Simultaneous renal clear cell carcinoma and primary clear cell carcinoma of the liver: A case report

Abstract

Rationale: Double primary clear cell carcinomas of the liver (PCCCL) and kidney are extremely rare; moreover, there have been no reported cases of adrenal metastasis from primary clear cell tumors of the liver.

Patient concerns: A 47-year-old male patient was admitted to our clinic with space-occupying lesions in the left kidney and liver during a regular medical examination.

Diagnoses: The tumors in the kidney and liver were diagnosed as primary clear cell carcinoma by histopathological examination.

Interventions: The patient subsequently underwent nephron-sparing surgery of the left kidney and radical partial excision of the right liver lobe by laparoscopic surgery. Transcatheter arterial chemoembolization (TACE) was performed for the patient 2 weeks after tumor resection. One month after the operation, the patient started adjuvant therapy with sorafenib (400 mg twice per day orally). However, follow-up CT imaging revealed a solid mass measuring 1.9 × 2.0 × 2.0 cm in the right adrenal gland at 2 months postoperatively, and then the patient underwent radiofrequency ablation (RFA) for the right adrenal tumor.

Outcomes: The patient remained cancer free for 2 years following the diagnosis despite early right adrenal metastasis.

Lessons: Hepatocyte immunostaining is sufficient for the diagnosis of PCCCL.

Figure 1

CT prior to nephron-sparing surgery of the left kidney and radical partial excision of the right liver lobe. (A) The enhanced computed tomography (CT) scan revealed a mildly enhanced tumor measuring approximately 3 × 4 × 5 cm³ in the right lobe of the liver. (B) Another significantly enhanced mass measuring approximately 2 × 3 × 3 cm³ was observed in the inferior pole of the left kidney without local invasion or lymph node metastases, and no mass lesions were found on the bilateral adrenal glands.

Figure 2

HE and immunological staining of the hepatic tumor: (A) Bulky cancer cells with entirely or almost entirely “clear” cytoplasm were found in the tumor (original magnification × 400); (B) hepatocyte staining revealed strong positivity in the tumor cells (original magnification × 400); (C) CD10 staining of the tumor cells was completely negative (original magnification × 400).

Figure 3

HE and immunological staining observation of the renal tumor: (A) Sheet of clear cells in the tumor (original magnification × 400); (B) CD10 staining revealed diffuse positivity among the tumor cells (original magnification × 400); (C) hepatocyte staining of tumor cells was completely negative (original magnification × 400).

Figure 4

Images of the right adrenal metastasis 2 months after radical partial excision of the right liver lobe. (A) Enhanced CT scan shows a tumor in the right adrenal gland; (B) 3 months after radiofrequency ablation, the tumor had been completely ablated and devascularized, with the disappearance of tumor enhancement.