title: Multiple chromophobe and clear cell renal cancer in a patient affected by Birt-Hogg-Dubè syndrome: a case report.
abstract: OBJECTIVE
  Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal dominant characterized by the presence of fibrofolliculomas and/or trichodiscomas, pulmonary cysts, spontaneous pneumothorax, and renal tumors. The syndrome is linked to mutations in the FLCN gene, which is preferentially expressed in the skin, kidney, and lung. The aim of our paper is to describe a case of multiple bilateral renal cancer in a patient affected by BHDS.
  
  
  METHODS
  Patient subjected to enucleoresection seven kidney tumors discovered right after ultrasound performed for other reasons. Definitive histologic examination were as follows: multifocal type chromophobe renal cell carcinoma and clear cell. After 1 month, the patient was readmitted for spontaneous pneumothorax. After about a year, the patient was again subjected to resection of multiple renal tumors left. Histological examination proved that it was multifocal renal cell carcinoma, clear cell varieties. The genome analysis highlighted positive for mutation c. 1379_1380 of FLCN gene, BHDS gene. Currently, the patient is under close follow-up. After 1 year, the chest computed tomography (CT) confirmed the presence of minute air bubbles scattered on both sides. Instead, the abdominal CT was positive for a small round lesion 6 mm exophytic.
  
  
  CONCLUSIONS
  The BHDS is a rare syndrome whose management is extremely complex both in terms of oncological and functional. Kidney tumors associated with BHDS usually have a favorable clinical course. Present evidence suggests a close follow-up of the carriers of the genetic mutation patients whether or not they have expressed the lesions of disease given the high rate of recurrence of renal lesions.
authors.affiliation: Department of Urology, Humanitas Gavazzeni Hospital, Bergamo - Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Castellucci
authors.affiliation: Department of Urology, SS. Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti - Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Marchioni
authors.affiliation: Department of Urology, Humanitas Gavazzeni Hospital, Bergamo - Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Valenti
authors.affiliation: Department of Urology, Humanitas Gavazzeni Hospital, Bergamo - Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sortino
authors.affiliation: Department of Urology, Humanitas Gavazzeni Hospital, Bergamo - Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Borgonovo
authors.affiliation: Department of Urology, Humanitas Gavazzeni Hospital, Bergamo - Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Pesenti
authors.affiliation: Department of Urology, Humanitas Gavazzeni Hospital, Bergamo - Italy.
authors.forename: Alberto C A
authors.initials: ACA
authors.lastname: Vismara
authors.affiliation: Azienda Ospedaliera per l'Emergenza "Cannizzaro", Catania - Italy.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Circo
authors.affiliation: Department of Radiology, "Papa Giovanni XXIII" Hospital, Bergamo - Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sessa
authors.affiliation: Department of Urology, Humanitas Gavazzeni Hospital, Bergamo - Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Micheli
authors.affiliation: Department of Urology, Humanitas Gavazzeni Hospital, Bergamo - Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Lembo
mesh_terms: D000328:Adult; D058249:Birt-Hogg-Dube Syndrome / Q000150:complications*; D002292:Carcinoma, Renal Cell / Q000209:etiology*; D006801:Humans; D007680:Kidney Neoplasms / Q000209:etiology*; D008297:Male