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Abo Kasem R, Joseph K, Shaik A, Downes A, Janjua MB. Metastasectomy for extracalvarial renal cell carcinoma. Clin Case Rep 2024; 12:e8967. [PMID: 38845800 PMCID: PMC11154766 DOI: 10.1002/ccr3.8967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/13/2024] [Accepted: 05/01/2024] [Indexed: 06/09/2024] Open
Abstract
Key Clinical Message Palliative surgical resection of extra-calvarial metastatic lesions from renal cell tumors is crucial for controlling metastatic spread, improving quality of life, and preventing associated morbidity. Careful surgical planning, including selective preoperative embolization and controlled resection around critical structures such as the sagittal sinus, is essential for successful outcomes. Cranioplasty with Titanium mesh and bone cement post-resection can provide symptomatic relief, better cosmesis, and overall improved quality of life. Abstract Renal cell carcinomas are aggressive tumors with distant systemic disease. The calvarium appears to be an unusual and rare site for distant metastasis. The treatment modalities are challenging and out of the normal realm for the management of these tumors. We report a case of a 63-year-old woman with a previous history of nephrectomy who presented with symptoms of severe headaches, and swelling of bi-frontal and bi-parietal scalp regions due to multifocal extracalvarial disease. Preoperative bilateral superficial temporal artery embolization was performed to control the intraoperative bleeding. Surgical technique has been described with the critical steps involved, and a literature review has been conducted. Palliative tumor resection surgery was performed to improve the patient's quality of life as well as to confirm the histopathological diagnosis. Gross total resection of the extracalvarial metastatic tumor was achieved. Biopsy confirmed renal cell tumor with the clear cell subtype. The patient recovered well from her surgery with slow healing of the scalp wound. At 6-month follow-up, no recurrence of the extracalvarial disease was observed on serial imaging. Extracalvarial metastasis is a rare presentation in renal cell carcinoma. Considering the inherent radioresistant nature of the tumor, palliative surgical resection can be offered to control the metastatic spread, relieve agonizing pain symptoms, and to improve the quality of life. Preoperative embolization helps to decrease intraoperative blood loss. Moreover, palliative surgical resection of extracalvarial diseases helps to treat the metastasis as well as avoiding the associated morbidity that may occur if left untreated.
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Affiliation(s)
- Rahim Abo Kasem
- Department of NeurosurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Karan Joseph
- Department of NeurosurgeryWashington University School of MedicineSt. LouisMissouriUSA
| | - Adnan Shaik
- School of Medicine University of Missouri‐Kansas CityKansas CityMissouriUSA
| | - Angela Downes
- Department of NeurosurgeryUniversity School of ColoradoDenverColoradoUSA
| | - M. Burhan Janjua
- Department of NeurosurgeryWashington University School of MedicineSt. LouisMissouriUSA
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Meshikhes HA, Al Khatem RS, Albusaleh HM, Alzahir AA. Metastatic Renal Cell Carcinoma to the Scalp: A Case Report With Review of Literature. Cureus 2023; 15:e34790. [PMID: 36915832 PMCID: PMC10006727 DOI: 10.7759/cureus.34790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
Renal cell carcinoma (RCC) is the most common type of renal neoplasm. It accounts for 3% of solid tumors in adults and mostly affects men with the peak incidence between the fifth and seventh decades. It metastasizes mainly through the hematogenous spread, and the lung is the most common site of metastasis followed by bone, lymph node, liver, brain, and adrenal glands. Skin metastasis is extremely rare and accounts for <7% of RCC metastases, with the scalp and face being the most reported sites. Skin metastases are usually diagnosed at a later stage of the disease, commonly post-nephrectomy, and are regarded as a poor prognostic factor. Here we report a case of a 54-year-old male who presented with a red, pedunculated, bleeding, and nontender scalp lesion (2x2cm in size) found on the right parietal area. with a history of left radical nephrectomy and adjuvant chemotherapy for clear cell RCC 17 years ago, as well as laminectomy and radiotherapy for bone metastases in C5 and C6 in 2015. After surgical excision of the scalp lesion, histology revealed metastatic clear cell RCC. The patient was doing well post-surgical excision and was referred back to oncology where palliative care and supportive treatment were initiated. In the span of five months post-resection, he developed several conditions where his health further deteriorated. He was announced dead in September 2022 due to cardiac arrest. This case highlights the occurrence of scalp metastases long after the surgical resection of RCC.
