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CASE REPORT |
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| Year : 2001 | Volume
: 17
| Issue : 2 | Page : 174-175 |
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Chest horn: An unusual metastasis from renal cell carcinoma
TP Rajeev, LN Dorairajan, AK Hemal
Department of Urology, All India Institute of Medical Sciences, New Delhi, India
Correspondence Address:
A K Hemal
Department of Urology, All India Institute of Medical Sciences, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
 Abstract | | |
A unique case of a patient of renal cell carcinoma presenting as cutaneous chest horn is presented. He had no urologic symptoms at presentation and was subsequently found on evaluation to have a right renal lump. This is the first case of its kind reported in the literature. The case emphasizes the need . for a careful physical examination in patients presenting with skin tumor
Keywords: Renal Cell Carcinoma; Cutaneous Metastasis
How to cite this article:
Rajeev T P, Dorairajan L N, Hemal A K. Chest horn: An unusual metastasis from renal cell carcinoma. Indian J Urol 2001;17:174-5 |
| Case Report | |  |
A 32-year-old male, labourer by profession, presented with a fungating swelling in the chest of 8-weeks' duration. He was also having breathlessness, weakness, reduced appetite and loss of weight for the last 1 month. He also had two bouts of haemoptysis. He had taken indigenous treatment in his village for his ailment. On clinical examination, he was thinly built, cachectic and anaemic. A fungating cutaneous lesion (2 cms x 1.75 cms x 2 cms) was present over the anterior surface of the right shoulder [Figure 1]. Per-abdominal examination revealed a right renal mass, bimanually palpable. Blood profile revealed that haemoglobin was 8 gm/dl; renal function and liver function tests were normal. X-ray chest revealed cannon ball shadows in both long fields. Fine needle aspiration cytology from the cutaneous lesion and right renal mass was consistent with renal cell carcinoma (RCC). In view of the advanced metastatic RCC, the patient was put on injection interferon - alpha 3 million units sub-cutaneously thrice weekly plus injection medroxyprogesterone acetate 450 mg intramuscularly thrice weekly. In spite of the treament, the patient did not show any improvement and was lost to follow-up after four weeks.
| Comments | | |
Cutaneous metastasis from renal cell carcinoma is extremely rare. [1],[2],[3],[4],[5] There are only a few anecdotal reports in literature of patients presenting with cutaneous metastasis. These cases were usually diagnosed during follow-up of patients proven to have renal cell carcinoma. Most of these patients had already undergone nephrectomy. [1],[2],[3],[4],[5] Our case is particularly interesting in that the patient presented with an ulcerating cutaneous horn in the chest and was subsequently diagnosed to have a renal tumour on evaluation. This case emphasizes the need for a thorough clinical evaluation of all patients presenting with a cutaneous tumour because this could be a metastasis from a primary elsewhere in the body.
Isolated reports exist where excision of a solitary skin metastasis in a patient with a renal cell carcinoma who has already undergone a nephrectomy, has resulted in long-term survival. [3] However, most patients presenting with cutaneous metastasis already have disease disseminated extensively.
Median survival for patients with metastatic disease is approximately 10 months. Tumour burden as reflected in the number of metastases, is closely related to survival. It is suggested that nephrectomy is not indicated in the management of metastatic renal cell carcinoma. [6] Exceptions are to palliate intractable pain or haematuria. Cytotoxic agents exhibit only marginal response rates and no survival benefit has been clearly demonstrated. Multimodal treament with biological response modifiers has produced durable response in some cases. [7] With this view, we started our patient on interferon therapy but he dropped out from treatment.
| References | | |
| 1. | Amo-Takyi BK. Handt S, Gunawan B, Hollweg HG. Fuzesi L. A cytogenetic approach to the differential diagnosis of metastatic clear cell renal carcinoma. Histopathology 1998: 32: 436-443.  |
| 2. | William JC. Heaney JA. Metastatic renal cell carcinoma presenting as a skin nodule: case report and review of the literature. J Urol 1994; 152: 2094-2095. |
| 3. | Paez Borda A, Nacarino Corbacho L, Diego Garcia A et al. Cutaneous and gynecologic metastases disclosing renal cell carcinoma: the diagnostic and therapeutic implications. Arch Esp Urol 1992; 45: 341-345. |
| 4. | Haruki T, Takahashi S. Morohashi M, Maruyama T. Ida M. Cutaneous metastasis of renal cell carcinoma: an electron microscopic study. J Dermatol 1919: 18: 218-224. |
| 5. | Peterson JL, McMarlin SL. Metastatic renal cell carcinoma presenting as a cutaneous horn. J Dermatol Surg Oncol 1983; 9: 815-818. |
| 6. | Franck W, Stuhldreher D, Saffrin R, Shott S, Guinan P. Stage IV renal cell carcinoma. J Urol 1994; 152: 1998-1999. |
| 7. | Rackley R, Novick A. Klein E et al. The impact of adjuvant nephrectomy on multimodality treatment of metastatic renal cell carcinoma. J Urol 1994: 152: 1399-1403. |
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