AB176. SOH22ABS212. A case of histologically distinct bilateral renal neoplasms and co-existing synchronous tumours

Background: Multiple synchronous tumours are an accepted phenomenon, yet it is still rare to find a case where three or more primary tumours are diagnosed simultaneously and especially within the same organ. A review of the literature describes a paucity of cases, such as we describe here.

Methods: We report the case of a 71-year-old man who presented with haematuria, CT imaging showed bilateral renal lesions. Subsequent staging CT and PET imaging showed a nodular thyroid lesion and a rectal mass. He underwent an elective left radical nephrectomy and emergency splenectomy.

Results: Histology confirmed two renal cell carcinoma (RCC) phenotypes in the left kidney comprising of a papillary RCC type 2 and a clear cell RCC, spatially distinct with no intermixing and a contralateral synchronous tumour in the right kidney. Rectal biopsy confirmed an adenoma with low grade dysplasia and thyroid ultrasound imaging was consistent with a benign tumour. Intraoperatively he had a locally advanced tumour with involvement of the renal vein. There were no visceral metastases. He was discharged home well postoperatively, for medical oncology review.

Conclusions: This case describes a rare phenomenon, which adds to and encourages the discourse around genomic advancements and familial syndromes in relation to multiple RCC’s. And, opens multi-disciplinary discussion around appropriate surgical management, the need for biopsy and targeted oncological treatments where synchronous tumours arise.

Keywords: Synchronous; tumour; renal; multiple; malignancy