Q J Med 2015; 108:161–162 doi:10.1093/qjmed/hcu146 Advance Access Publication 14 July 2014
Clinical picture An unusual case of metastatic renal clear cell carcinoma presented as a solitary subcutaneous mass invading the manubrium A 60-year-old Chinese man presented with a 7-month history of a mass with tenderness in the front of chest which gradually enlarged (Figure 1A). Chest computed tomography (CT) scan from local hospital demonstrated a lesion of 6.2 5.4 3.5 cm in the manubrium invading adjacent soft tissue without metastasis in the lung or the mediastinum (Figure 1B). In our hospital, physical examination revealed a subcutaneous fixed mass with tenderness in the front of manubrium without other accompanied abnormality. Solitary plasmacytoma or metastatic
carcinoma was initially suspected for this patient. Results of blood cell count, urine routine, comprehensive biochemistry and immunoglobulins are all in normal range whereas carcino-embryonic antigen was slightly higher than normal with 5.11 ng/ml. Bence-Jones protein was negative in the urine and immunofixation electrophoresis revealed no abnormality. Biopsy of the manubrium mass with 18-G core needle was performed and histopathology analysis revealed metastatic clear cell carcinoma in it. A subsequent abdominal contrast CT scan displayed a mass of 3.0 2.2 2.0 cm in the left kidney
Figure 1. (A) A subcutaneous fixed mass with tenderness in the front of manubrium; (B) chest CT image showing a mass in the manubrium; (C) bone scan showing a solitary bone invasion in the manubrium; (D) abdominal CT image showing the right kidney mass.
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
162
Clinical picture
without metastasis in the liver or the celiac lymph nodes (Figure 1D). And bone scan found no other bone invasion except in the manubrium (Figure 1C), whereas cranial CT scan displayed no brain metastasis. The patient was then transferred to the department of urology surgery for partial nephrectomy after a discussion of oncology multidisciplinary team. However, total nephrectomy was performed due to extensive infiltration of tumor tissue in the left kidney revealed during surgery. Histopathology analysis after nephrectomy confirmed the kidney mass as renal clear cell carcinoma. Surgical manubrium metastasectomy and local metastasis radiotherapy combined with tyrosine kinase inhibitor therapy were strongly suggested for this patient. Solitary metastasis of renal cell carcinoma in the sternum is a rare medical condition. Most reported sternal metastasis of renal cancer was found as one of multiple metastases in recurrent patients.1,2
Photographs and text from: J.S. Li, Department of Medical Oncology, Cancer Center, Qilu Hospital of Shandong University, Jinan, China; C.K. Zhou, Department of Urology Surgery, Cancer Center, Qilu Hospital of Shandong University, Jinan, China; C.H. Yi, W.D. Zhang and L. Li, Department of Medical Oncology, Cancer Center, Qilu Hospital of Shandong University, Jinan, China. email: [email protected] Conflict of interest: None declared.
References 1. Lee SY, Lee SJ, Lee CS. Sternum resection and reconstruction for metastatic renal cell cancer. Int J Surg Case Rep 2011; 2:45–6. 2. Molardi A, Nicolini F, Beghi C, Agostinelli A, Gherli T. Aortic valve replacement with right thoracotomy in a patient with sternal metastasis from renal carcinoma. Acta Biomed 2009; 80:150–2.
Clinical picture An unusual case of metastatic renal clear cell carcinoma presented as a solitary subcutaneous mass invading the manubrium A 60-year-old Chinese man presented with a 7-month history of a mass with tenderness in the front of chest which gradually enlarged (Figure 1A). Chest computed tomography (CT) scan from local hospital demonstrated a lesion of 6.2 5.4 3.5 cm in the manubrium invading adjacent soft tissue without metastasis in the lung or the mediastinum (Figure 1B). In our hospital, physical examination revealed a subcutaneous fixed mass with tenderness in the front of manubrium without other accompanied abnormality. Solitary plasmacytoma or metastatic
carcinoma was initially suspected for this patient. Results of blood cell count, urine routine, comprehensive biochemistry and immunoglobulins are all in normal range whereas carcino-embryonic antigen was slightly higher than normal with 5.11 ng/ml. Bence-Jones protein was negative in the urine and immunofixation electrophoresis revealed no abnormality. Biopsy of the manubrium mass with 18-G core needle was performed and histopathology analysis revealed metastatic clear cell carcinoma in it. A subsequent abdominal contrast CT scan displayed a mass of 3.0 2.2 2.0 cm in the left kidney
Figure 1. (A) A subcutaneous fixed mass with tenderness in the front of manubrium; (B) chest CT image showing a mass in the manubrium; (C) bone scan showing a solitary bone invasion in the manubrium; (D) abdominal CT image showing the right kidney mass.
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
162
Clinical picture
without metastasis in the liver or the celiac lymph nodes (Figure 1D). And bone scan found no other bone invasion except in the manubrium (Figure 1C), whereas cranial CT scan displayed no brain metastasis. The patient was then transferred to the department of urology surgery for partial nephrectomy after a discussion of oncology multidisciplinary team. However, total nephrectomy was performed due to extensive infiltration of tumor tissue in the left kidney revealed during surgery. Histopathology analysis after nephrectomy confirmed the kidney mass as renal clear cell carcinoma. Surgical manubrium metastasectomy and local metastasis radiotherapy combined with tyrosine kinase inhibitor therapy were strongly suggested for this patient. Solitary metastasis of renal cell carcinoma in the sternum is a rare medical condition. Most reported sternal metastasis of renal cancer was found as one of multiple metastases in recurrent patients.1,2
Photographs and text from: J.S. Li, Department of Medical Oncology, Cancer Center, Qilu Hospital of Shandong University, Jinan, China; C.K. Zhou, Department of Urology Surgery, Cancer Center, Qilu Hospital of Shandong University, Jinan, China; C.H. Yi, W.D. Zhang and L. Li, Department of Medical Oncology, Cancer Center, Qilu Hospital of Shandong University, Jinan, China. email: [email protected] Conflict of interest: None declared.
References 1. Lee SY, Lee SJ, Lee CS. Sternum resection and reconstruction for metastatic renal cell cancer. Int J Surg Case Rep 2011; 2:45–6. 2. Molardi A, Nicolini F, Beghi C, Agostinelli A, Gherli T. Aortic valve replacement with right thoracotomy in a patient with sternal metastasis from renal carcinoma. Acta Biomed 2009; 80:150–2.
