TRIPLE PRIMARY CANCERS INVOLVING KIDNEY, URINARY-BLADDER, AND LIVER IN A DYE WORKER

A case of triple primary cancers (renal cell carcinoma of the kidney, transitional cell carcinoma of the bladder, and hepatocellular carcino ma of the liver) was reported at autopsy. A 53-year-old man, who had a history of exposure to benzidine, underwent nephrectomy for a left re nal cell carcinoma and 10 years later; transurethral resection of blad der tumor (TUR-Bt) for a transitional cell carcinoma of the bladder. A t the age of 65, he was diagnosed as having multiple hepatic tumors. H istological examination of biopsy specimens showed these lesions to be undifferentiated carcinomas. Immunohistological examination of both b iopsy and autopsy specimens revealed that multiple hepatic tumors were hepatocellular carcinomas, not metastatic tumors from kidney or urina ry bladder: tumor cells of hepatic tumors were positive for alpha-feto protein, although renal cell carcinomas and transitional cell carcinom as of urinary bladder were positive for Ber-EP4 and keratin, respectiv ely. These findings suggest not only that immunohistological examinati on is helpful for the diagnosis of multiple primary cancers but also t hat benzidine may be hepatocarcinogenic in addition to those cancers t hat are known to be associated with benzidine exposure, i.e., renal ce ll carcinomas and transitional cell carcinomas in in urinary bladder. (C) 1997 Wiley-Liss, Inc.