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Pulmonary Procedures |

Metastatic Medullary Renal Cell Carcinoma Diagnosed by Endobronchial Ultrasound Guided Transbronchial Needle Aspiration

Amanda Goss, DO; Jesse Sherratt, DO
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Tripler Army Medical Center, Kaneohe, HI


Chest. 2015;148(4_MeetingAbstracts):845A. doi:10.1378/chest.2254075
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Abstract

SESSION TITLE: Procedures Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Renal medullary carcinoma (RMC) is a rare, aggressive renal carcinoma which occurs almost exclusively in conjunction with sickle cell trait. Most often metastatic on presentation, it occurs in young, black males and carries a poor prognosis. We describe a typical presentation of RMC in a 28 year old Haitian male with sickle cell trait which was diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

CASE PRESENTATION: 28 year-old Haitian male with sickle cell trait initially seen by Oncology with 8 months of right hip pain and 6 months of dyspnea on exertion (DOE). The DOE was seen initially after running 2 miles but progressed to limiting ambulation to 100ft with associated violent, non-productive cough. Initial treatments by his PCM were targeted toward his musculoskeletal complaints. During our evaluation, he endorsed 3 weeks of scant hemoptysis, decreased appetite, 20 pound unintentional weight loss, and malaise. He denied hematuria, flank pain, night sweats, chills. His past medical, surgical, family, and socially histories were unremarkable with the exception of some tobacco use as child. Labs were remarkable for LDH 376, Alk phos 209, CRP 2.610 and ESR 11. A CT chest, abdomen, and pelvis revealed mediastinal, hilar, and retroperitoneal lymph nodes along with scattered ground glass and solid pulmonary nodules. Further evaluation with PET revealed a hypermetabolic left renal mass with additional areas of increased metabolic activity in the lung parenchyma, previously noted lymph nodes, and skeletal system (Figure 1). EBUS-TBNA of the left lower paratracheal (4L) lymph node(Figure 2) revealed a poorly differentiated carcinoma with further immunological stains tests confirming medullary renal cell carcinoma.

DISCUSSION: RMC was first described in 1995. By 2009, only 120 cases had been reported. Only one of these cases was in a patient who did not have the sickle cell trait and none appear to have been diagnosed via EBUS-TBNA. RMC typically affects young, black males with median age of 22. The tumor arises from the epithelium of the distal collecting ducts and is highly aggressive with most cases presenting with metastatic disease. Common symptoms include hematuria and flank pain1. The case of our patient is unique in that based off our literature review there does not appear to be a case of RMC ever having been diagnosed via EBUS-TBNA.

CONCLUSIONS: EBUS-TBNA has become the standard for mediastinal staging of primary lung cancers. Our case demonstrates the role of EBUS-TBNA as a valuable diagnostic tool for uncommon extrapulmonary malignancies including renal medullary carcinoma.

Reference #1: Tsaras, Geoffrey, Amma Owusu-Ansah, Freda Owusua Boateng, and Yaw Amoateng-Adjepong. "Complications Associated with Sickle Cell Trait: A Brief Narrative Review." The American Journal of Medicine 122.6 (2009): 507-12. Pubmed. Web. 22` Mar. 2015.

DISCLOSURE: The following authors have nothing to disclose: Amanda Goss, Jesse Sherratt

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