Renal cell carcinoma associated with peritumoral sarcoid-like reaction without intratumoral granuloma
© Ouellet et al; licensee BioMed Central Ltd. 2012
Received: 21 January 2012
Accepted: 18 March 2012
Published: 18 March 2012
Non-necrotizing epithelioid granulomas have been described in association with many primary tumors. In such cases, they are designated as sarcoid-like reaction. Although it is more seen in carcinomas than in sarcomas, it is very rarely reported in renal carcinoma. Here, we describe a rare association of prominent peritumoral sarcoid-like reaction without intratumoral granulomas and conventional clear cell renal carcinoma in a 62-year-old-male, without clinical or laboratory finding of sarcoidosis. At 30 months follow-up, he had no recurrence.
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4054525336657922
KeywordsSarcoid-like reaction Granuloma Renal cell carcinoma
Non-necrotizing granulomas have been described in association with several primary cancers. Histologically, this sarcoid-like reaction is undistinguishable from granulomas found in systemic sarcoidosis. It is composed of a focal accumulation of epitheloid cells and multinucleated giant cells . Few cases of association of sarcoid-like reaction with renal cell carcinoma have been described [2–6], and some in patients with a known or suspected systemic sarcoidosis [7–10]. Here, we describe a renal cell carcinoma associated with a peritumoral granulomatous reaction in a patient without systemic sarcoidosis.
Macroscopically, the tumor lesion revealed a 3.5 cm encapsulated yellowish mass with bosselated surface with small foci of hemorrhage and necrosis.
The frequency of sarcoid like reactions in certain tumor types and in different locations varies from 4% in carcinoma, to 20% in lymphoma . Non-caseating granulomas can be caused by chemical exposure, infections, foreign bodies, granulomatous diseases and tumors [1, 11]. Therefore, before claiming an association between renal cell cancer and sarcoid-like reaction, the other causes must be excluded by a careful clinical history, diagnostic tests and pathologic examination .
Antigens expressed by the neoplastic cell or soluble tumor antigens trigger an immune response which leads to the formation of non-caseating granulomas. Such reaction, locally mediated by T-cell, can be found in involved or uninvolved remote site, in regional lymph nodes and less frequently in tumoral areas [1–11].
A certain number of cases in the literature reports sarcoid-like reaction associated with renal cell carcinoma in patient with sarcoidosis [7–10]. Renal involvement in sarcoidosis displays a wide range of clinical manifestations. Renal histopathology shows granulomatous interstitial nephritis. Alexandrescu et al  reported one case of renal cancer with non-cutaneous sarcoidosis. Lucci et al  described the 6th case of clear cell renal cell carcinoma associated with sarcoidosis, this association is very rare.
Clinicopathological features of reported cases of sarcoid-like reaction associated with conventional clear cell type renal carcinoma in patients without sarcoidosis
Tumor size (cm)
Hes et al.  (2003)
73 to 85 (mean 78.3)/2M, 1F
Granulomatous reaction within tumorous stroma
2.3 to 7.0 (mean 4.4)
6 months to 4 years
Kovacs et al.  (2004)
Granulomatous reaction within tumorous stroma and fibrous stroma surrounding the tumor
Shah et al.  (2010)
Granulomatous reaction within tumorous stroma
Peritumoral sarcoid-like reaction without intratumoral granulomas
Interestingly, in our case we did not find granulomatous reaction within the tumor as described in some carcinoma, including breast , renal [2–5] and hepatocellular carcinomas . We presented the sixth case of this reaction in conventional clear cell type renal carcinoma, in patients without sarcoidosis. However, it is, to our knowledge the first case of conventional clear cell type renal carcinoma to show peritumoral sarcoid-like reaction without intratumoral involvement.
We report a rare association between conventional clear cell type renal carcinoma and peritumoral sarcoid-like granulomatous reaction in a patient without clinical, radiologic or laboratory finding of sarcoidosis. Due to the low number of published cases, prognostic value of peritumoral non-necrotizing epithelioid granulomas has yet to be determined. Further cases are needed to provide information on the mechanism and prognostic value of peritumoral granuloma reaction in renal cell carcinoma.
Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of written consent is available for review by the Editor-in-Chief of this journal.
We would like to thank Tania Fayad, Ph D for the critical reading of this article.
