Original Article
A series of collision tumors in the genitourinary tract with a review of the literature

https://doi.org/10.1016/j.prp.2013.12.005Get rights and content

Abstract

Collision tumors, characterized by the coexistence of phenotypically and genotypically distinct tumors at the same site, are distinctly rare in the genitourinary tract and pose a diagnostic challenge. The goal of this study is to present a series of such cases from a single institution highlighting the unusual clinicopathologic features of these tumors.

Six cases were retrospectively identified from our surgical pathology files and included internal and consultation cases (2006–2012). All tumors were identified by H&E and selected immunohistochemistry.

There were 5 males and 1 female patients ranging in age from 57 to 84 years (average 73 years). The sites of these collision tumors were located in the kidney (3 cases), bladder (2 cases), and prostate. All collision tumors involved at least one malignant neoplasm.

The diagnosis of collision tumors in the genitourinary tract is a perplexing task. Awareness of these rare entities, thorough sampling of the tumor mass, and appropriate use of ancillary techniques to demonstrate the different tumor components can help avoid an incorrect diagnosis, as well as with pathologic staging.

Introduction

The occurrence of collision tumors in the genitourinary tract is fairly uncommon in comparison to other neoplastic events like synchronous tumors. Collision tumors are defined as two distinct, spatially separated malignancies with discrete sites of origin with an area of interaction or mixing [1]. The tumors are genetically different and usually sharply demarcated from one another. They differ from synchronous and composite tumors, in which two spatially distinct tumors have no interaction or the neoplasms reveal divergent histologic findings but share a common source, respectively [2].

Collision tumors are well-documented in the literature throughout various organ systems involving neoplasms such as thyroid carcinoma, meningioma, mammary carcinoma, gastric adenocarcinoma, and renal cell carcinoma [2], [3], [4]. The interactions of these neoplasms can be sub-classified as synchronous tumors with different lineages, such as a colonic adenocarcinoma and a neuroendocrine carcinoma with direct extension and intermixing [5]; tumor-to-tumor metastasis [3], [4], [6]; neoplasms interacting with a systemic process such as a renal cell carcinoma with intravascular lymphomatosis [10]; and collision metastasis [7], [8], [9].

We present seven cases of collision tumors (Table 1) involving the genitourinary tract that include: renal cell carcinoma (RCC) and pulmonary adenocarcinoma (previously published case) [2]; angiomyolipoma and mammary carcinoma; chromophobe renal cell carcinoma and papillary renal cell carcinoma; and three cases of urothelial carcinoma and prostatic adenocarcinoma.

Section snippets

Materials and methods

The cases were selected from the surgical pathology archives and referrals from outside institutions (2006–2012). Specimens were fixed in 10% formalin, dehydrated in graded ethanol, cleared with xylene, and embedded with paraffin for histological examination. Histologic sections were stained with hematoxylin and eosin (H&E). Relevant immunohistochemical studies were also performed using formalin-fixed, paraffin-embedded sections. Avidin–biotin peroxidase complex and peroxidase–antiperoxidase

Results

All tumors were identified by morphology and immunohistochemistry. The clinical history and immunochemical results are summarized in Table 3, Table 4. Clinical history was available for 3 of the 6 patients.

Discussion

Collision tumors are uncommon neoplasms that in some way interact. However, various authors have proposed slightly different definitions. Meyer suggested that this phenomenon occurs when two malignancies from separate locations meet and intermix [11]. Dodge expanded upon this definition by adding that separate tumor areas should contain distinct histological patterns, whether they collide in their native organ or intermix as a collision metastasis [12]. This definition excludes any tumors that

Conclusion

In summary, the collision tumor cases presented in this series represent infrequent events that can occur between two tumors. The possibility of a collision tumor should be raised whenever dimorphic morphology is encountered in a patient with more than one primary tumor. These tumors can be subclassified as: synchronous tumors that “collide,” tumor-to-tumor metastasis, tumors intermixing as a result of a systemic malignancy, or collision metastasis. Although the definition of collision tumors

Conflict of interest

None.

Source of funding

None.

References (55)

  • L.V. Campbell et al.

    Metastases of cancer to cancer

    Cancer

    (1968)
  • D. Kim et al.

    A case of colonic collision tumor (adenocarcinoma and neuroendocrine carcinoma)

    Korean J. Gastroenterol.

    (2012)
  • L.A. Granville et al.

    Pathologic quiz case

    Arch. Pathol. Lab. Med.

    (2005)
  • T. Bhavsar et al.

    Collision metastasis of urothelial and prostate carcinomas to the same lymph node: a case report and review of the literature

    J. Med. Case Rep.

    (2012)
  • A. Ergen et al.

    Collision metastasis of bladder and prostate carcinoma to a single pelvic lymph node

    Int. Urol. Nephrol.

    (1995)
  • K. Overstreet et al.

    Urothelial and prostate carcinoma metastasizing to the same lymph node

    Arch. Pathol. Lab. Med.

    (2001)
  • B. Wang et al.

    Renal cell carcinoma with intravascular lymphomatosis: a case report of unusual collision tumors with review of the literature

    Arch. Pathol. Lab. Med.

    (2001)
  • R. Meyer

    Beitrag zur Verstandigung uber die Namengebung in der Geschwulstlehre

    Zentralbl. Allg. Pathol.

    (1919)
  • O. Dodge

    Gastro-oesophageal carcinoma of mixed histological type

    J. Pathol. Bacteriol.

    (1961)
  • M. Brandwein-Gensier et al.

    Collision tumor of the thyroid: a case report of metastatic liposarcoma plus papillary thyroid carcinoma

    Head Neck

    (2004)
  • L. Ottosson et al.

    Metastasis from carcinoma to carcinoma

    Acta Pathol. Microbiol. Scand.

    (1968)
  • M.T. Kien et al.

    Urothelial carcinoma and prostatic adenocarcinoma presenting as collision tumors

    Can. J. Urol.

    (2009)
  • R. Ricketts et al.

    Tumor-to-tumor metastasis: report of 2 cases of metastatic carcinoma to angiomyolipoma of the kidney

    Arch. Pathol. Lab. Med.

    (2008)
  • T. Shin et al.

    Tumor-to-tumor metastasis to chromophobe renal cell carcinoma: a first report

    Case Rep. Urol.

    (2011)
  • C. Perrin et al.

    Breast carcinoma metastasis into a renal cell carcinoma

    Ann. Pathol.

    (2001)
  • L.K. Van Wynsberge et al.

    Breast cancer metastatic to a renal cell carcinoma

    Aktuelle Urol.

    (2004)

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