Case Reports in Oncological Medicine

Case Reports in Oncological Medicine / 2020 / Article

Case Report | Open Access

Volume 2020 |Article ID 5315178 |

Dayne Ashman, Gabriela Quiroga-Garza, Daniel Lee, "Rare Presentation of Metastatic Lobular Breast Carcinoma Involving Clear Cell Renal Cell Carcinoma", Case Reports in Oncological Medicine, vol. 2020, Article ID 5315178, 5 pages, 2020.

Rare Presentation of Metastatic Lobular Breast Carcinoma Involving Clear Cell Renal Cell Carcinoma

Academic Editor: Raffaele Palmirotta
Received23 Mar 2020
Accepted03 Sep 2020
Published15 Sep 2020


Although the first case of tumor-to-tumor metastasis was reported over a century ago, it remains a rare occurrence. We report a rare case of metastatic infiltrating lobular carcinoma involving clear cell renal cell carcinoma, as well as offer a brief literature review.

1. Introduction

The phenomenon of one malignant tumor metastasizing to another, unrelated, primary tumor, has been termed “tumor-to-tumor” metastasis (TTM); it is a rare occurrence. To date, there have been fewer than 200 cases reported in the English literature. Here, we report a rare case of metastatic infiltrating lobular carcinoma involving clear cell renal cell carcinoma.

2. Case Report

A 57-year-old woman with a past medical history of stage IIA (pT2 N0 M0) multifocal infiltrating lobular carcinoma of the right breast, and multifocal lobular carcinoma in situ of the left breast (both diagnosed 11 years prior), was initially managed with surgery and adjuvant hormonal therapy. An overview of her clinical history and management is given in Figure 1. She recently presented with a right renal mass, incidentally identified during computerized tomography (CT) scan performed as part of her follow-up (Figure 2). An ultrasound-guided needle biopsy of the right renal mass was performed.

Microscopic examination of the biopsy specimen revealed two distinct neoplasms (Figure 3). The first neoplasm identified demonstrated cells arranged in nests and solid sheets with delicate vasculature. Cytologically, these neoplastic cells demonstrated clear cytoplasm with round nuclei and inconspicuous nucleoli, morphologically consistent with a clear cell renal cell carcinoma (ccRCC).

The second neoplasm was identified within the substance of the ccRCC and consisted of a fairly well-circumscribed 0.5 mm solid nest of cells, with a vaguely nodular architecture. Cytologically, this second population of neoplastic cells showed basophilic cytoplasm, with hyperchromatic nuclei exhibiting moderate nuclear pleomorphism. Some areas exhibiting intracytoplasmic mucin were also identified. No host reaction was apparent.

A panel of immunohistochemical stains was performed in order to confirm the identity of the two distinct neoplasms. The stains performed included: cytokeratin 7 (CK7), GATA3, estrogen receptor (ER), e-cadherin (ECAD), PAX-8, CD10, and renal cell carcinoma antigen (RCC) (see Figure 4). The morphologic impression and immunophenotype of the 1st neoplasm were consistent with ccRCC. The morphologic impression and immunophenotype of the 2nd neoplasm were consistent with metastatic lobular carcinoma of the breast.

The patient remains on fulvestrant and palbociclib with stable disease on the most recent scan. As renal lesions often grow slowly and have good prognosis, her scans will be closely monitored for a potential nephrectomy.

3. Discussion

Metastasis from one neoplasm (the donor) to another neoplasm (the recipient) was first reported over a century ago by Berent in 1902. This sentinel case involved squamous cell carcinoma of the jaw and renal cancer, as the donor and recipient, respectively. During the decades that followed, various authors reported this phenomenon, with the donor neoplasm arising from a variety of sites, including breast [13], lung [46], and less common sites such as skin [7] and prostate [8]. Frequently reported recipient tumors include renal cell carcinoma, meningioma, and sarcoma [9, 10], with renal neoplasms being the most common tumor metastasis recipient. To date, a variety of renal neoplasms have been reported to be involved in TTM as the recipient neoplasm, including renal oncocytoma [11, 12] as well as chromophobe RCC [13, 14], but ccRCC has been the most frequently reported recipient renal neoplasm. We report a case of metastatic invasive lobular carcinoma involving ccRCC. A few cases have been previously reported of metastatic breast cancer involving ccRCC, but most of these cases involved metastatic infiltrating ductal carcinoma [15, 16].

