Renal carcinoma

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Physical appearance of a renal carcinoma in a dog[1]
Renal carcinoma showing high cell density with diffuse necrosis (asterisk) and hemorrhage[2]

Renal carcinoma are a relatively uncommon metastatic neoplasia of the kidney in older dogs (> 8 years) and the most common form of renal neoplasia.

Renal adenocarcinoma are a less common variant involving glandular epithelial neoplastic cells.

Male dogs appear more predisposed to renal carcinoma than females (2:1) but no breed predilection has been noted. Middle-aged and older dogs are more likely to be affected, but renal carcinoma has been reported in dogs as young as 1 year of age[3].

The prevalence of primary renal neoplasia in dogs is estimated to be 0.3 – 1.5 % of all the canine neoplasms[4].

Although the specific cause of these tumors is unknown, the pathogenesis appears to involve mitogenic gene mutations that leads to protein kinase and matrix metalloproteinase activation[5]. This results in propagation of neoplastic cells throughout the renal parenchyma via release of macrophage-expressed COX-2[6], TNF-α and hypoxia inducible factor 1α[7]. Local invasion and distal metastasis of canine renal carcinoma are important predictors of clinical outcomes and increased expression of several matrix metalloproteinases are associated with a poor prognosis[8].

Renal carcinoma are usually classified by pathologists based on their histological (papillary, tubular, and solid type) and cytological (chromophobic, eosinophilic, and clear cell type) appearances, but the relevance of this clinically is open to debate[9].

These tumors are believed to originate from the epithelium of proximal convoluted tubules[10].

Affected dogs frequently present with a vague history of hematuria, anorexia and weight loss over a 1 - 3 month period. A palpable abdominal mass may sometimes be evident[11] and secondary hypertrophic osteoarthropathy, dermatofibrosis[12] and skin tumors have been reported.

Blood tests may reveal paraneoplastic increases in ALT, ALP[13], as well as leukocytosis, neutrophilia, eosinophilia, erythrocytosis, thrombocytopenia[14], hypercalcemia[15] and non-regenerative anemia but these signs are not always concurrent with clinical symptoms[16].

Even in bilateral cases, signs of renal failure may not be present, as adequate kidney function requires only 25% of the parenchyma to be normal[17].

Diagnosis is usually presumptive based on radiographic, CT and ultrasonographic imaging[18] and intravenous urography[19].

Since metastases to the caudal vena cava, lung, thoracic vertebrae[20], ribs and adrenal gland are common[21], abdominal radiographs aid in identifying the organ(s) primarily involved, the size and location of the neoplasm, and metastatic foci, which will influence treatment protocols. Generalized lymphedema and purpura have been reported in dogs where renal carcinoma have metastasied into the vena cava and caused secondary thromboembolism[22].

A definitive diagnosis requires post-operative histological examination of sample tissues[23]. Classification is based on cytological appearance and immunohistochemical staining with vimentin[24]cytokeratin and c-KIT[25].

In most cases, percutaneous biopsy of the mass is not recommended, due to the potential for iatrogenic metastasis along the needle tract[26]. Percutaneous biopsy is indicated, however, when bilateral involvement is detected.

A differential diagnosis would include renal lymphoma, nephroblastoma, renal pelvic squamous cell carcinoma[27], histiocytic sarcoma, oncocytoma, myxoma, adenocarcinoma, cysts and renal transitional cell carcinoma[28].

Treatment requires nephroureterectomy with removal of regional lymph nodes, affording a reasonable prognosis. Some studies report survival times up to 4 years after surgical excision of a unilateral malignant renal neoplasm[29].

In cases of highly aggressive or invasive bilateral renal carcinoma, cytotoxic chemotherapy should be considered as adjunctive therapy to surgery, but the prognosis is considered poor.

Renal carcinoma are generally considered resistant to multidrug chemotherapy, hormonal therapy and radiation therapy and response rates to chemotherapy are < 10% due to chemoresistance

