Fibular metastasis from renal cell carcinoma masquerading as deep vein thrombosis

Solitary fibular metastasis from nonsmall cell lung carcinoma

Solitary bone metastasis to fibula in patients of lung carcinoma is a rare entity, with only four cases reported in literature. We, hereby, present a case of a 50 year-old-male who was given three cycles of chemotherapy for lung carcinoma with no distant metastasis but presented 2 months later with a fusiform, painful swelling around the knee that was clinically suspected to be inflammatory in nature but proved to be fibular metastasis on cytology. There was no evidence of skeletal metastasis on initial bone scan. He was given palliative radiotherapy for this with symptomatic relief.

Bilateral acrometastasis in a case renal cell carcinoma

We present a unique case of bilateral skeletal metastasis below the knee in a patient with renal cell carcinoma. In this rarest of rare cases, bony metastases were the first presentation of a primary tumour. Incidentally, the primary tumour (renal cell carcinoma) involved the solitary kidney of the patient and the same patient also had coexisting carcinoma of the prostate.

Lateral ankle reconstruction using a patellar tendon graft: a case report

A 64-year-old patient presented with a solitary osseous metastasis of the renal cell carcinoma. The localization of the metastasis in the distal fibula is rare. A distal fibulectomy was performed, and the lateral ankle ligaments were reconstructed using a patellar bone-tendon-bone allograft. Postoperatively the ankle was immobilized in plaster, followed by mobilization with an ankle brace. One year postoperatively the result was good. The ascribed method is a new and elegant way of reconstruction of the lateral ankle ligaments after distal fibulectomy. Lateral fibulectomy is rare, thus making the ascribed way of reconstruction rare. We think, however, for this specific indication this operation deserves a place among other lateral ankle reconstructions.

LEVEL OF CLINICAL EVIDENCE

4.

Steal phenomenon in the lower limb: presentation of a case with osseous metastases secondary to renal cell carcinoma and review of the literature

Renal cell carcinoma is reported to have potent angiogenic activity with a high microvascular density in both primary and metastatic sites compared with other adenocarcinomas. Angiogenesis can lead to the formation of abnormal arteriovenous shunts that can, in patients with peripheral vascular disease, result in worsening of the degree of ischaemia by producing a vascular steal-like phenomena. Nevertheless, steal phenomena secondary to malignancies are extremely rare. We report a case of distal critical limb ischaemia in a patient with peripheral vascular disease exacerbated by massive arteriovenous shunting due to tibial metastases from renal cell carcinoma.