－S 887 －
― S-281 ―
Detection of HHV-8 virogenes in a patient with past history of Castleman’s disease and plasmacytoma
Department of Internal Medicine National Health Insurance Corporation Ilsan Hospital1, Department of Internal Medicine2 and Department of Pathology3 Yonsei University College of Medicine, Current Affiliation is Mt. Vernon Hospital, Mt. Vernon, NY, USA4
*Min Seob Cha1, Yu Ri Choi1, Ha-Na Kim1, Sunhye Kim1, Hyewon Lee1,2, Yong Tai Kim1, Woo-Ick Yang3, Seung-Tae Lee2,4, Hoyoung Maeng1
Latent infection of human herpes virus 8 (HHV-8) has been identified as a key organism for several malignancies, such as multicentric Castleman's disease, Kaposi’s sarcoma and primary effusion lymphoma (PEL). Affected person with this virus carries virion in lymphocyte.
Association of this virus with several malignancies has been reviewed by different researchers but the exact mechanism of carcinogenesis has not been proved yet. We experienced a 57-year-old HIV-negative male patient with fever, pancytopenia and uncontrolled ascites. He was a HBV carrier with positive HBeAg with impaired liver function (Child Pugh B) and had a previous history of pulmonary tuberculosis resulted in destroyed lung. He had medical history of multicentric Castleman's disease cured with 6 cycles of combination chemotherapy 19 years ago and a single plasmacytoma treated with radiation 3 years before the visit to our institution. CT revealed multiple retroperitoneal lymph node enlargement and marked hepatosplenomegaly. Pathology of spleen was consistent with peripheral T-cell lymphoma and cytospin of ascites showed numerous malignant lymphocytes. To investigate the correlation between three different diseases sequentially developed, we tried to detect HHV-8 in each tumor tissue. We could detect the latent nuclear protein (LNA-1) in Castleman's disease and plasmacytoma tissues by immunohistochemistry while not in PTCL tissue. We also detected viral genes (ORF-25 and ORF-26) in the prior two tissues by polymerase chain reaction. He died of respiratory failure with pneumonia after induction chemotherapy with partial response. In Asia where HHV-8 sero-positivity with HIV sero-negativity is much higher than in Western countries, role of HHV-8 latent infection in carcinogenesis might be understood more clearly than in Westerners. Further investigations to elucidate the role of HHV-8 protein in plasma cell dyscrasia will be followed.
― S-282 ―
Metastatic renal cell carcinoma in a supraclavicular lymph node without an identifiable primary tumor
1Department of Internal Medicine, 2Department of Pathology, Chungbuk National University College of Medicine, Cheong-ji, Korea
*Young rak Choi, M.D.1, Hye-Suk Han, M.D.1, Ok-Jun Lee, M.D.2, Ki Hyeong Lee, M.D.1, Seung Taik Kim, M.D.1
Although metastasis is relatively frequent in renal cell carcinoma (RCC), metastasis in cervical or supraclavicular lymph node (LN) is relatively rare. Moreover, a case of non identifiable kidney mass is extremely rare in metastatic RCC. We report on a case of metastatic RCC in a supraclavicular LN without primary kidney lesion. A 69-year-old man presented with a 2-week history of progressively enlarging supraclavicular mass. Computed tomography (CT) scan of the neck showed an 8.0 cm sized right supraclavicular LN enlargement. Incisional biopsy of the supraclavicular LN was performed; histologic examination revealed a metastatic RCC by morphology on H&E stain (Fig. A) and by immunohistochemical staining which was positive for pancytokeratin, vimentin, CD 10 (Fig. B), cytokeratin 7, but negative for TTF-1 and cytokeratin 20. However, no tumor could be found in either kidney even though various examinations, including abdomen/pelvis CT, and positron emission tomography (PET)-CT were performed. The patient was initially treated with radiotherapy for relief of symptoms, and then followed by sunitinib. After 2 cycles of sunitinib, a follow-up CT scan performed 3 months later revealed that the supraclavicular LN had markedly decreased. This case report suggests that even though there is no primary kidney lesion, clinicians must consider the possibility of metastatic RCC when evaluating patients with clear cell carcinoma of an unknown primary sites.