References

  1. Vet surgery central
  2. Carvalho et al (2011) Renal Cell Carcinoma with Cutaneous Metastasis in a Dog. Braz J Vet Pathol 4(2):132-137
  3. Caywood DD et al (1980) Neoplasms of the canine and feline urinary tracts. In: Kirk RW, ed. Current Veterinary Therapy VII. Philadelphia: WB Saunders. pp:1203–1208
  4. Meuten DJ ( 2002) Tumors of the urinary system. In: Tumors in domestic animals, ed. Meuten DJ, 4th ed., pp:509–516. Iowa State Press, Ames, IA
  5. Mahimkar R et al (2011) Graded activation of the MEK1/MT1-MMP axis determines renal epithelial cell tumor phenotype. Carcinogenesis 32(12):1806-1814
  6. Khan KN (2001) Expression of cyclooxygenase-2 in canine renal cell carcinoma. Vet Pathol 38(1):116-119
  7. Yhee JY et al (2012) Angiogenesis and expression of vascular endothelial growth factor, tumour necrosis factor-α and hypoxia inducible factor-1α in canine renal cell carcinoma. J Comp Pathol 147(2-3):129-138
  8. Kamiya N et al (2003) Increased in situ gelatinolytic activity in renal cell tumor tissues correlates with tumor size, grade and vessel invasion. Int J Cancer 106:480–485
  9. Meuten DJ et al (2004) Histological classification of tumors of the urinary system of domestic animals. In: World Health Organization international classification of tumors of domestic animals, ed. Yvonne Schulman F, 2nd ed., pp:14–20. Armed Forces Institute of Pathology Press, Washington, DC
  10. Maxie MG (1993) The urinary system. In: Jubb KVF, Kennedy PC, Palmer N, eds. Pathology of Domestic Animals, 4th ed. San Diego: Academic Pr. pp:518–522
  11. Klein MK et al (1988) Canine primary renal neoplasms: A retrospective review of 54 cases. J Am Anim Hosp Assoc 24:443–452
  12. Vilafranca M et al (1994) Chromophilic-eosinophilic (oncocyte-like) renal cell carcinoma in a dog with nodular dermatofibrosis. Vet Pathol 31(6):713-716
  13. Zini E et al (2003) Sarcomatoid renal cell carcinoma with osteogenic differentiation and paraneoplastic hepatopathy in a dog, possibly related to human Stauffer's syndrome. J Comp Pathol 129(4):303-307
  14. Bryan JN et al (2006) Primary renal neoplasia of dogs. J Vet Intern Med 20(5):1155-1160
  15. Bergman PJ (2012) Paraneoplastic hypercalcemia. Top Companion Anim Med 27(4):156-158
  16. Crow SE (1985) Urinary tract neoplasms in dogs and cats. Compend Contin Educ Pract Vet 7:607–615
  17. Klausner JS & Caywood DD (1995) Neoplasms of the urinary tract. In: Osborne CA, Finco DR, eds. Canine and Feline Nephrology and Urology. Baltimore: Williams & Wilkins. pp:903–916
  18. Haers H et al (2010) Contrast harmonic ultrasonographic appearance of focal space-occupying renal lesions. Vet Radiol Ultrasound 51(5):516-522
  19. Caywood DD et al (1980) Neoplasms of the canine and feline urinary tracts. In: Kirk RW, ed. Current Veterinary Therapy VII. Philadelphia: WB Saunders. pp:1203–1208
  20. Arai C et al (1991) Canine renal carcinoma with extensive bone metastasis. J Vet Med Sci 53(3):495-497
  21. Chiang YC et al (2007) Hypertrophic osteopathy associated with disseminated metastases of renal cell carcinoma in the dog: a case report. J Vet Med Sci 69(2):209-212
  22. Saridomichelakis MN et al (2004) Extensive caudal vena cava thrombosis secondary to unilateral renal tubular cell carcinoma in a dog. J Small Anim Pract 45(2):108-112
  23. Borjesson DL (2003) Renal cytology. Vet Clin North Am Small Anim Pract 33(1):119-134
  24. Kobayashi N et al (2010) Chromophobe renal cell carcinoma with sarcomatoid transformation in a dog. J Vet Diagn Invest 22(6):983-987
  25. Gil da Costa RM et al (2011) Immunohistochemical characterization of 13 canine renal cell carcinomas. Vet Pathol 48(2):427-432
  26. Klein MK et al (1988) Canine primary renal neoplasms: a retrospective review of 54 cases. J Am Anim Hosp Assoc 24:443–452
  27. Dagli ML et al (1997) Squamous cell carcinoma of the renal pelvis with metastasis in a dog. J Comp Pathol 116(4):397-402
  28. Grillo TP et al (2007) Hypertrophic osteopathy associated with renal pelvis transitional cell carcinoma in a dog. Can Vet J 48(7):745-747
  29. Peeters D et al (2001) Resolution of paraneoplastic leukocytosis and hypertrophic osteopathy after resection of a renal transitional cell carcinoma producing granulocyte-macrophage colony-stimulating factor in a young Bull Terrier. J Vet Intern Med 15:407–411