title: Intraglomerular metastasis from pancreatic cancer.
abstract: Few case reports have shown the presence of metastatic tumor cells in renal glomeruli. We report one case with intraglomerular metastasis proved at renal biopsy. A 60-year-old man suffered from weight loss and fever of unknown origin. Urinalysis revealed proteinuria with cellular and granular casts. Because vasculitis was suspected, renal biopsy was performed. Presence of tumor cells occupying the glomerular capillary lumina was shown by means of light microscopy and electron microscopy. Laboratory findings revealed elevated leukocyte count (28.9 x 10(3)/mm(3)), serum granulocyte colony-stimulating factor (G-CSF) (77 pg/mL), and serum CA 19-9 (21,885 U/mL). The patient soon developed disseminated intravascular coagulation and died. Autopsy findings revealed pancreatic cancer showing positive staining for G-CSF and CA 19-9. Tumor cells in the glomerular capillary lumina showed positive staining for CA 19-9 and proliferating cell nuclear antigen (PCNA). These results suggest that the pancreatic tumor cells producing G-CSF were entrapped in the glomerular capillary lumina where they proliferated. This may have been the first step in renal metastasis.
authors.affiliation: Departments of Nephrology, Respiratory Medicine, and Pathology, Saiseikai Nakatsu Hospital, Osaka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yokoi
authors.forename: M
authors.initials: M
authors.lastname: Nakata
authors.forename: K
authors.initials: K
authors.lastname: Sawai
authors.forename: T
authors.initials: T
authors.lastname: Yoshida
authors.forename: M
authors.initials: M
authors.lastname: Koshikawa
authors.forename: S
authors.initials: S
authors.lastname: Joyama
authors.forename: A
authors.initials: A
authors.lastname: Tanaka
authors.forename: M
authors.initials: M
authors.lastname: Goto
authors.forename: S
authors.initials: S
authors.lastname: Ueda
authors.forename: H
authors.initials: H
authors.lastname: Senzaki
authors.forename: A
authors.initials: A
authors.lastname: Sugawara
authors.forename: T
authors.initials: T
authors.lastname: Kuwahara
mesh_terms: D018395:CA-19-9 Antigen / Q000032:analysis; D017809:Fatal Outcome; D016179:Granulocyte Colony-Stimulating Factor / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D007678:Kidney Glomerulus / Q000737:chemistry / Q000473:pathology* / Q000648:ultrastructure; D007680:Kidney Neoplasms / Q000378:metabolism / Q000556:secondary*; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000378:metabolism / Q000473:pathology*; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis
chemical_list: D018395:CA-19-9 Antigen; D018809:Proliferating Cell Nuclear Antigen; D016179:Granulocyte Colony-Stimulating Factor