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Affiliation(s)
- Huda A Meshikhes
- Medicine and Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | | | - Ali A Alzahir
- Surgery, King Fahad Specialist Hospital, Dammam, SAU
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3
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Escobar Gil T, Saldarriaga Santamaría S, Del Valle Saavedra JJ, Mejía Giraldo AM, Peña Zúñiga EB. An Atypical Cutaneous Metastasis in a Case of Clear Cell Renal Carcinoma. Cureus 2022; 14:e30722. [DOI: 10.7759/cureus.30722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
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Hopkins DT, Waters D, Manecksha RP, Lynch TH. Isolated soft tissue mass of the finger as the first presentation of oligometastatic renal cell carcinoma. BMJ Case Rep 2022; 15:e248718. [PMID: 35580945 PMCID: PMC9114857 DOI: 10.1136/bcr-2021-248718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/04/2022] Open
Abstract
A man in his 70s was referred to plastic surgery with a suspected foreign body in the pulp of his right index finger. An excisional biopsy was performed for a presumed foreign body granuloma. Histology revealed metastatic renal cell carcinoma (mRCC). CT imaging demonstrated a 7.4 cm heterogeneous mass arising from the upper pole of the left kidney consistent with primary renal malignancy, in addition to a 9 mm lung nodule. He underwent an uncomplicated left laparoscopic cytoreductive nephrectomy and made a satisfactory recovery. To our knowledge, this is the first reported case of primary mRCC presenting with digital soft tissue metastasis. Cytoreductive nephrectomy with metastasectomy is the preferred management for mRCC where feasible. For unfavourable mRCC cases, first-line systemic therapy is indicated. Adjuvant systemic therapy in mRCC is currently limited to clinical trials, though promising data emerging on the use of pembrolizumab may herald a future shift in practice.
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Affiliation(s)
- David T Hopkins
- Department of Urology, Saint James's Hospital, Dublin, Ireland
- Department of Surgery, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Darragh Waters
- Department of Urology, Saint James's Hospital, Dublin, Ireland
| | - Rustom P Manecksha
- Department of Urology, Saint James's Hospital, Dublin, Ireland
- Department of Surgery, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Thomas H Lynch
- Department of Urology, Saint James's Hospital, Dublin, Ireland
- Department of Surgery, Trinity College Dublin School of Medicine, Dublin, Ireland
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García Carretero R, Ordonez-Garcia M, Hernandez-Puche S, Arias-Baldo P. Paucisymptomatic clinical presentation of an advanced malignant lung disease: solitary skull metastasis as the initial exploratory sign. BMJ Case Rep 2022; 15:e248659. [PMID: 35228251 PMCID: PMC8886390 DOI: 10.1136/bcr-2021-248659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/04/2022] Open
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6
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Leve PP, Felício J, Carneiro R, Zagalo C. Recurrent renal cell carcinoma presenting as a cutaneous metastasis: A case report and review of the literature. Urol Ann 2021; 13:174-176. [PMID: 34194146 PMCID: PMC8210725 DOI: 10.4103/ua.ua_2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022] Open
Abstract
Renal cell carcinoma (RCC) is a common urological malignancy. Despite early detection and surgical treatment, some lesions recur late at distant sites. The most common dissemination sites are lung, bone, and liver. Skin metastases are not common, and the incidence and clinical manifestations are poorly established in the literature. We report here the case of a male patient with an isolated scalp cutaneous metastase of RCC, 7 years after radical nephrectomy. An excisional biopsy was performed and confirmed metastatic RCC.
