title: Patients with colorectal and renal cell carcinoma diagnoses appear to be at risk for additional malignancies.
abstract: Patients with colorectal cancer (CRC) and renal cell carcinoma (RCC) may be at risk for additional primary malignancies. A review of 101 patients with these concurrent diagnoses was performed. Forty-two percent of patients had 1 or more additional malignancies; none appeared to be associated with Lynch syndrome (LS). This suggests the need for careful follow-up in these patients and further study.
  
  
  BACKGROUND
  Small studies have demonstrated that patients who have both colorectal and renal cell carcinoma may be at increased risk for the development of additional malignancies. A possible genetic basis has been suggested. Our study describes the clinicopathologic features of these patients and clarifies the relationship of this cohort with Lynch syndrome (LS).
  
  
  METHODS
  Patients with primary CRC and RCC treated at our institution were identified. Medical records were reviewed for demographic and clinical information. Immunohistochemical staining for mismatch repair (MMR) proteins was performed on tumor tissue when possible.
  
  
  RESULTS
  During the study period, 24,642 patients were treated for CRC and 7,366 were treated for RCC at our institution. One hundred seventy-nine patients had both diagnoses, with 101 patients eligible for inclusion in our cohort. Tumors were typically early stage. The 2 cancers presented as synchronous lesions in 42% of patients. Thirty-two patients had 1 additional primary malignancy, 7 patients had 2 additional primary malignancies, and 3 patients had 3 additional primary malignancies. No patient had a family history that met the Amsterdam II criteria (AC) for LS, but 50% had family members with 1 malignancy. One of 10 colorectal tumors analyzed for the absence of MMR protein expression demonstrated the absence of MSH6, but the corresponding RCC demonstrated intact expression of all 4 MMR proteins.
  
  
  CONCLUSIONS
  It is rare for patients to be diagnosed with both CRC and RCC. The clinicopathologic features of this cohort and the results of immunohistochemical analysis performed on a sample of these patients do not suggest LS. However, the high rate of additional carcinomas suggests a need for careful follow-up. Multicenter longitudinal studies are warranted to further understand the natural history and possible genetic basis for this entity.
authors.affiliation: Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Steinhagen
authors.forename: Harvey G
authors.initials: HG
authors.lastname: Moore
authors.forename: Steven A
authors.initials: SA
authors.lastname: Lee-Kong
authors.forename: Jinru
authors.initials: J
authors.lastname: Shia
authors.forename: Anne
authors.initials: A
authors.lastname: Eaton
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Markowitz
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
authors.forename: José G
authors.initials: JG
authors.lastname: Guillem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D001932:Brain Neoplasms; D002292:Carcinoma, Renal Cell / Q000150:complications* / Q000175:diagnosis; D015179:Colorectal Neoplasms / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D007680:Kidney Neoplasms / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology*; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000209:etiology*; D009386:Neoplastic Syndromes, Hereditary; D011379:Prognosis; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor