대한흉부영상의학회 Weekly Chest Cases

Case No : 1211 Date 2021-01-06

Courtesy of Won Gi Jeong, Jong Eun Lee, Yun-Hyeon Kim / Chonnam National University Hwasun Hospital
Age/Sex 56 / M
Chief ComplaintBlood-tinged sputum

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7

Diagnosis With Brief Discussion

Diagnosis: Metastatic renal cell carcinoma (clear cell type)
Radiologic Findings: Fig 1. Chest PA shows approximately 4.5 cm mass in right hilum
Fig 2-5. CT scans shows heterogeneously enhancing masses with internal hypoattenuating portions in central portion of right upper lobe and right lower paratracheal area.
Fig 6-7. 18F-FDG PET/CT demonstrates high FDG uptake within the lesions (SUVmax : 3.3).
Brief Review: Clear cell renal cell carcinoma (RCC) is the most common subtype, representing 75%–80% of all RCCs according to the Heidelberg classification and has the highest risk of developing metastatic disease. By invading the retroperitoneal lymphatics and traversing the thoracic duct, RCC can sometimes reach distant locations, such as the thoracic (mediastinal and hilar) or supraclavicular nodes, and even the lung (through thoracic duct drainage into the subclavian vein). Metastatic lesions usually show contrast enhancement similar to that of the primary tumor. Pulmonary metastases account for 45% of all metastases from RCC, representing the most common anatomic site of disseminated RCC. Lymph node metastasis is the third most common group of metastatic RCC lesions, accounting for 22% of cases. Recurrence of RCC after initial curative treatment typically occurs within 5 years in most patients. However, a late recurrence more than 5 years after the initial treatment can also occur, which is one of the specific biological behaviors of RCC. It has been reported that 4.7 – 11% of patients developed a late recurrence 10 years after initial nephrectomy.
References: 1. Brufau BP, Cerqueda CS, Villalba LB, Izquierdo RS, González BM, Molina CN. Metastatic renal cell carcinoma: radiologic findings and assessment of response to targeted antiangiogenic therapy by using multidetector CT. Radiographics. 2013 Oct;33(6):1691-716. doi: 10.1148/rg.336125110.
2. Park YH, Baik KD, Lee YJ, Ku JH, Kim HH, Kwak C. Late recurrence of renal cell carcinoma >5 years after surgery: clinicopathological characteristics and prognosis. BJU Int. 2012 Dec;110(11 Pt B):E553-8. doi: 10.1111/j.1464-410X.2012.11246.x.
Keywords: lymph node, metastasis ,

No. of Applicants : 91

▶ Correct Answer : 6/91, 6.6%

- Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
- National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
- Gifu University Hospital , Japan Yo Kaneko
- Chonnam National University Hospital , Korea (South) SUNGMO KIM
- , Korea (South) JOON YOUNG PARK
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi

▶ Correct Answer as Differential Diagnosis : 20/91, 22.0%

- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- TWMU Medical Center East , Japan MASAFUMI KAIUME
- National cancer center hospital east , Japan SHIOTO ODA
- McGill University Health Center , Canada ALEXANDRE SEMIONOV
- , France LE GUEN RAPHAEL
- The University of Tokyo Hospital , Japan MOTO NAKAYA
- Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
- Asan Medical Center , Korea (South) EUNJI CHOI
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Other , Korea (South) SEONGSU KANG
- Soonchunhyang University Hospital Bucheon , Korea (South) SEONGHWAN BYUN
- Mayo Clinic , Japan HIROAKI TAKAHASHI
- Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
- Other , Korea (South) JANGHYEON SONG
- Ajou University Hospital , Korea (South) HYERIN KIM
- Kyeongpook National University Hospital , Korea (South) PARK BYUNG GEON
- Fortis hospital , Mohali , India SHALEEN RANA
- Toranomon Hospital , Japan KAORU SUMIDA
- , Japan KAZUMA TERAUCHI
- Hamamatsu University Hospital , Japan YUKI HAYASHI

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1211 Date 2021-01-06

Discussion

No. of Applicants : 91