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Affiliation(s)
- Paulo Pe Leve
- Urology Department, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - João Felício
- Urology Department, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Rui Carneiro
- Urology Department, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | - Carlos Zagalo
- Head and Neck Department, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
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Singh P, Somani K. Latent distant metastasis of renal cell carcinoma to skin: A case report. Clin Case Rep 2020; 8:1138-1141. [PMID: 32695344 PMCID: PMC7364088 DOI: 10.1002/ccr3.2844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/29/2020] [Accepted: 03/20/2020] [Indexed: 11/16/2022] Open
Abstract
Renal cell carcinoma (RCC) is known to recur decades after nephrectomy; however, isolated cutaneous metastasis is rare. Previous clinical history plays vital role. Newly occurring skin lesions in follow-through patients of RCC should be carefully evaluated, and possibility of its metastasis should be acknowledged. Disease-free survival postmetastasectomy is possible.
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Affiliation(s)
- Pretty Singh
- Department of PathologyApollomedics Super Speciality HospitalLucknowIndia
| | - Kavita Somani
- Department of PathologyApollomedics Super Speciality HospitalLucknowIndia
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Ferhatoglu MF, Senol K, Filiz AI. Skin Metastasis of Renal Cell Carcinoma: A Case Report. Cureus 2018; 10:e3614. [PMID: 30680270 PMCID: PMC6340412 DOI: 10.7759/cureus.3614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/19/2018] [Indexed: 11/21/2022] Open
Abstract
Metastasis of renal cell carcinoma is seen in approximately 25% of all cases. Rarely, they can appear in unusual sites. Herein, we present a 40-year-old female patient with an itching scalp mass. The mass appeared one year after the nephrectomy performed for a right renal cell carcinoma. Computed tomography scans have not identified any metastasis during the postoperative evolution of the disease. We excised the mass with a large surgical margin under local anesthesia. Pathological examination of the lesion diagnosed metastasis of clear cell carcinoma. Our case is not just the rare metastatic site but also the fact that the tumor appeared despite its low grade (T2N0MO). Unfortunately, the prognosis of metastatic renal cell carcinoma (RCC) with skin metastasis is in most cases unfavorable. We believe that our case could add more information to the following measures, complete the frame of rare oncologic cases and consolidate the data published on the topic so far. Although skin metastases are a poor sign of progression, disease-free follow-up is possible after appropriate surgical excision.
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Affiliation(s)
| | - Kazim Senol
- General Surgery, Koc University Hospital, Istanbul, TUR
| | - Ali I Filiz
- General Surgery, Okan University, Istanbul, TUR
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Miglino B, Graziola F, Palicelli A, Boggio P, Giacalone A, Veronese F, Colombo E, Savoia P, Tiberio R. Unique facial cutaneous metastasis as the primary presentation of an unexpected voluminous renal cell carcinoma. Ital J Dermatol Venerol 2018; 156:716-718. [PMID: 30428657 DOI: 10.23736/s2784-8671.18.06226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Benedetta Miglino
- Department of Dermatology, Maggiore della Carità Hospital, UPO University, Novara, Italy -
| | - Francesca Graziola
- Department of Dermatology, Maggiore della Carità Hospital, UPO University, Novara, Italy
| | - Andrea Palicelli
- Department of Health Science, School of Medicine, UPO University, Novara, Italy.,Unit of Pathology, AUSL-IRCCS, Reggio Emilia, Italy
| | - Paolo Boggio
- Department of Dermatology, Maggiore della Carità Hospital, UPO University, Novara, Italy
| | - Angela Giacalone
- Unit of Pathology, Maggiore della Carità Hospital, Novara, Italy
| | - Federica Veronese
- Department of Dermatology, Maggiore della Carità Hospital, UPO University, Novara, Italy
| | - Enrico Colombo
- Department of Dermatology, Maggiore della Carità Hospital, UPO University, Novara, Italy
