Vertebral metastasis from renal cell carcinoma

Case contributed by Dr Roberto Schubert

Presentation

60 year old male patient presenting with severe backache radiating to the right lower abdomen. Known history of right nephrectomy for RCC of the clear cell type.

Patient Data

Age: 60
Gender: Male

T1-hypointense lesion with irregular margins outgrowing the dorsal border of the 2nd lumbar vertebral body.
T2-weighted MRI in the same plane as Fig. 1. Heterogeneous signal, mostly isointense to the vertebral body. Invasion of the spinal canal.
Transverse T1-weighted MRI shows invasion of the epidural space.
T2-weighted image corresponding to Fig. 3. There is some displacement of the cauda roots on the right.

Transverse CT (bone window) shows an osteolytic destruction with disruption of the cortical borders of the L2 vertebral body.
The pathologic fracture extends beyond the osteolysis (Fig. 5).

Case Discussion

Renal cell carcinoma is not a frequent malignancy, but its metastases seem to have a predilection for the skeleton. They are invariably osteolytic and therefore hypointense on T1- (Figs. 1&3) and inhomogeneously iso-or hyperintense on T2-weighted images (Figs. 2&4). They are almost always associated with intense pain and often lead to pathologic fractures (Figs. 5&6).

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Case information

rID: 13684
Case created: 7th May 2011
Last edited: 9th Oct 2015
Inclusion in quiz mode: Included

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