Hemoptysis: Atypical presentation of a renal carcinoma

Alvarez Mavarez, J.D.; Garcia Coya, E.; Gutierrez Rodriguez, M.

doi:10.1016/j.acuroe.2019.12.002

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B) Chest CT with intravenous contrast, showing endobronchial tumor with left lower lobe atelectasis. C) Endoscopic view of the tumor in the left main bronchus. D) Histology of clear cell carcinoma." ] ] ] "textoCompleto" => "Endobronchial metastases are defined as documented extrathoracic malignancies within the visible range of the bronchoscope.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Usually found in colon and breast cancer staging tests, they are rare entities occasionally able to develop in advanced stage renal carcinomas.<a class="elsevierStyleCrossRefs" href="#bib0010">2–5</a>We present the case of a 61-year-old woman who visited the emergency department for hemoptysis and a 24-h fever. The patient had reported dyspnea with nonspecific chest discomfort and stress in recent weeks. Among relevant background data were ranitidine allergy, type 2 diabetes mellitus treated with metformin and hysterectomy due to adenomyosis. She had normal vital signs and decreased breath sounds in the left base of the lung was the only mild finding. Additional tests show C-reactive protein of 10,7 mg/l and mild anemia (hemoglobin concentration of 11,9 g/dl). Chest x-ray is performed showing increased density in the left base with clear volume loss. The evaluation is completed with thorax-abdominal CT evidencing a 26 mm endobronchial lesion of increased tracer accumulation, located at the origin of the left main bronchus with tracheal invasion, which determines a practically complete atelectasis of the left lower lobe and partial upper lobe, with significant mediastinal shift (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There is evidence of a 10 mm nodule in the apical segment of the right upper lobe. A 36 × 26 mm mass is seen at the upper pole of the right kidney; the rest is within normal limits.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>A bronchoscopy is performed after these findings, showing a necrotic tumor obstructing 60% of the tracheal lumen, impeding visualization of the left bronchial tree and the main carina. Clear cell renal carcinoma with positive immunohistochemical expression of CD10, vimentin, EMA and CCR was detected in a subsequent biopsy.Renal cancer accounts for between 2 and 3% of all malignant tumors in adults, with clear cell carcinoma being the most frequently diagnosed. It is twice as common in men than in women, and most cases are diagnosed in the 4th or 6th decades.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> 25 to 30% renal carcinomas have metastases at diagnosis with lung as the second organ involved; endobronchial metastases are rare. Being clinically similar to primary lung tumors, they may not show symptoms or manifest as cough, hemoptysis or dyspnea.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> According to the published literature, the mean time from diagnosis of the primary malignant neoplasm to the onset of endobronchial metastasis can vary from 9 months to 7 years.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> In this unusual case, the onset was hemoptysis without previous diagnosis. Therefore, and despite their low incidence, endobronchial metastases should be considered in cases of extrathoracic neoplasms diagnosis with respiratory symptoms during follow-up. Endoscopic evaluation is recommended in these cases." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Alvarez Mavarez JD, Garcia Coya E, Gutierrez Rodriguez M. Hemoptisis como presentación atípica de un carcinoma renal. Actas Urol Esp. 2019. https://doi.org/10.1016/j.acuro.2019.09.003" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1156 "Ancho" => 805 "Tamanyo" => 116617 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "A) PA and lateral chest x-ray. B) Chest CT with intravenous contrast, showing endobronchial tumor with left lower lobe atelectasis. C) Endoscopic view of the tumor in the left main bronchus. D) Histology of clear cell carcinoma." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endobronchial metastasis: An epidemiologic and clinicopathologic study of 174 consecutive cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Marchioni" 1 => "A. Lasagni" 2 => "A. Busca" 3 => "A. Cavazza" 4 => "L. Agostini" 5 => "M. 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Bellmunt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/(SICI)1096-9098(199608)62:4<249::AID-JSO4>3.0.CO;2-6" "Revista" => array:8 [ "tituloSerie" => "J Surg Oncol" "fecha" => "1996" "volumen" => "62" "numero" => "4" "paginaInicial" => "249" "paginaFinal" => "252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8691837" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S188558571300176X" "estado" => "S300" "issn" => "18855857" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endobronchial metastasis from extrathoracic malignancies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Breta" 1 => "S. Arava" 2 => "K. Madan" 3 => "A. Singh" 4 => "D. Jain" 5 => "R. Guleria" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/lungindia.lungindia_438_17" "Revista" => array:8 [ "tituloSerie" => "Lung India" "fecha" => "2019" "volumen" => "36" "numero" => "3" "paginaInicial" => "212" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31031341" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1885585714000711" "estado" => "S300" "issn" => "18855857" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000004400000001/v2_202001231019/S2173578619301404/v2_202001231019/en/main.assets" "Apartado" => array:4 [ "identificador" => "6296" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000004400000001/v2_202001231019/S2173578619301404/v2_202001231019/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578619301404?idApp=UINPBA00004N"]

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Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided. It has high visibility and accessibility and is found in the most important data bases, Medline/Pubmed, Emabase, JCR, Ïndice Médico Español, Índice bibliográfico Español en Ciencias de la Salud (IBECS), Cuiden, Dialnet, Hinari, Scopus, Google Scholar.

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