Kidney tumor
Adult renal cell carcinoma
Metastases to kidney

Author: Nicole K. Andeen, M.D.
Editor: Maria Tretiakova, M.D., Ph.D.
Deputy Editor Review: Debra Zynger, M.D.

Revised: 9 July 2018, last major update June 2018

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: "kidney metastases"

Cite this page: Andeen, N.K. Metastases to kidney. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/kidneytumormalignantmetastases.html. Accessed December 13th, 2018.
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

Images hosted on other servers:

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

Images hosted on PathOut server:

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

Images hosted on PathOut server:

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