Abstract
This report delineates the clinical progression of a renal oncocytoma in a 38-year-old female, initially asymptomatic, over a three-year follow-up period following her treatment for papillary thyroid cancer. The timeline of this case is as follows: In 2016, the patient was treated with total thyroidectomy and I131 for thyroid cancer. During an annual follow-up, an incidental renal mass was detected via FDG PET/CT, initially characterized as a benign, non-FDG-avid renal oncocytoma. Over two years, this lesion demonstrated a remarkable increase in FDG uptake and a slight growth in size, coupled with new I131 uptake in subsequent scans. These findings led to a reassessment of the diagnosis, initially suggesting a potential small renal cell carcinoma (RCC). Histopathological analysis eventually confirmed the diagnosis of oncocytoma. This case is notable for the tumor’s unusual metabolic evolution and the challenges it posed in differential diagnosis.
Case presentation
A 38-year-old woman with a history of papillary thyroid cancer (treated by total thyroidectomy and I131 in 2016, stimulated TG was 1.8). During annual follow-up, the patient had an elevated thyroglobulin (TG) with a negative I131 whole-body scan, for which she underwent further evaluation by FDG PET/CT, where she has shoulder and mediastinal metastasis.
The FDG PET/CT showed an incidental finding of benign non FDG avid renal mass consistent with renal oncocytoma based on morphological appearance (Figure 1). The renal mass demonstrates no iodin uptake in post therapy images. Over a follow-up period of two-years, this lesion showed interval increase in FDG uptake to a marked level (above reference liver) with yet minimal increase in size (Figure 2), as well as interval development of I131 uptake in consecutives post therapy images. The maximum standardized uptake value (SUV max) of the mass normalized for body weight was 11.5 and it measured 2.8 x 2.1cm. Enhanced abdomen MRI was performed, and it revealed a solid enhancing left lower pole lesion with diffusion restriction; this appearance was suspicious for a small renal cell carcinoma RCC (Figure 3). A 3-months follow-up FDG PET/CT (Figure 4) showed further increase in metabolic activity and size [SUV max 16.9, size 3.1 x 3.2 cm]. The interval increase in metabolic and morphologic features were not in support of renal oncocytoma as portrayed in the literature. This has hence raised the suspicion of well-differentiated RCC. Although metastatic renal disease is a possibility, the slow progress made it seem less likely. This warranted further histopathology evaluation which yielded a pathologic diagnosis of oncocytoma rather than well-differentiated renal cell carcinoma or metastatic renal disease.
Figure 1
Figure 2
Figure 3
Figure 4
Discussion
Renal oncocytoma is usually asymptomatic and is observed incidentally during routine examination for non-urological abnormalities (1). It usually appears as a solitary tumor measuring between 4–8 cm, which may infiltrate peripheral renal tissues (2, 3). CT can reveal the presence of a solid homogeneous lesion with a centrally located scar, and arteriography may reveal a spoke-wheel vascular pattern (1, 4). However, these markers do not definitively distinguish oncocytoma from other renal tumors. As a result, numerous patients with oncocytoma are treated aggressively, due to the possibility of renal malignancy.
In the present case, the tumor was observed during routine examinations. Over a three-year of follow-up, there was interval increase in metabolic activity, although no evidence of local invasion or distant metastasis was demonstrated.
To our knowledge, there has been no published cases demonstrating a metabolic evolution of renal oncocytoma over three-year period, or renal oncocytoma of high I-131 accumulation on post-therapy scan.
Multiple studies have shown a relatively low sensitivity (31–77%) and high specificity (100%) for detection of renal masses with 18F-FDG PET (5–8).
Given the significant differences in management approaches of oncocytomas compared to RCC and other renal tumors, it is important to recognize that oncocytomas can yield false positive results on 18F-FDG PET, and absolute radiologic differentiation of oncocytoma from RCC remains challenging.
Conclusion
This case study presents a rare evolution of renal oncocytoma in a patient with a history of papillary thyroid cancer. The tumor developed GLUT I transporter for FDG and sodium-iodide symporter expression, with accumulating I-131 over three years, highlighting the complexity and diagnostic challenges in such cases.
Statements
Data availability statement
The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.
Ethics statement
Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.
Author contributions
AA: Writing – original draft. NE: Writing – review & editing. JB: Supervision, Writing – review & editing.
Funding
The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Summary
Keywords
renal cell oncocytoma, FDG PET/CT, I123 scan, thyroid cancer, renal cancer
Citation
Alduraibi AK, Essa NB and Bomanji J (2024) Renal cell oncocytoma tumor evolutions: a case report. Front. Oncol. 14:1282508. doi: 10.3389/fonc.2024.1282508
Received
24 August 2023
Accepted
13 February 2024
Published
01 March 2024
Volume
14 - 2024
Edited by
Cecilia Ana Suarez, National Scientific and Technical Research Council (CONICET), Argentina
Reviewed by
Yu Xie, Hunan Cancer Hospital, China
Rana A. Youness, German International University, Egypt
Updates
Copyright
© 2024 Alduraibi, Essa and Bomanji.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Alaa Khalid Alduraibi, dr.alduraibi@gmail.com
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.