Calvarial and cutaneous metastasis as the primary presentation of a renal cell carcinoma

Metastasectomy for extracalvarial renal cell carcinoma

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.

Metastatic Renal Cell Carcinoma to the Scalp: A Case Report With Review of Literature

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.

Isolated soft tissue mass of the finger as the first presentation of oligometastatic renal cell carcinoma

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.

Recurrent renal cell carcinoma presenting as a cutaneous metastasis: A case report and review of the literature

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.

Latent distant metastasis of renal cell carcinoma to skin: A case report

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.

Skin Metastasis of Renal Cell Carcinoma: A Case Report

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.

Solitary calvarial haemangioma presenting as metastatic renal cell carcinoma

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.

A Rare Subcutaneous Manifestation of Metastatic Renal Cell Carcinoma

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.

Lung carcinoma presenting as a solitary, painless frontal bone lump

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).