Mucin‑poor and aggressive mucinous tubular and spindle cell carcinoma of the kidney: Two case reports
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- Published online on: August 28, 2017 https://doi.org/10.3892/mco.2017.1400
- Pages: 777-782
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Copyright: © Uchida et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
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Abstract
Mucinous tubular and spindle cell carcinoma (MTSCC) is a relatively rare renal epithelial neoplasm. Although MTSCC is considered to be a low‑grade and indolent neoplasm, aggressive cases have been recently reported. The present study discussed two additional cases of high‑grade MTSCC causing multiple distant metastases with a fatal course. In case 1, a 71‑year‑old patient presented with hematuria and pyuria. Computed tomography (CT) scan of the right kidney revealed a mass lesion, for which partial nephrectomy was performed. However, a follow‑up CT imaging revealed distant metastases in the liver, the paraaortic lymph nodes and the bone. Despite molecular targeted therapy and irradiation, the patient succumbed due to tumor progression. In case 2, a 64‑year‑old patient presented with an incidentally identified mass lesion in the right kidney. A laparoscopic nephrectomy was performed, and a follow‑up CT imaging revealed metastases in the skin and lungs. The cytology of pleural effusion revealed pleuritis carcinomatosa. Histologically, both cases were diagnosed as mucin‑poor MTSCC with high‑grade transformation, which comprised uniform tumor cells primarily forming slender tubules. The tumors contained low‑ and high‑grade regions. In addition, venous invasion and necrosis were observed. The tumor cells also demonstrated increased Ki‑67 labeling indices and cellular tumor antigen p53 (p53) nuclear accumulation. High‑grade transformation, large tumor size, necrosis, venous invasion, high Ki‑67 labeling index and p53 nuclear accumulation are generally predictive findings for aggressive behavior of malignant tumors. In the current report, it was emphasized that MTSCC possesses a wide spectrum of clinicopathological features. Thus, careful postoperative investigation is required for MTSCC with high‑grade elements due to its aggressive nature.
