- Case Report
- Open Access
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.
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- Sarcoid-like reaction
- 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.
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