Small cell carcinoma of the kidney: A clinicopathologic study of 14 cases

Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Human pathology (Impact Factor: 2.77). 07/2011; 42(11):1792-8. DOI: 10.1016/j.humpath.2011.03.005
Source: PubMed


Small cell carcinoma of the kidney is distinctively rare. We searched pathology files in 2 institutions and found 14 cases of renal small cell carcinoma. The patients' mean age at diagnosis was 59 years (range, 22-75 years); 8 were women, and 6 were men. Patients usually presented with hematuria (n = 6) and abdominal pain (n = 5). The mean tumor size was 7.1 cm (range, 3.5-14.0 cm). The small cell carcinoma was pure in 9 cases and mixed with high-grade urothelial carcinoma in 5 cases. None was associated with any type of renal cell carcinoma. Tumor necrosis was present in all cases, and lymphovascular invasion was identified in 6 cases. The tumor invaded the perinephric adipose tissue in 13 cases and was confined to the kidney in only 1 case. Lymph node metastases were identified in all patients who underwent lymph node dissection (5/5). On immunostains, the small cell carcinoma cells were positive for pancytokeratin (11/12), chromogranin (6/9), and synaptophysin (8/9). Follow-up data were available for 13 patients, and 11 died of small cell carcinoma at a mean of 15 months (range, 4-31 months) after diagnosis. Of the 2 surviving patients, 1 was alive at 5 months after diagnosis, and the other, whose disease was confined to the kidney, was alive with no evidence of disease at 137 months. In summary, renal small cell carcinoma is a highly aggressive disease that often presents at an advanced stage with widespread metastases. Patients usually have a poor clinical outcome despite multimodal therapy. The frequent coexistence of small cell carcinoma with urothelial carcinoma suggests that renal small cell carcinomas may evolve from a preexisting urothelial carcinoma.

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  • Human pathology 01/2012; 43(1):151-152. DOI:10.1016/j.humpath.2011.09.006 · 2.77 Impact Factor
  • Human pathology 01/2012; 43(1):150-1; author reply 151-2. DOI:10.1016/j.humpath.2011.09.005 · 2.77 Impact Factor
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    ABSTRACT: Primary small cell carcinoma of the kidney is an extremely rare neoplasm. Less than 100 cases of primary small cell carcinoma of the kidney have so far been reported in the literature. In view of this most practitioners globally would not be accustomed to the biological behaviour of this neoplasm. There is therefore the need to review the literature on primary small cell carcinoma of the kidney. To review the literature on primary small cell carcinoma of the kidney, various internet search engines were used to form a foundation for the literature review including: Google; Google scholar; educus; Up To Date; Pub Med. The median age at diagnosis of small cell carcinoma of the kidney was 62 years and there was a female preponderance. Abdominal pain and haematuria are common symptoms of small cell carcinoma of the kidney. At the time of initial diagnosis slightly less than a third of the patients have distant metastasis. Surgery in the form of nephrectomy and systemic chemotherapy, have been the main forms of treatment modalities which include: nephrectomy alone; nephrectomy and chemotherapy; chemotherapy alone. The median survival in one series was about 8 months and this has ranged on the whole from between 1 month to 101 months. In another series the overall median survival was 9.9 months (range 6.9 to 31.6 months). Data on demographics, clinical symptoms, tumour staging and tumour characteristics recorded at the time of diagnosis was not found to be related to survival. The use of cisplatin-based chemotherapy was in some cases observed to be predictive of better overall survival. Small cell carcinoma of the kidney is an extremely rare neoplasm which mimics small cell carcinoma of the tracheobronchial tree and other extra-pulmonary sites, its aggressive biological behaviour and its high ability to result in the development of loco-regional and distant dissemination. The development of symptoms or clinical presentation tends to be usually late in the course of the disease. Utilization of platinum-based chemotherapeutic regimen has been found to be associated with tumour regression and prolonged survival. Small cell carcinomas of the genitourinary tract have been more commonly reported in the urinary bladder in comparison with primary small cell carcinoma of the kidney which is very rare. In view of the rarity of primary small cell carcinoma of the kidney its natural history, diagnosis and management is not well known. Despite the use of cisplatin-based chemotherapeutic regimen in the treatment of small cell carcinoma of the kidney there is not enough documentation of any treatment modality that would prolong life for a very long time. There is therefore the need for Urologists and oncologists throughout the world to come together in order to undertake a multicentre trial of chemotherapeutic modalities in the management of small cell carcinoma of the kidney in order to find ways of further improving the prognosis of such a rare carcinoma.. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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