Kidney tumor
Adult renal cell carcinoma
Metastases to kidney

Deputy Editor: Debra Zynger, M.D.

Topic Completed: 1 June 2018

Revised: 5 March 2019

Copyright: 2003-2019, PathologyOutlines.com, Inc.

PubMed Search: "kidney metastases"
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Cite this page: Andeen NK, Tretiakova M. Metastases to kidney. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/kidneytumormalignantmetastases.html. Accessed April 23rd, 2019.
Definition / general
  • Malignant neoplasm metastatic to kidney, not of primary renal or renal pelvis origin
  • Most are carcinomas (80.8%)
    • Primary site (BJU Int 2016;117:775)
      • Usually lung (43.7%)
      • Colorectal (10.6%)
      • ENT (6%)
      • Breast (5.3%)
      • Soft tissue (5.3%)
      • Thyroid (5.3%)
  • Also melanoma, pancreas, ovary, testis
Essential features
  • In surgical pathology based studies, metastasis to kidney is uncommon; usually recognized after the diagnosis of primary tumor and may not be seen until long after that diagnosis
Epidemiology
Clinical features
  • Presents with flank pain (30%), hematuria (16%) and weight loss (12%) (BJU Int 2016;117:775)
  • Often solitary (77%), although most later develop more sites of metastasis (BJU Int 2016;117:775)
  • 88% diagnosed after primary tumor, 9% concurrent with primary; in 2% the metastasis to kidney preceded diagnosis of primary tumor (Histopathology 2015;66:587)
  • In 19%, there is a > 10 year interval between time of diagnosis of primary tumor and diagnosis of kidney metastasis (Histopathology 2015;66:587)
  • 37% of patients have no other known metastasis at time of diagnosis (Histopathology 2015;66:587)
  • Renal cell carcinoma is the most common recipient of tumor to tumor metastasis in malignant tumors (Urology 1987;30:35)
Radiology description
  • Compared with renal primaries, more often solid and endophytic; no difference in tumor size, polar predominance or CT enhancement patterns (AJR Am J Roentgenol 2011;197:W680)
Radiology images

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Metastatic oral squamous cell carcinoma

Metastatic phyllodes tumor

Prognostic factors
  • In a series of 151 patients with tumors metastatic to kidney, median overall survival from time of metastatic diagnosis was 1.1 years and median overall survival from primary tumor diagnosis was 3 years (BJU Int 2016;117:775)
Case reports
Treatment
  • May be treated with ablation or resection
Gross description
Gross images

Contributed by Debra Zynger, M.D.

Lung squamous cell carcinoma



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Myeloma

Small cell lung cancer

Solitary fibrous tumor

Microscopic (histologic) description
  • Varies; may mimic urothelial carcinoma with divergent differentiation or unusual primary kidney tumors
Microscopic (histologic) images

Maria Tretiakova, M.D., Ph.D. and Nicole K. Andeen, M.D.

Breast carcinoma

Gastric carcinoma

Well differentiated neuroendocrine tumor



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Pancreatic neuroendocrine carcinoma

Lung: adenocarcinoma metastatic to angiomyolipoma

Cytology description
Negative stains
  • Renal cell carcinoma markers: PAX8 (83% of renal cell carcinomas are positive), EMA (78% of clear cell renal cell carcinomas are positive), CAIX (87% of clear cell renal cell carcinoma are positive), hKIM-1 (human kidney injury molecule-1) (83% of clear cell renal cell carcinoma are positive), PAX2, renal cell carcinoma (Am J Surg Pathol 2011;35:678)
Molecular / cytogenetics description
  • Molecular testing not currently used consistently; diagnosis is based on history, morphology and IHC
Differential diagnosis
Board review question #1
Which is the most useful immunohistochemical panel to differentiate adrenal cortical carcinoma from clear cell renal cell carcinoma?

  1. Inhibin, calretinin, CD10, PAX2
  2. MelanA, CK7, RCC, PAX2
  3. SF-1, calretinin, CAIX, PAX8
  4. SF-1, CK7, RCC, CD10
Board review answer #1
C. SF-1, calretinin, CAIX, PAX8

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