Although the exact mechanism by which tumor-to-tumor metastasis occurs is yet to be detailed, authors have relied on various theories to help explain this phenomenon, including the metabolic theory [17, 18] and the mechanical/anatomic theory [19]. The metabolic theory, also referred to as “the seed and soil theory”, was proposed by Stephen Paget in 1889 after carefully analyzing postmortem data of 735 patients with metastatic breast cancer. He concluded that metastatic tumor cells (the seed) would preferentially grow in microenvironments (the soil) with abundant micronutrients. In the years that followed, this hypothesis was challenged by some, including James Ewing, who proposed that tumor metastasis was mainly determined by hemodynamic factors of the vascular and lymphatic system, as these factors were most important for successful delivery of metastatic tumor cells [19].

Considering these two theories, it is understandable why renal cell carcinoma, and in particular-ccRCC, is such a frequent recipient tumor. The kidneys receive approximately 20% of the cardiac output (approximately 1.0 liter/minute) [20]. In ccRCC, von Hippel Lindau tumor suppressor gene is inactivated, which increases hypoxia-inducible factor, which in turn increases vascular endothelial growth factor. As a result, ccRCC is highly vascularized [21]. From a mechanistic perspective, this situation is hemodynamically favorable. From a metabolic perspective, ccRCC has increased glycogen and lipid content [22], which may account for it being a favorable microenvironment. With this in mind, it is easy to understand why, even decades ago, renal cell carcinoma was proclaimed to be the best recipient of tumor-to-tumor metastasis [10].

The patient is sufficiently anonymized according to ICMJE guidelines.

Conflicts of Interest

The authors declare that there is no conflict of interest regarding the publication of this article.


All authors participated in the conception, design, writing, and approval of the manuscript. This study was performed as part of the employment of the University of Pittsburgh.


