Renal cell carcinoma metastasis

Case contributed by Dr Ian Bickle

Presentation

Persistent left knee pain not responding to simple analgesia. No past medical history.

Patient Data

Age: 66
Gender: Male
X-ray

Lucent expansile lesion in the lateral femoral metaphysis with cortical thinning and breech.

No periosteal reaction.

MRI

Lucent expansile lesion in the lateral femoral epiphysis and metaphysis with cortical breech.

It exhits intermediate T1 and high T2 signal with mild contrast enhancement.

Small joint effusion.

Nuclear medicine

High tracer uptake in the distal femur corresponding with the other modalities.

CT of the chest, abdomen and pelvis identified a renal mass.

Subsequent biopsy of the femoral lesion indicated a renal cell carcinoma metastasis.

Case Discussion

A common site of metastasis of renal cell carcinoma is the skeleton, giving rise to lytic expansile metastases.

On occasion the first presentation ( presenting symptoms ) may be from a bony metastasis.  In this case the lesion was thought to initially represent a primary bone lesion, which is within the differential.

Solitary bone lesions may be broadly divided into agressive and non-aggressive from their appearances on plain film.

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Case information

rID: 34631
Case created: 2nd Mar 2015
Last edited: 13th Jul 2016
Tag: rdgh
Inclusion in quiz mode: Included

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