Abstract. The simultaneous occurrence of renal cell carcinoma (RCC) and urothelial carcinoma (UC) in the same kidney is extraordinarily rare, and is also known as multiple primary malignant tumors. The present study reports the case of a 76-year-old female with synchronous ipsilateral RCC and UC of the renal pelvis, who underwent operation, chemotherapy and reoperation when recurrence of RCC or UC was identified. Cluster of differentiation 44 (CD44) is one of the promising markers for identifying cancer stem cells in various solid tumors, along with aldehyde dehydrogenase 1 A1 (ALDH1A1). Detection of CD44 and ALDH1A1 prior to and subsequent to chemotherapy could provide useful prognostic information. New treatments against the cancer stem cells fraction should be used in combination with chemotherapy to improve the outcome for patients with overexpression of CSC markers.
IntroductionCombined renal cell carcinoma (RCC) and urothelial carcinoma (UC) of the renal pelvis is a rare type of multiple primary malignant tumor, which is characterized by the coexistence of two histologically distinct malignant tumors in the same organ with a shorter median time to relapse and mortality compared with a solitary tumor (1). There are only a few such cases in the world (2,3). Research into prognostic markers of multiple primary malignant tumors is important to establish adequate therapeutic strategies. Cancer stem-like cells (CSCs) are a small population of cancer cells that have the properties of tumor-initiating ability, self-renewal and differentiation (4). CSCs are more resistant to chemotherapy and radiotherapy than non-CSC populations via various mechanisms (5). Several studies have indicated that detection of CSC markers such as cluster of differentiation 44 (CD44) and aldehyde dehydrogenase 1 A1 (ALDH1A1) in urologic neoplasms can provide useful prognostic information (6-8). Furthermore, CD44 and ALDH1A1 have demonstrated high levels of activity in several types of solid cancer (9).The present study reports a case of synchronous RCC and UC of the left kidney with poor prognosis. Abnormal expression of CD44 and ALDH1A1 CSC markers investigated prior to and subsequent to chemotherapy may indicate poor prognosis.
Materials and methods
Patient.A 76-year-old female with a 5-month history of left flank pain presented to the Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School (Nanjing, China) without a history of fever, fatigue, weight loss or gross hematuria in March 2014. Her medical history included an 8-year history of hypertension, and there was no family history of urologic malignancies. Physical examination revealed that her vital signs were stable, and no palpable abdominal mass could be detected. Results from routine examinations, including electrocardiogram, chest radiography, pulmonary function test and laboratory tests of blood and urine, were all within the normal limits, with the exception of 8.4 red blood cells (RBC)/µl in urine (normal range, 0-5 RBC...