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Medical and Pediatric Oncology 33:432–433 (1999)
Letter to the Editor: Metachronous Renal Cell Carcinoma in a Child Cured
of Neuroblastoma
Key words: metachronous cancer; renal cell carcinoma; neuroblastoma; children,
childhood cancer
To the Editor: With the increase of long-term survivors of childhood cancer, second malignancies caused by
chemo/radiotherapy have become a source of concern
[1]. Renal cell carcinoma (RCC) as a second malignant
neoplasm has received little attention. We incidentally
found an RCC in an autopsied patient who died from
interstitial pneumonia 12 years after initial diagnosis of
neuroblastoma (NBL).
The patient (a 2-year-old boy) was admitted to our
hospital because of left upper abdominal tumor in 1976.
The resected tumor originated from the left adrenal gland
and was diagnosed as Evans stage II NBL. The patient
received multiagent chemotherapy (vincristine, cyclophosphamide, and doxorubicin) and local irradiation (total dose: 31.3 Gy). The left kidney was partially blocked,
where the radiation dose was 7.0 Gy. No recurrences
were observed during the subsequent 12 years, but the
patient developed interstitial pneumonia due to cyclophosphamide and expired in 1989 at the age of 14 years.
Autopsy revealed no residual NBL but extensive lung
fibrosis. The left kidney showed a 11 × 1-cm solid, cystic
lesion at the upper pole (Fig. 1A). Histology was clear
cell–type RCC with Grade I nuclear atypia (Fig. 1B).
A literature review revealed nine NBL patients who
developed RCC from childhood to early adulthood. Their
ages at diagnosis for NBL and RCC were 2–24 months
and 3–35 years, respectively. The interval between the
two tumors ranged from 3 to 35 years, with a median of
15 years [2–4]. All cases, including the present one, had
received chemotherapy and/or radiotherapy for the NBL.
Although a recent report referred to a possible association between RCC and radiation therapy [2], the literature review showed two patients with RCC who had
received no irradiation to the kidney. Chemotherapy
alone might be a predisposing factor for RCC. An accumulation of cases is necessary to clarify the relationship
between RCC and treatments for NBL.
Six out of the nine previously reported patients were
asymptomatic at the time of diagnosis for RCC. Four out
of these six patients were alive without tumor, one was
alive with tumor, and one was lost to follow-up. In contrast, among the three patients with symptoms, one died
© 1999 Wiley-Liss, Inc.
Fig. 1. A: Gross picture of the left kidney, demonstrating a welldefined solid, cystic lesion in the upper pole. B: Neoplastic cells with
clear cytoplasm arranged in a tubular fashion. Original magnification
×80.
of RCC, one was alive with tumor, and one was alive
without tumor.
Incidentally detected RCCs generally have a more favorable prognosis than those with clinical signs. Careful
follow-up for possible occurrence of RCC is desirable in
NBL patients who have undergone chemotherapy and/or
radiation therapy.
*Correspondence to: Keisuke Kato, MD, Division of Pathology, Kanagawa Children’s Medical Center, Mutsukawa 2-138-4, Minami-ku,
Yokohama, 232-8555, Japan. E-mail: [email protected]
Received 1 April 1999; Accepted 27 April 1999
Metachronous Renal Cell Carcinoma
REFERENCES
1. Smith MB, Xue H, Strong L, et al. Forty-year experience with
second malignancies after treatment of childhood cancer: analysis
of outcome following the development of the second malignancy.
J Pediatr Surg 1993;28:1342–1349.
2. Vogelzang NJ, Yang X, Goldman S, et al. Radiation induced renal
cell cancer: a report of 4 cases and review of the literature. J Urol
1998;160:1987–1990.
3. Fenton DS, Taub JW, Amundson GM, et al. Renal cell carcinoma
occurring in a child 2 years after chemotherapy for neuroblastoma.
Am J Roentgenol 1993;161:165–166.
4. Manion S, Hayani A, Husain A, et al. Partial nephrectomy for
pediatric renal cell carcinoma: an unusual case presentation. Urology 1997;49:465–468.
Keisuke Kato, MD*
Division of Pathology
Kanagawa Children’s Medical Center
Yokohama, Japan
Rieko Ijiri, MD
Division of Pathology
Kanagawa Children’s Medical Center
Yokohama, Japan
433
Yukichi Tanaka, MD
Division of Pathology
Kanagawa Children’s Medical Center
Yokohama, Japan
Hisato Kigasawa, MD
Division of Hematology
Kanagawa Children’s Medical Center
Yokohama, Japan
Yasunori Toyoda, MD
Division of Oncology
Kanagawa Children’s Medical Center
Yokohama, Japan
Yutaka Senga, MD
Division of Urology
Chigasaki City Hospital
Chigasaki, Japan
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