| | - Paola Savoia
- Department of Dermatology, Maggiore della Carità Hospital, UPO University, Novara, Italy
| | - Rossana Tiberio
- Department of Dermatology, Maggiore della Carità Hospital, UPO University, Novara, Italy
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Pang C, Loo YL, Corns R, Mohammed R. Solitary calvarial haemangioma presenting as metastatic renal cell carcinoma. BMJ Case Rep 2018; 2018:bcr-2017-223334. [PMID: 29754133 DOI: 10.1136/bcr-2017-223334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Renal cell carcinoma is the most common renal tumour in adult that often metastasises to the lung, liver or bone. Head and neck lesions are uncommon with no early warning signs and presents with overt metastases at primary presentation in 25%-30% of reported cases. The incidence of haemangiomas that suggest malignancy are similar to that of bone metastasis. Calvarial haemangiomas usually present as asymptomatic and discovered incidentally on imaging or postmortem examination. We report a case where an initial diagnosis of benign tumour of the skull was made based on clinical presentation and calvarial haemangioma on CT head but was confirmed as metastatic clear cell carcinoma of the kidney after histopathological results. Skull metastases are rare and present late in the course of the disease. It is unusual for metastatic lesion to be the primary presentation in a clinically silent renal cell carcinoma.
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Affiliation(s)
- Calver Pang
- Department of Surgery and Interventional Science, Royal Free London NHS Foundation Trust, London, UK
| | - Yew Loong Loo
- Department of Plastic and Reconstructive Surgery, Pinderfields General Hospital, Mid Yorkshire NHS Trust, Wakefield, UK
| | - Robert Corns
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Rasheed Mohammed
- Department of Geriatric Medicine, Airedale NHS Foundation Trust, Keighley, UK
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A Rare Subcutaneous Manifestation of Metastatic Renal Cell Carcinoma. Case Rep Surg 2016; 2016:6453975. [PMID: 28070440 PMCID: PMC5192310 DOI: 10.1155/2016/6453975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/25/2016] [Accepted: 11/23/2016] [Indexed: 12/24/2022] Open
Abstract
We report a rare case of advanced metastatic renal cell carcinoma which initially presented to the clinic with back and forehead lumps. Ultrasound imaging of the lumps and later of the abdomen picked up a right renal tumour which led to further computed tomography and bone scans. The bone scan confirmed that the forehead lump was a calvarial metastasis and such a presentation for metastatic RCC is very rare which bears a significantly poorer prognosis.
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12
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García Carretero R, Sanchez-Redondo J, Barrio-Alonso MJ, Lopez-Marti MP. Lung carcinoma presenting as a solitary, painless frontal bone lump. BMJ Case Rep 2015; 2015:bcr-2015-212038. [PMID: 26677150 DOI: 10.1136/bcr-2015-212038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A 50-year-old patient, a smoker, was admitted to the hospital, with a solitary scalp lump. Subcutaneous lumps of the scalp are common but usually benign; however, the painless lump in our patient turned out to be a malignant osteolytic lesion of the skull. Frontal bone was involved, and the disease had spread to the dura. Neuroimaging showed osteolytic lesions involving the axial skeleton, skull and several vertebrae. MRI showed the involvement of the second cervical vertebra, which prompted us to start treatment with dexamethasone. Since the spinal cord was not involved, Oncologists decided not to start radiotherapy treatment until we had reached the final diagnosis. A frontal bone biopsy confirmed the diagnosis of lung carcinoma. Chest X-ray did not identify the pulmonary nodule, but CT scan revealed a 1 cm peripheral, spiculated, pulmonary nodule within a pathological parenchyma (severe diffuse pulmonary emphysema).
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Affiliation(s)
| | - Jorge Sanchez-Redondo
- Department of Internal Medicine, Mostoles University Hospital, Mostoles, Madrid, Spain
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