- Brinker H: Sarcoid reactions in malignant tumours. Cancer Treat Rev. 1986, 13: 147-156. 10.1016/0305-7372(86)90002-2.View Article
- Marinides GN, Hajdu I, Gans RO: A unique association of renal carcinoma with sarcoid reaction of the kidney. Nephron. 1994, 67: 477-480. 10.1159/000188023.View ArticlePubMed
- Hes O, Hora M, Vanecek T, Sima R, Sulc M, Havlicek F, Beranova M, Michal M: Conventional renal cell carcinoma with granulomatous reaction: a report of three cases. Virchows Arch. 2003, 443: 220-221. 10.1007/s00428-003-0860-9.View ArticlePubMed
- Kovacs J, Varga A, Bessenyei M, Gomba S: Renal cell cancer associated with sarcoid-like reaction. Pathol Oncol Res. 2004, 10: 169-171. 10.1007/BF03033747.View ArticlePubMed
- Shah VB, Sharma P, Pathak HR: Conventional clear renal cell carcinoma with granulomatous reaction. Indian J Pathol Microbiol. 2010, 53: 379-380. 10.4103/0377-4929.64307.View ArticlePubMed
- Piscioli I, Donato S, Morelli L, Del Nonno F, Licci S: Renal cell carcinoma with sarcomatoid features and peritumoral sarcoid-like granulomatous reaction: report of a case and review of the literature. Int J Surg Pathol. 2008, 16: 345-348. 10.1177/1066896907309579.View ArticlePubMed
- Moder KG, Litin SC, Gaffey TA: Renal cell carcinoma associated with sarcoid-like tissue reaction. Mayo Clin Proc. 1990, 65: 1498-1501.View ArticlePubMed
- Bottone AC, Labarbera M, Asadourian A, Barman A, Richie C: Renal sarcoidosis coexisting with hypernephroma. Urology. 1993, 41: 157-159. 10.1016/0090-4295(93)90171-6.View ArticlePubMed
- Campbell F, Douglas-Jones AG: Sarcoid-like granulomas in primary renal cell carcinoma. Sarcoidosis. 1993, 10: 128-131.PubMed
- Lucci S, Rivolta R, Fazi M, Iorio L, Raschellà GF, Merlino G, Giordano R, Redler A: Sarcoidosis and clear cell carcinoma of the kidney: the sixth case?. G Chir. 2002, 23: 75-78.PubMed
- Bhatia A, Kumar Y, Kathpalia AS: Granulomatous inflammation in lymph nodes draining cancer: a coincidence or a significant association!. Int J Med Med Sci. 2009, 1: 13-16.
- Alexandrescu DT, Kauffman CL, Ichim TE, Riordan NH, Kabigting F, Dasanu CA: Cutaneous sarcoidosis and malignancy: An association between sarcoidosis with skin manifestations and systemic neoplasia. Dermatol Online J. 2011, 17: 2-PubMed
- Kamiyoshihara M, Hirai T, Kawashima O: Sarcoid reaction in primary pulmonary carcinoma. Report of seven cases. Oncol Rep. 1998, 5: 177-180.PubMed
- Pavic M, Debourdeau P, Vacelet V, Rousset H: Sarcoidosis and sarcoid reactions in cancer. Rev Med Interne. 2008, 29: 39-45. 10.1016/j.revmed.2007.09.041.View ArticlePubMed
- Marcella S, Welsh B, Foley P: Development of sarcoidosis during adalimumab therapy for chronic plaque psoriasis. Australas J Dermatol. 2011, 52: 8-11.View Article
- Burns AM, Green PJ, Pasternak S: Etanercept-induced cutaneous and pulmonary sarcoid-like granulomas resolving with adalimumab. J Cutan Pathol. 2012, 39: 289-293. 10.1111/j.1600-0560.2011.01795.x.View ArticlePubMed
- Bassler K, Birke F: Histopathology of tumor associated sarcoid-like stromal reaction in breast cancer. An analysis of 5 cases with immunohistochemical investigation. Virchows Arch A Pathol Anat Histopathol. 1988, 412: 231-239. 10.1007/BF00737147.View ArticlePubMed
- Tomimastsu H, Kojiro M, Nakashima T: Epithelioid granulomas associated with hepatocellular carcinoma. Arch Pathol Lab Med. 1982, 106: 538-539.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.