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Kidney Week

Abstract: FR-PO689

Recurrent Laryngeal Cancer with Uncommon Kidney Metastasis

Session Information

Category: Trainee Case Report

  • 1500 Onco-Nephrology

Authors

  • Abramson, Matthew, New York Presbyterian, New York, New York, United States
  • Seshan, Surya V., Weill Cornell Medical College, New York, New York, United States
  • Shingarev, Roman A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Glezerman, Ilya, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Gutgarts, Victoria, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Introduction

Laryngeal cancer is the fourteenth most common malignancy worldwide, where squamous cell carcinoma (SCC) is the most prominent subtype. Distant metastases occur in less than ten percent and involve the lung, liver, and bone but kidney metastases are seldomly reported. We report a rare case of recurrent laryngeal cancer with infiltrative kidney metastases.

Case Description

64-year-old man with recurrent metastatic laryngeal carcinoma was evaluated for worsening kidney function. First diagnosed with laryngeal carcinoma in 2011, managed with radiation therapy, with reoccurrence in 2017 requiring laryngectomy. Follow-up scans showed new metastatic lung disease treated with left upper lobe resection and cisplatin chemotherapy. Creatinine rose to 2.5 (0.7-1.3)mg/dl (baseline of 1.0mg/dl) over 3 months. He denied use of nonsteroidal anti-inflammatory drugs, and had not received intravenous contrast. He was recently started on ramipril for hypertension. Urinalysis showed no protein, with bland urine sediment. Renal ultrasound revealed enlarging kidneys, right 12.3cm (increased from 9.8cm 4 months prior) and left 11.9cm, without hydronephrosis. Positron emission tomography (PET) revealed several new areas of increased uptake by both kidneys, pulmonary nodules and diffuse hilar and retroperitoneal lymphadenopathy. Renal biopsy showed diffuse infiltrative moderately to focally well differentiated SCC replacing most of the cortical and medullary tissue. Four of 29 glomeruli were globally sclerosed, minimal changes in remaining glomeruli, with diffuse tubular atrophy and interstitial fibrosis. Immunofluorescence microscopy was not performed due to diffuse renal tissue infiltration. The patient’s creatinine remained elevated at 2.5mg/dl with plan by head and neck oncology for combination carboplatin, taxol, and cetuximab given the rapidly progressive nature of the disease.

Discussion

Kidney dysfunction in the setting of malignancy is often attributed to nephrotoxic chemotherapy as a potential cause. It is important to recognize that kidney infiltration is also possible where treatment can be aimed at addressing the underlying malignancy. The above case is unique in that it highlights the rare entity of laryngeal carcinoma metastasizing to the kidneys and should be considered in patients presenting with kidney dysfunction and large kidneys.