Letter to the Editor
Bloody Expectoration as First Manifestation of Bilateral Kidney Cancer
Expectoración hemoptoica como primera manifestación de un cáncer renal bilateral
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Luz Mateo Lázaro, M. del Mar Villanueva Gimeno, Eva Vilar Bonacasa" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M. Luz" "apellidos" => "Mateo Lázaro" "email" => array:1 [ 0 => "mlmateol@salud.aragon.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M. del Mar" "apellidos" => "Villanueva Gimeno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Eva" "apellidos" => "Vilar Bonacasa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Sección de Neumología, Hospital Obispo Polanco, Teruel, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Obispo Polanco, Teruel, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Expectoración hemoptoica como primera manifestación de un cáncer renal bilateral" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1087 "Ancho" => 995 "Tamanyo" => 71343 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fiberoptic bronchoscopy, showing the lesion in the right main bronchus.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Endobronchial metastasis (EBM) is rare and has been associated with breast, colon, kidney and pancreatic cancers. It can be asymptomatic or manifest as cough, hemoptysis or dyspnea, and is generally diagnosed during the course of the initial disease. We report the case of a patient with 3 bilateral renal tumors that first manifested as bloody expectoration.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 76-year-old man with no toxic habits, coal-miner. Clinical history included left pleuritis as a young man, arterial hypertension, and diabetes. No significant family history was reported. He was referred to the respiratory medicine department due to 4–5 daily episodes of expectoration of red blood for some days, after cough. The patient was negative for fever, chest pain, dyspnea, extrathoracic symptoms, loss of weight and hematuria. Physical examination: good general condition, with mildly reduced breath sounds in the left hemithorax, no lymphadenopathies or masses. Clinical laboratory test results showed glucose 125<span class="elsevierStyleHsp" style=""></span>mg/dl and microhematuria. Lung function values were normal. Chest X-ray revealed aortic atheromatosis and left calcified pachypleuritis. Thoracoabdominal computed tomography (CT) revealed an intraluminal nodular lesion measuring 7<span class="elsevierStyleHsp" style=""></span>mm at the entrance of the right main bronchus (RMB), an expansive heterogeneous lesion of 6.6<span class="elsevierStyleHsp" style=""></span>cm in the upper pole of the right kidney, and another measuring 3.7<span class="elsevierStyleHsp" style=""></span>cm in the lower pole. Another lesion (2.6<span class="elsevierStyleHsp" style=""></span>cm) was observed in the upper pole of the left kidney. Fiberoptic bronchoscopy showed 2 vascularized polypoid lesions, one in the anterior aspect of the RMB (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and the other at the entrance of the right lower lobar bronchus. Biopsy results reported metastasis from clear cell carcinoma. Urine cytology testing was negative for malignancy. In view of the extension of the disease, no diagnostic procedures of the renal masses were initiated, and the patient was referred to the oncology department for treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Kidney cancer (KC) represents 3% of all tumors. Renal cell carcinoma is the most common subtype (85%). It often occurs between the ages of 50 and 60, mostly in men (2:1). It appears as hematuria (60%), lower back pain (40%) or masses (30%–40%). Other manifestations include polyglobulia, hypercalemia or Stauffer's syndrome. In 0.4%–6% of cases of KC, presentation is bilateral. Tumors can exist in a hereditary (in younger patients) or sporadic form. The latter account for 2% of bilateral synchronous tumors.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Between 25% and 30% of KCs present metastasis on diagnosis, and the lung is the second most common site of distant disease (36%). Endobronchial metastases, described in several extrathoracic tumors, are rare (2% in the autopsies of patients who have died from solid organ tumors).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The clinical manifestation of this type of tumor is no different from that of primary lung tumors (cough, hemoptysis, dyspnea, or asymptomatic, in up to 60% of cases).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The mean time to diagnosis is generally 41 months.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This case has several unusual features: hemoptysis led to a diagnosis of primary renal cancer, with the peculiarity of presenting in the form of 3 bilateral synchronous tumors. One of the sites of metastasis could be detected with chest computed tomography (which has little sensitivity for distant disease), but the bronchial biopsy obtained by FB was decisive in the final diagnosis. The absence of family history and the patient's age suggest they were sporadic renal tumors.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Mateo Lázaro ML, Villanueva Gimeno MdM, Vilar Bonacasa E. Expectoración hemoptoica como primera manifestación de un cáncer renal bilateral. Arch Bronconeumol. 2015;51:529–530.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1087 "Ancho" => 995 "Tamanyo" => 71343 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fiberoptic bronchoscopy, showing the lesion in the right main bronchus.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal cell carcinoma: unusual imaging manifestations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Prando" 1 => "D. 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Bellmunt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/(SICI)1096-9098(199608)62:4<249::AID-JSO4>3.0.CO;2-6" "Revista" => array:6 [ "tituloSerie" => "J Surg Oncol" "fecha" => "1996" "volumen" => "62" "paginaInicial" => "249" "paginaFinal" => "252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8691837" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endobronchial metastases secondary to solid tumors: report of eight cases and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.P. Katsimbri" 1 => "A.T. Bamias" 2 => "M.E. Frouda Froudarakis" 3 => "I.A. Peponis" 4 => "S.H. Constantopoulos" 5 => "N.A. Paulido" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lung Cancer" "fecha" => "2000" "volumen" => "28" "paginaInicial" => "163" "paginaFinal" => "170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10717334" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endotracheal/endobronchial metastases: clinopathologic study with special reference to development modes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Kiryu" 1 => "H. Hoshi" 2 => "E. Matsui" 3 => "H. Iwata" 4 => "M. Kokubo" 5 => "K. Shimokawa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2002" "volumen" => "119" "paginaInicial" => "768" "paginaFinal" => "775" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11243955" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000010/v1_201509302252/S1579212915002803/v1_201509302252/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000010/v1_201509302252/S1579212915002803/v1_201509302252/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915002803?idApp=UINPBA00003Z" ]
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| 2019 January | 33 | 20 | 53 |
| 2018 December | 33 | 14 | 47 |
| 2018 November | 86 | 20 | 106 |
| 2018 October | 100 | 19 | 119 |
| 2018 September | 35 | 8 | 43 |
| 2018 May | 24 | 1 | 25 |
| 2018 April | 48 | 2 | 50 |
| 2018 March | 45 | 5 | 50 |
| 2018 February | 37 | 7 | 44 |
| 2018 January | 37 | 4 | 41 |
| 2017 December | 39 | 3 | 42 |
| 2017 November | 22 | 6 | 28 |
| 2017 October | 25 | 3 | 28 |
| 2017 September | 21 | 15 | 36 |
| 2017 August | 23 | 9 | 32 |
| 2017 July | 23 | 10 | 33 |
| 2017 June | 36 | 15 | 51 |
| 2017 May | 42 | 9 | 51 |
| 2017 April | 32 | 11 | 43 |
| 2017 March | 23 | 13 | 36 |
| 2017 February | 19 | 3 | 22 |
| 2017 January | 13 | 3 | 16 |
| 2016 December | 28 | 6 | 34 |
| 2016 November | 38 | 6 | 44 |
| 2016 October | 38 | 14 | 52 |
| 2016 September | 33 | 12 | 45 |
| 2016 August | 37 | 8 | 45 |
| 2016 July | 31 | 11 | 42 |
| 2016 May | 0 | 6 | 6 |
| 2016 April | 0 | 2 | 2 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 3 | 4 |
| 2016 January | 0 | 8 | 8 |
| 2015 October | 1 | 1 | 2 |
Show all
