Metastatic renal cell carcinoma to the prostate and seminal vesicle

Abstract

Renal cell carcinoma (RCC) a common malignancy with potential to metastasize to visceral organs. However, it uncommonly spreads to the lower genitourinary tract. We present a man with a history of RCC status post radical nephrectomy in April 2012. He presented 8 years later with obstructive lower urinary tract symptoms and an elevated prostate specific antigen (PSA). Further imaging showed a large enhancing mass with internal blood vessels posterior to the left prostate and seminal vesicle. A prostate biopsy was performed and consistent with metastatic RCC. He was ultimately treated with immunotherapy and focal stereotactic radioablation.

Keywords: Pathology; Prostate metastasis; Radiology; Recurrence; Renal cell carcinoma.

Fig. 1

An axial (A) and sagittal view (B) of the patient's T2-weighted MRI demonstrating a 2.4 × 3.0 × 2.9 cm mass abutting the left posterior prostate and seminal vesicle. Initial MRI in October 2019 demonstrated a 3 cm avidly enhancing solid mass with internal blood vessels posterior to the left peripheral zone and seminal vesicle.

Fig. 2

The pathology obtained from a transrectal prostate biopsy is shown above. (A) demonstrates the H&E stained tissue that was positive for clear cell metastatic renal cell carcinoma (RCC). This was confirmed with further immunohistochemical stains. (B) demonstrates the tissue that is negative for PSA staining. (C) demonstrates the tissue was positive for PAX8 staining confirming the diagnosis of RCC and the metastatic nature of the tumor.