《Table 1 Differential diagnosis of isolated biopsy-proven metastatic retroperitoneal lymph node》

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《Metastatic clear cell renal cell carcinoma in isolated retroperitoneal lymph node without evidence of primary tumor in kidneys: A case report》

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The present case posed a dilemma due to the inconsistency between the immunohistochemical conclusions and the radiological findings of the isolated biopsy-proven metastatic retroperitoneal lymph node.The positive nuclear staining of both PAX8 and CK AE1 and AE3 suggested a CCRCC，however，the lack of renal pathology on all previous radiological examinations prompted an investigation of a primary site other than renal.Several neoplasms were included in the differentialdiagnosis，as highlighted in Table 1.Given the history and morphological features，urothelial carcinoma in the upper urinary tract was considered.Additionally，thyroid or thymic neoplasms were also in the differential diagnosis，although it was unlikely that they would have metastasized to a retroperitoneal lymph node.Other possibilities included primary adenocarcinoma of the retroperitoneum，lymphoma，and a testicular malignancy although there was no overtly suspicious mass noted on a scrotal ultrasound.Due to the patient’s history of severe prostatic enlargement，a primary malignancy of the prostate was also broached.Despite numerous oncological malignancies in the differential diagnosis，the lymph node in the left para-aortic space in our case was most likely a CCRCC based on immunohistochemical and morphological features.A nephrectomy was not performed as renal abnormalities on imaging were never observed.Although the prognosis of an isolated retroperitoneal lymph node with RCC is usually poor，our patient had no recurrent or metastatic disease and no evidence of retroperitoneal adenopathy 5 years following his LND.