Presentation
History of renal cell carcinoma of the clear cell histological type two years ago
Patient Data
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 blurring and a small posterior deviation of the fabella. The sign of the Codman triangle indicates an aggressive lesion, particularly when associated with the previous clinical history of a renal tumor.
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 a left paraaortic mass involving the adjacent kidney, likely 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 for surgical intervention (Mirels 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.