AB 50. Diagnostic value of urine cytology test in differential diagnosis in relapsed lung cancer to renal cell carcinoma

Background: Urine cytology test is a useful diagnostic tool in detection of urinary tract cancer. However, the presence of cancer cells in urine cytology sediment in patients with relapsed lung cancer and renal metastases could be used widely in order to avoid interventional procedures of the urothelial tract in a false positive diagnosis of a primary renal cancer.

Patients and methods: A 52 year-old smoker woman of 40 p/y was presented for examination of intermittent episodes of haematuria over a 2 months period. The patient had right lower lobectomy (3 years ago) due to well differentiated squamous cell lung cancer, treated with neo-adjuvant chemotherapy and local relapse at the coloboma, 19 months after the surgery. The patient received chemotherapy of 4500 Gy. Eleven months later because of the history of haematuria, the patient proceeded in Contrast enhanced computed tomography (CT) examination of the abdomen revealed a heterogeneous mass of the right kidney. Before of a prospective FNA right renal biopsy, the patient proceeded in an every day urine cytology test and chest CT examination in order to exclude a new relapse of lung cancer.

Results: The urine cytology test with Thin Prep technique was positive and detected squamous cell lung cancer well differentiated. Bronchoscopy followed chest CT defined and showed clear evidence of new lesions and tracheal invasion. We would like to notice that there is no histological existence of primary squamous renal cancer.

Conclusions: Every renal lesion detected in patients with lung cancer history must alert metastatic disease, especially if computed tomography of the mass demonstrates relative homogeneity and minimal enhancement. Recent studies strongly showed that renal metastases count maximum 19% and usually have occult radiological findings. Urine cytology could be valuable to patients with lung cancer and urinary tract signs, especially if there are radiological lesions from lower abdomen CT scan. The above mentioned may be used in order of detection of renal metastases and especially to differentiate metastatic lung disease from primary renal cancer.