Metastatic renal cell carcinoma - bones and lungs

Presentation

A patient with a history of renal cell carcinoma of the clear cell histological type two years ago.

Patient Data

Age: 60 years
Gender: Female

Radiography of the right knee shows a lesion in the posterior cortex of the distal femur associated with a mass in the adjacent popliteal fossa with fat blur and a small posterior deviation of the female. The sign of the Codman triangle indicates an aggressive lesion, particularly when associated with the previous clinical history of the patient with a renal tumor.

X-ray

X-ray 4 months later

Distal metaphyseal lesion of the right femur, with the destruction of the cortical bone, irregular borders and posterior displacement of the fabella, aggressive features.

Chest CT with pulmonary window demonstrates multiple nodules of metastatic origin, some with the features of "cannonball" metastases.

CT of the abdomen non-contrast with left paraaortic mass involving the adjacent kidney, likey due to confluent local recurrence and secondary lymph node enlargement.

Case Discussion

Oncologic patient with a history of renal mass on the left treated with radical nephrectomy, the surgical specimen was referred for histopathological study, which confirmed grade IV clear cell renal carcinoma.

Among renal carcinomas, the clear cell subtype is the most common, affecting mainly the population in the age group of 60 to 70 years, with a higher incidence in males. Metastases are usually osteolytic, rapidly evolving, and may culminate in pathologic fractures, with bone metastases being an independent factor of poor prognosis in renal neoplasia, which may directly impact the quality of life of the patient. In the reported scenario, the patient has an indication of surgical intervention (Mirel’s score-9 ); however, there is a high chance of developing irreversible sequelae. Due to her clinical situation and comorbidities, conservative treatment was chosen.

Case contributed by: Dr. Ana Carolina Freitas, Dr. Daniel Medeiros, Dr. Leonardo Cordeiro, Dr. Aline Freitas and Dr. Karen Bueno.

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Case information

rID: 66619
Published: 31st Mar 2019
Last edited: 22nd Apr 2019
Inclusion in quiz mode: Included
Excluded from licensing
Institution: Hospital de Base do Distrito Federal

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