Papillary renal cell carcinoma with metastatic laparoscopic port site and vaginal involvement: a case report

Abstract

Introduction: Laparoscopic port-site metastasis is a rare but well recognized outcome following surgery in urological cancers, with its etiology not clearly understood. Additionally, vaginal metastasis in clear cell renal cell carcinoma is rare, and has not been previously reported in the setting of papillary renal cell carcinoma.

Case presentation: We present the case of a 71-year-old Chinese woman with metastatic type II papillary renal cell carcinoma with histologically verified vaginal involvement and a concurrent laparoscopic port-site metastasis. This was also associated with a unique constellation of widely disseminated metastatic sites, which include a local relapse, the peritoneum and the urethra.

Conclusion: Laparoscopic port-site metastases are associated with the presence of advanced cancer with multiple sites of metastasis. We hypothesize from the findings of our report and background data that this phenomenon is more likely to be related to tumor factors rather than operative factors. We also present what is, to the best of our knowledge, the first reported case in the literature of vaginal and urethral metastasis and the second reported case of laparoscopic port-site recurrence.

Figure 1

Images of the metastatic papillary renal cell carcinoma (RCC). (A) Laparoscopic port-site metastasis (arrow); (B) local recurrence at the right renal bed (black arrow) and ring enhancing liver metastasis (white arrow); (C) a superficial mass representing tumor metastasis at the urethral orifice; (D) a similar tumor located at the right vaginal wall imaged on colposcopy, from which a biopsy was taken; (E) a hematoxylin and eosin stained histological section of the primary papillary RCC (20 × magnification); (F) a hematoxylin and eosin stained histological section of the metastatic vaginal lesion (20 × magnification).