대한흉부영상의학회 Weekly Chest Cases

Case No : 1104 Date 2018-12-25

Courtesy of Dabee Lee, MD.,Eun Jin Chae, MD / Asan Medical Center, University of Ulsan College of Medicine
Age/Sex 52 / M
Chief ComplaintFollow up for lung cancer on chemotherapy

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Diagnosis With Brief Discussion

Diagnosis: Crizotinib associated complex renal cysts
Radiologic Findings: Figs 1. Initial chest CT shows irregular nodule in LLL, which biopsy proved lung cancer.
Fig 2-3. The patient have chemotherapy for advanced disease (lymph node metastasis in right supraclavicular area, not shown). After chemotherapy, CT scans shows decreased size of primary lung cancer in LLL. On mediastinal window setting, there are no abnormal findings in abdomen including both kidneys.
Figs 4-5. After 3 months later, CT scan with mediastinal window setting shows newly developed complicated cystic lesion in left kidney and fluid density in right perirenal space. There are no evidence of progression in primary tumor in LLL.
Fig 6. The primary lung cancer was positive ALK translocation. He had treatment with crizotinib for lung cancer.
Fig 7. After 1 year, CT scan show resolution of complicated renal cyst despite continuing crizotinib treatment.
Brief Review: Crizotinib is an inhibitor of several receptor tyrosine kinases, including anaplastic lymphoma kinase (ALK), hepatocyte growth factor receptor (HGFR, c-Met), and c-ros oncogene 1. It has been approved for the treatment of advanced ALK-positive non–small-cell lung cancer (NSCLC) in many countries. The development of complex renal cyst has been observed in seven (4%) patients as stated in the latest label of crizotinib published by the US Food and Drug Administration (FDA).
On recent report, among 255 crizotinib-treated patients, 22%, 3%, and 2% had preexisting simple cysts, complex cysts, or both, respectively. At the 6-month tumor assessment, 9% of all patients had acquired new cysts, and 2% of patients with preexisting cysts had developed new cysts and enlargements (>50%) of preexisting simple cysts. Asians appeared to have an increased risk of developing new cysts on treatment; Koreans in particular had 5.18 times higher odds of developing cysts than non-Asians.
The mechanisms by which crizotinib may increase the risk of developing renal cysts are currently unknown.
In all cases, no evidence of renal malignancy was found based on diagnostic testing (including follow-up with imaging scans) or clinical follow-up in any of the crizotinib-treated patients diagnosed with complex renal cysts.
Patients who developed renal cysts generally did not require dose reductions, and no patients required permanent discontinuation of crizotinib treatment due to this adverse effect. In some cases, this led to cystic invasion into adjacent tissue requiring drainage. While close monitoring is recommended, dosing modification was not generally necessary, allowing patients to continue to benefit from crizotinib treatment.
References: 1. Yen-Ting Lin, MD, Yu-Fen Wang, MD, James Chih-Hsin Yang, MD. Development of Renal Cysts after Crizotinib Treatment in Advanced ALK-Positive Non–Small-Cell Lung Cancer. Journal of Thoracic Oncology. 2014 Nov; 9(11): 1720-1725.
2. Schnell P, Bartlett CH, Solomon BJ, Complex renal cysts associated with crizotinib treatment. Cancer Med. 2015 Jun;4(6):887-96.
Keywords: Lung, kidney, Drug related disease,

No. of Applicants : 72

▶ Correct Answer : 45/72, 62.5%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- Niigata University , Japan ATSUSHI UEHARA
- , Japan MASAFUMI KAIUME
- Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
- The University of Tokyo Hospital , Japan Akifumi Hagiwara
- National cancer center hospital east , Japan SHIOTO ODA
- Chonbuk National University Medical School , Korea (South) HYEJIN YANG
- Chonbuk National University Hospital , Korea (South) MINGI SHIN
- McGill University Health Center , Canada Alexandre Semionov
- Chonbuk National University Hospital , Korea (South) EUN HA JUNG
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Other , Korea (South) SEONGSU KANG
- DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
- Seoul National University Hospital , Korea (South) Ju Gang Nam
- Freelance resident in Reunion Island , Reunion Fabien HO
- The Jikei university , Japan TAKU GOMI
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Ajou University Hospital , Korea (South) Taeyang Ha
- Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Myongji Hospital , Korea (South) KI EON KWON
- Asan Medical Center , Korea (South) JOOAE CHOE
- Gifu University Hospital , Japan Yo Kaneko
- Samsung Medical Center , Korea (South) MIN YEONG KIM
- The University of Tokyo Hospital , Japan RYO KUROKAWA
- Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
- , United States MAANSI P
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
- Azienda Ospedaliera di Cremona , Italy Pietro Sergio
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- Multimagem Diagn泥sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
- Fortis hospital , Mohali , India SHALEEN RANA
- Teikyo University Hospital , Japan KAORU SUMIDA
- National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
- , Korea (South) JONGSUN LEE
- Hamamatsu University Hospital , Japan YUKI HAYASHI
- Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
- University of Utah , United States AKIHIKO SAKATA
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- Ajou University Hospital , Korea (South) YONG HO JANG
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 1/72, 1.4%

- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY

▶ Semi-Correct Answer : 5/72, 6.9%

- Chonbuk National University Hospital , Korea (South) SANGHEON KIM
- 罹stanbul , Turkey AYHAN YILMAZ
- Seoul National University Hospital , Korea (South) JI HEE KANG
- TB centre kasaragod. , India rikhy krishnan
- Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1104 Date 2018-12-25

Discussion

No. of Applicants : 72