Renal cell carcinoma - bone metastasis

Case contributed by Dr Bassem Marghany

Presentation

Severe left shoulder pain. Past history of right nephrectomy for renal cell carcinoma (RCC).

Patient Data

Age: 70 years
Gender: Male

Left shoulder

X-ray

Destructive osteolytic lesion at the neck of the left scapula underlying the glenoid fossa, showing a wide transition zone suggesting an aggressive neoplastic nature.

Lung nodule in the left mid-zone.

Left shoulder

MRI

Destructive marrow infiltrative mass involving the scapular neck and glenoid fossa, with extra-osseous soft tissue mass formation, highly suggestive of aggressive neoplastic nature. 

Altered signal of the surrounding rotator cuff muscles, likely attributed to muscle strain.  

Left shoulder

CT

An expansile lytic destructive mass lesion with pathological fractures of the glenoid fossa, spine and acromion process of the left scapula.

Mass in the left upper lobe.

Case Discussion

The patient had a past history of renal cell carcinoma (RCC), for which he underwent right total nephrectomy, followed by chemotherapy (last session 2 years ago).

No contrast was given on MRI due to poor renal function.

The patient succumbed shortly after diagnosis owing to widespread lung and bone metastasis, as well as other comorbidities including cerebral hemorrhage and extensive pneumonia.

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