Synchronous Clear Cell Renal Carcinoma and Hepatocellular Carcinoma: A Rare Case of Dual Primary Malignancy
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Abstract
Clear cell renal carcinoma (ccRCC) and hepatocellular carcinoma (HCC) are two distinct malignant neoplasms with different risk factors, pathogenesis, and clinical behavior. The synchronous occurrence of both tumors is extremely rare and poses significant diagnostic and therapeutic challenges. We present the case of a 48-year-old male patient with a history of poorly controlled type 2 diabetes mellitus and systemic arterial hypertension. He was diagnosed with left renal cell carcinoma after presenting with lumbar pain and hematuria. A radical nephrectomy was performed, and histopathological examination revealed a clear cell renal carcinoma, Fuhrman grade 3, with invasion into the perirenal fat and lymphovascular structures. A postoperative follow-up CT scan showed a small hepatic lesion, which was biopsied and confirmed as a well-differentiated hepatocellular carcinoma. Immunohistochemical studies demonstrated positivity for Hepar1 and CD34, and negativity for Glypican3, supporting a primary hepatic origin. The patient was started on pembrolizumab and axitinib, with good clinical response and stable renal function. This case highlights the importance of considering dual primary malignancies in patients with multifocal tumors and underscores the role of immunohistochemistry in distinguishing synchronous primary neoplasms from metastatic disease.
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