  1. M. Savoiardo and S. Lodrini, “Hypodense area within a meningioma: metastasis from breast cancer,” Neuroradiology, vol. 20, no. 2, pp. 107–110, 1980. View at: Publisher Site | Google Scholar
  2. L. I. Zon, W. D. Johns, P. C. Stomper et al., “Breast carcinoma metastatic to a meningioma. Case report and review of the literature,” Archives of Internal Medicine, vol. 149, no. 4, pp. 959–962, 1989. View at: Publisher Site | Google Scholar
  3. A. Fornelli, A. Bacci, G. Collina, and V. Eusebi, “Breast carcinoma metastatic to meningioma: review of the literature and description of 2 new cases,” Pathologica, vol. 87, no. 5, pp. 506–512, 1995. View at: Google Scholar
  4. B. M. Fried, “Metastatic Inoculation of a Meningioma by Cancer Cells from a Bronchiogenic Carcinoma,” The American Journal of Pathology, vol. 6, no. 1, pp. 47–52.1, 1930. View at: Google Scholar
  5. R. Pamphlett, “Carcinoma metastasis to meningioma,” Journal of Neurology, Neurosurgery, and Psychiatry, vol. 47, no. 5, pp. 561–563, 1984. View at: Publisher Site | Google Scholar
  6. P. Bhargava, K. M. McGrail, H. J. Manz, and S. Baidas, “Lung carcinoma presenting as metastasis to intracranial meningioma: case report and review of the literature,” American Journal of Clinical Oncology, vol. 22, no. 2, pp. 199–202, 1999. View at: Publisher Site | Google Scholar
  7. H. Takei and S. Z. Powell, “Tumor-to-tumor metastasis to the central nervous system,” Neuropathology, vol. 29, no. 3, pp. 303–308, 2009. View at: Publisher Site | Google Scholar
  8. L. Döring, “Metastasis of carcinoma of prostate to meningioma,” Virchows Archiv. A, Pathological Anatomy and Histology, vol. 366, no. 1, pp. 87–91, 1975. View at: Publisher Site | Google Scholar
  9. C. Petraki, M. Vaslamatzis, T. Argyrakos et al., “Tumor to tumor Metastasis,” International Journal of Surgical Pathology, vol. 11, no. 2, pp. 127–135, 2016. View at: Publisher Site | Google Scholar
  10. A. Sella and J. Y. Ro, “Renal cell cancer: best recipient of tumor-to-tumor metastasis,” Urology, vol. 30, no. 1, pp. 35–38, 1987. View at: Publisher Site | Google Scholar
  11. D. P. Bitner, M. B. Clements, H. P. Cathro, A. Mithqal, and N. S. Schenkman, “Remote development of tumor-to-tumor metastasis of breast adenocarcinoma in a renal Oncocytoma,” Urology, vol. 107, pp. e1–e2, 2017. View at: Publisher Site | Google Scholar
  12. A. J. Horn, B. E. Fritz, C. A. LaGrange, W. W. West, and S. M. Lele, “Clinically Undiagnosed Prostate Carcinoma Metastatic to Renal Oncocytoma,” Case Reports in Urology, vol. 2012, Article ID 307813, 3 pages, 2012. View at: Publisher Site | Google Scholar
  13. T. Shin, T. Kan, F. Sato, and H. Mimata, “Tumor-to-tumor metastasis to chromophobe renal cell carcinoma: a first report,” Case Reports in Urology, vol. 2011, Article ID 520839, 3 pages, 2011. View at: Publisher Site | Google Scholar
  14. A. Cavalcante, M. D. Cordeiro, P. S. Sierra et al., “A rare case of t-to-tumor metastasis: prostate cancer to chromophobe renal cell carcinoma,” Urol Case Rep, vol. 23, pp. 17-18, 2019. View at: Publisher Site | Google Scholar
  15. J. F. Val-Bernal, F. Villoria, and M. A. Pérez-Expósito, “Concurrent angiomyolipomas and renal cell carcinoma harboring metastatic foci of mammary carcinoma in the same kidney: an incidental autopsy finding in a patient with a follow-up of thirty years,” Annals of Diagnostic Pathology, vol. 5, no. 5, pp. 293–299, 2001. View at: Publisher Site | Google Scholar
  16. C. Perrin, M. Talarmin, A. Fontaine et al., “Breast carcinoma metastasis into a renal cell carcinoma,” Annales de Pathologie, vol. 31, no. 5, pp. 399–401, 2011. View at: Publisher Site | Google Scholar
  17. S. Paget, “The distribution of secondary growths in cancer of the breast. 1889,” Cancer and Metastasis Reviews, vol. 8, no. 2, pp. 98–101, 1989. View at: Google Scholar
  18. I. J. Fidler and G. Poste, “The “seed and soil” hypothesis revisited,” The Lancet Oncology, vol. 9, no. 8, p. 808, 2008. View at: Publisher Site | Google Scholar
  19. J. Ewing, Neoplastic diseases; a treatise on tumors, W. B. Saunders company, Philadelphia and London, 2d edition, 1922.
  20. D. P. Kaufman, H. Basit, and S. J. Knohl, “Physiology, Glomerular Filtration Rate (GFR),” StatPearls, StatPearls Publishing, 2020. View at: Google Scholar
  21. X. I. Na, G. Wu, C. K. Ryan, S. R. Schoen, P. A. Di’ Santagnese, and E. M. Messing, “Overproduction of vascular endothelial growth factor related to von Hippel-Lindau tumor suppressor gene mutations and hypoxia-inducible factor-1α expression in renal cell carcinomas,” The Journal of Urology, vol. 170, no. 2, pp. 588–592, 2003. View at: Publisher Site | Google Scholar
  22. J. H. Pinthus, K. F. Whelan, D. Gallino, J. P. Lu, and N. Rothschild, “Metabolic features of clear-cell renal cell carcinoma: mechanisms and clinical implications,” Canadian Urological Association Journal, vol. 5, no. 4, pp. 274–282, 2011. View at: Publisher Site | Google Scholar

Copyright © 2020 Dayne Ashman et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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