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
Modality: X-ray

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

No periosteal reaction.

Modality: 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.

Modality: 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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