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LETTERS TO THE EDITOR
Year : 2019  |  Volume : 56  |  Issue : 2  |  Page : 185
 

Renal metastasis of lung cancer mimicking renal infarction


Department of Pulmonology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

Date of Web Publication2-May-2019

Correspondence Address:
Keisuke Watanabe
Department of Pulmonology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_512_18

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How to cite this article:
Watanabe K, Yumoto K, Kaneko T. Renal metastasis of lung cancer mimicking renal infarction. Indian J Cancer 2019;56:185

How to cite this URL:
Watanabe K, Yumoto K, Kaneko T. Renal metastasis of lung cancer mimicking renal infarction. Indian J Cancer [serial online] 2019 [cited 2019 Jul 15];56:185. Available from: http://www.indianjcancer.com/text.asp?2019/56/2/185/257562




Sir,

Cancer patients have increased risk of arterial thromboembolism,[1] and renal metastasis from non-small cell lung cancer is rare. We report renal metastasis of lung adenocarcinoma, which was difficult to differentiate from renal infarction with single modality.

A 71-year-old man, who had postoperative-recurrent lung adenocarcinoma with multiple bone and lung metastasis, visited emergency room for sudden onset of back pain. Limbus fracture with known metastasis was thought to be the cause of pain. However, enhanced computed tomography (CT) revealed unenhancing lesion in left kidney with cortical rim sign [Figure 1]a; D-dimer was extremely high (27.65 μg/mL). Hence, there was a need to differentiate renal metastasis from renal infarction. Ultrasonographic examination showed avascular mass in left kidney [Figure 1]b, and we diagnosed renal metastasis. After he died of pneumonia, autopsy was performed, and pathological findings confirmed renal metastasis of lung adenocarcinoma.
Figure 1: (a) Enhanced CT showed unenhanced lesion with cortical rim sign in left kidney and (b) ultrasonographic examination showed avascular mass in left kidney

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Cortical rim sign is the characteristic CT finding of renal infarction.[2] But renal metastasis in this case showed this sign, and 32.4% of renal infarction had hypoattenuated area with associated mass effect.[2] Besides, cancer patients have increased risk of arterial thromboembolism,[1] and renal metastasis from non-small cell lung cancer is rarely diagnosed in live patients.[3] Therefore, it was difficult to differentiate renal metastasis from renal infarction with single modality in this case.

In conclusion, it is challenging to diagnose renal metastasis when symptoms and CT findings mimic renal infarction. In such cases, multimodality approach might be helpful to diagnose the condition.

We appreciate Ms. Cathy Endo for English editing.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Navi BB, Reiner AS, Kamel H, Iadecola C, Okin PM, Elkind MSV, et al. Risk of arterial thromboembolism in patients with cancer. J Am Coll Cardiol 2017;70:926-38.  Back to cited text no. 1
    
2.
Suzer O, Shirkhoda A, Jafri SZ, Madrazo BL, Bis KG, Mastromatteo JF. CT features of renal infarction. Eur J Radiol 2002;44:59-64.  Back to cited text no. 2
    
3.
Tomita M, Ayabe T, Chosa E, Nakamura K. Isolated renal metastasis from non-small-cell lung cancer: Report of 2 cases. Case Rep Surg 2015;2015:357481.  Back to cited text no. 3
    


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