clinically, sunitinib is effective against both tumors, which may represent a promising novel treatment approach for these patients. This agent potently inhibits the vascular endothelial growth factor receptor, platelet-derived growth factor receptor, and c-Kit in addition to other kinases proved in biochemical and cell-based assays. [5] It is now approved as first-line therapy for patients with RCC and second-line therapy for GIST by the US Food and Drug Administration in January 2006. [6],[7]

Our current case is novel in that concurrent RTK-related tumors are involved in one case. In our case, first we used surgical resection with radical nephrectomy and partial gastrectomy. Surgical resection is the mainstay of treatment for patients with operable tumors. It was the only effective intervention prior to the novel targeted therapies, such as sunitinib. The case described is not only of interest due to the unusual co-incidence of two malignancies, but also emphasizes the importance of a thorough exploration of the patient. The role of this thorough search has clearly not been made obsolete by the tremendous advances in preoperative imaging modalities. The impact of synchronously existing tumors on the overall prognosis of a patient must be considered when planning therapy in such instances as well.

 
   References Top

1.Escudier B, Kataja V. ESMO Guidelines Working Group. Renal cell carcinoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009;20 Suppl 4:81-2.  Back to cited text no. 1
    
2.Antonini C, Forgiarini O, Chiara A, Briani G, Belmonte P, Zucconelli R, et al. Stromal tumor ofthe ileum (GIST) at the same time as a renal carcinoma.Description of a case and review of the literature. Pathologica.1998; 90:160-4.  Back to cited text no. 2
    
3.Beisland C, Talleraas O, Bakke A, Norstein J. Multiple primary malignancies in patients with renal cell carcinoma: a national population-based cohort study. BJU Int 2006;97:698-702.  Back to cited text no. 3
    
4.Au WY, Ho KM, Shek TW. Papillary renal cell carcinoma and gastrointestinalstromal tumor: A unique association. Ann Oncol 2004;15:843-4.  Back to cited text no. 4
    
5.Mena AC, Pulido EG, Guillén-Ponce C. Understanding the molecular-based mechanism of action of the tyrosine kinase inhibitor: Sunitinib. Anticancer Drugs 2010;21:S3-11.  Back to cited text no. 5
    
6.Sulkes A. Novel multitargeted anticancer oral therapies: Sunitinib and sorafenib as a paradigm. Isr Med Assoc J 2010;12:628-32.  Back to cited text no. 6
    
7.Boone SL, Jameson G, Von Hoff D, Lacouture ME. Blackberry-induced hand-foot skin reaction to sunitinib. Invest New Drugs 2009;27:389-90.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed1539    
    Printed55    
    Emailed0    
    PDF Downloaded262    
    Comments [Add]    

Recommend this journal