Journal of Biosensors, Biomarkers and Diagnostics

Renal metastasis from primary colon cancer is very rare. By 2011, 11 cases were reported in the medical literature of colonic adenocacinoma metastatic to the kidney. In a 51-year-old female in USA, the report was of “extraluminal colonic adenocarcinoma which directly invaded into the kidney.” Therefore, the author presents 2 cases of colon cancer spreading to the kidney from the Igbo ethnic group in Nigeria. A clarification of the difference between direct extension and metastasis is deemed to be essential.

Keywords: Colon; Cancer; Metastasis; Kidney; Igbos; Nigeria;

Renal metastasis from primary colon cancer is so rare that, from USA, Nelson’s associates reported “a unique case of a 51-year-old female with extra luminal colonic adenocarcinoma which directly invaded into the kidney.” Therefore, the author describes two such cases among 50-year-old females who belong to the Igbo ethnic group [1,2]. This was facilitated by the advice of a Birmingham (UK) group [3]. As they had put it, the establishment of a histopathology data pool is fruitful epidemiologically. Concerning the present cases, being the pioneer pathologist at the Regional Pathology Laboratory established at Enugu by the Government, I was in the position to observe such obscure relationships in cancer metastasis [4].

I encouraged physicians working among the Igbo ethnic group in South Eastern Nigeria to send to me surgical specimens provided they were preserved in formol-saline and were accompanied by well filled Request Forms. Having kept personal copies of all the Reports, it was relatively easy to amass materials since 1970. Hence, the 2 cases, which were found to exhibit both colonic and renal growths, are deemed to be worthy of documentation.

1. NC, a 50-year-old female consulted Dr. Attah at the University of Nigeria Teaching Hospital, Enugu, for a painful left flank of a year’s duration. There was weight loss. An ovoid, firm 10 x 14 renal mass was noted. X-Ray showed non functional kidney. Ultra sound revealed cancer invasion of the sigmoid colon and part of the descending colon. Nephrectomy and colectomy were carried out.

The specimen consisted of a 10 x 5 cm kidney and 40 cm colon, both being fused centrally by a 10 x 8 x 7 cm hemorrhagic firm mass. On section, the mass was polypoid and also cystic and contained soft discolored materials. Part of the kidney and bowel were infiltrated by tumor tissue. On microscopy, well differentiated carcinoma without clear cell changes could be made out, indicating that the renal growth was a secondary.

2. IJ, a 50-year-old female, consulted Dr. Nkire at the Eastern Nigeria Medical Center, Enugu, on account of a mass in the right flank since 2 years. Nausea, abdominal pain and weight loss were noteworthy. At laparotomy, a 5 x 4 cm firm tumor of the ascending colon was extending from the ileocecal junction up to 2 cm along the ascending colon. It partly narrowed the lumen. The kidney measured 10 x 6 x 1.2 cm. On section, a suspicious area 2 cm across was noted at its proximal end. On microscopy, the colonic growth was a well differentiated, tall columnar, mucin producing carcinoma. It invaded the coats and reached beyond the serosa. The kidney was involved, the growth compressing its parenchyma. Colonic adenocarcinoma was diagnosed with renal metastasis.

Turkish authors documented a patient with left colon cancer and isolated metastasis to the right kidney [5]. They called it a “very rare event” and attributed it to blood-borne metastasis. Other examples were found on searching the literature [6,7].

Elsewhere [8], I reviewed the wide problem of “hematoginous metastasis” from the historical angle actually; I also dealt with the fundamental differences between direct spread and metastatic spread [9]. In this context, there is the relative fewness of the metastasis to the kidney and spleen [10,11].

I am persuaded that there is need to recognize that what is seemingly direct spread is actually metastatic spread. A good example is the problem of lymph node cum pancreas relationship which I explained with lung cancer spreading to the pancreas and its abutting lymph nodes [12]. This was possible because of employing the mono-block formalin-fixation method for investigating cancer metastasis [13].

In conclusion, Lithuanian authors found that the distant metastases from colorectal cancer most frequently spread to the liver and lungs, metastasis to be kidney being extremely rare [14]. Therefore, this case adds to the world literature of this curious combination. Incidentally, the two cases illustrated here are typical as regards (a) seemingly mere contiguity and (b) strictly sound metastasis.

1. Nelson J, Rinard K, Haynes A, Filleur S, Nelius T. Extraluminal colonic invading into kidney: A case report and review of the literature. Intl Scho Res Notices. 2011:707154. doi: 10.5402/2011/707154
2. Basden GT. Niger Ibos. 1st ed. London: Frank Cass & Co; 1966.
3. Macartney JC, Rollaston TP, Codling BW. Use of a histopathology data pool for epidemiological analysis. J Clin Pathol. 1980;33(4):351-355.
4. Onuigbo WIB. Does bodily temperature explain the differential incidence of gonadal Burkitt tumor? Arch Case Rep Clin Med. 2016;3(1):134.
5. Aksu G, Fayda M, Sakar B, Kapran Y. Colon cancer with isolated metastasis to the kidney at the time of initial diagnosis. Intl J Gastroint Cancer. 2003; 34(2-3):73-77.
6. Klaassen Z, Prabhakar R, Madi R, Terris M. Bilateral metachronous colon cancer metastasis to kidneys: A rare case with a treatment dilemma. Urol Today Intl J. 2013;6(1):11. doi: 10.3834/uij.1944-5784.2013.02.11
7. Melichar B, Moravek P, Ferko A, Podhola M. Metastatic colorectal carcinoma and kidney tumors: A report of four cases. Tumori. 2010;96(3):483-486.
8. Onuigbo WIB. A history of hematogenous metastasis. Cancer Res. 1970;30(12):2821-2826.
9. Onuigbo WIB. Fundamental differences between direct and metastatic spread clarified with lung cancer. Br J Di Chest. 1973;67:131-140.
10. Onuigbo WIB. The relative fewness of renal metastases in lung cancer is probably explicable with the “Erythrocyte Associated Necrosis Factor” which may be an Oncobiomarker. J Oncobiomarkers. 2017;3(1):3.
11. Onuigbo WIB. Does the “Erythrocyte Associated Necrosis Factor” explain the scarcity of metastases in the spleen? Trans Med. 2016;6(3):177. doi:10.4172/2161-1025.1000177
12. Onuigbo WIB. Lung cancer metastasis to the pancreas and its surrounding nodes. Br J Dis Chest. 1966;60:152-155.
13. Onuigbo WIB. A mono-block formalin-fixation method for investigating cancer metastasis. Z Krebs. 1963;65(3):209-210.
14. Dulskas A, Bagurskas P, Sinkevicius Z, Samalavicius N. Sigmoid adenocarcinoma with metastases to the kidney: Report of a rare case and review of the literature. Oncol Lett. 2015;10(2):1191-1193. doi:  10.3892/ol.2015.3290