Synchronous Hepatocellular Carcinoma and Renal Cell Carcinoma in a Liver Transplant Recipient: A Case Report

Abstract

A 52-year-old male with liver cirrhosis secondary to hepatitis virus C, Child-Pugh score of C10, and Model for End-stage Liver Disease score of 20 was listed for liver transplant. During the pretransplant management, an abdominal computed tomography (CT) and magnetic resonance imaging (MRI, Fig. 1) showed a 2.7ϫ2.2 cm mass in the liver and a 1.7ϫ1.2 cm tumor in the right kidney. The liver mass on the CT was hyperdense with the liver parenchyma in the early arterial phase of contrast enhancement and hypodense in the portal phase; on the MRI, on T1-weighted sequences, it was hypointense to the liver and, on T2-weighted, it was hyperintense, suggesting hepatocellular carcinoma (HCC). The renal tumor on the CT and was a solitary solid lesion with contrast enhancement during the arterial phase; on the MRI, on T2-weighted images, it was hyperintense to the liver; on T1-weighted, it was hypointense, with a high degree of confidence in diagnosing renal cell carcinoma (RCC).Being a Child-Pugh C patient, he had a prohibitive risk to perform either a biopsy of the kidney tumor or its resection. Based on the fact that renal metastasis from a primary hepatocellular carcinoma is a extremely rare event (1), on the initial stage of both tumors and finally on the MRI and CT findings, we considered the possibility of two synchronous tumors and decided not to contraindicate the liver transplant. During the liver transplantation procedure, after the recipient's hepatectomy, we performed a partial nephrectomy to resect the kidney mass. Then, the donor liver was implanted. Histopathological analysis confirmed a synchronous HCC and RCC. He showed a good recovery and left the hospital 7 days after the transplant. His immunosuppression regimen was based on tacrolimus and prednisone. After a 12-month followup, patient is alive with good graft function and has no clinical or CT sign of any other tumor.Synchronous early primary cancers are rare. One study showed an incidence of 3.7% of synchronous cancers related to RCC. The most common sites involved were prostate, bladder, and lung. The occurrence of synchronous RCC and HCC is extremely rare (2).There is just one case of synchronous HCC and RCC resected simultaneously during a liver transplantation procedure, recently published on the literature (3). The prognosis of RCC is not likely to be changed by immunosuppression. However, a 5-year follow-up is necessary to confirm the results. The possibility of a synchronous tumor should be considered in cirrhotic patients with HCC.

Risk for Renal Cell Carcinoma in Chronic Hepatitis C Infection

“…Our findings validate previously published reports (10,16) suggesting that older age and African-American race are independent risk factors for RCC. Our findings thus corroborate our own clinical observations and seropositivity data, as well as frequent anecdotal reports in the literature that have strongly suggested an association between chronic HCV infection and RCC (11)(12)(13)(14)17).…”

“…Di Micco et al (11) reported a cluster of five cases of RCC developing among HCV patients within a brief time frame and were the first to strongly suggest a renal oncogenic potential for HCV infection. Fayek et al (12) in 2007 reported two cases of coexisting HCV and RCC in liver transplant candidates, and Garcia et al (13) in 2007 reported synchronous hepatocellular carcinoma and RCC in a liver transplant recipient. In 2008 Rifkin (14) described a chronic hemodialysis patient with simultaneous HCV and RCC.…”

A synchronous hepatocellular carcinoma and renal cell carcinoma treated with radio-frequency ablation

“…One study showed an incidence of 3.7% of synchronous cancers related to RCC. 1 Such malignancies include urological cancers, esophageal carcinomas, colorectal carcinomas, lung cancer, breast cancer, gynecological cancer, sarcoma and non-Hodgkin's lymphoma. 6 The occurrence of synchronous RCC and HCC is extremely rare.…”

“…The coexistence hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC) is extremely rare, and only a few case reports could be found in the literature. 1 …”

Hepatitis C Virus and Cancers: How Strong Is the Relationship?

“…Case reports exist of renal lymphoma [37] and renal cell carcinoma [38] in the setting of CHC. Given the rarity of renal lymphoma, the lack of clear pathophysiologic basis, and the infrequent nature of case reports, the possibility of this being a chance occurrence should be considered.…”