Solitary Pancreatic Metastasis from Renal Cell Carcinoma Concomitant with Early Gastric Cancer 17 Years After Nephrectomy: Report of a Case

The pancreas is an uncommon site for metastasis from renal cell carcinoma. We report the case of a 70-year-old man in whom a solitary pancreatic metastasis from renal cell carcinoma, found 17 years after nephrectomy, was successfully resected, combined with gastrectomy for early gastric cancer. We also discuss the relevant literature, including all the reports of pancreatic metastasis from renal cell carcinoma found in Medline. More than half the cases, like ours, were asymptomatic. A good prognosis can be expected once the pancreatic metastatic lesions are surgically excised, especially if it is a solitary metastasis. Therefore, surgical resection of pancreatic metastases is recommended to achieve the best chance of long-term survival. Special attention must be paid to the possibility of recurrence, even more than 10 years after nephrectomy for renal cell carcinoma, and imaging modalities should be part of the routine follow-up to detect metastases at an early stage.     

Solitary renal cell carcinoma metastasis to the hand: the need for wide excision or amputation

Metastatic renal cell carcinoma responds poorly to chemotherapy or radiation therapy and is associated with a dismal survival rate. In cases of a solitary acrometastasis, the literature supports complete resection of the lesion in an effort to prolong survival. We report a patient who presented with a solitary metachronous renal cell metastasis to the middle phalanx of the index finger. The lesion was correctly identified as a renal cell metastasis and aggressive surgical management was performed with curative intent.     

Gastric metastasis from renal cell carcinoma fourteen years after radical nephrectomy

We report one case of solitary gastric metastasis from renal cell carcinoma following radical excision of the primary tumour 14 years previously. During evaluation for a severe anaemia with melaena, a patient underwent upper gastrointestinal endoscopy that evidenced the presence of a small polypoid lesion in the body of the stomach. Endoscopic biopsy revealed renal cell carcinoma. There was no evidence of further metastatic disease. A subtotal gastric resection with Roux-en-Y gastrojejunal reconstruction was performed. After 6 months follow-up, the patient was disease-free. This case confirms the potential of renal cell carcinoma for late and solitary metastasis with circumscribed local invasiveness and suggests that endoscopic resection may be feasible.     

Rare presentation of renal cell carcinoma: Solitary sternal metastasis

Renal cell carcinoma (RCC) may present as metastatic disease. However, RCC with solitary sternal metastasis is rare. We report a rare case of RCC with synchronous solitary sternal metastasis. The patient underwent radical nephrectomy, sternal tumour resection and reconstruction as a one‐stage procedure. The role of open sternal biopsy is also described. Review of the literature was carried out and a reasonably lengthy survival was observed. We concluded that radical surgical resection and reconstruction may offer the best chance of survival in managing RCC with solitary sternal metastasis in renal cell carcinoma.     

Endoprosthetic elbow replacement in patients with solitary metastasis resulting from renal cell carcinoma

Renal cell carcinoma is one of the most common cancers, and solitary metastasis to bone occurs in 2.5% of these patients. Localization of solitary metastasis to the elbow joint is rarer still, and data about these patients are limited. Because, in these cases, metastasis presents with osteolytic bone destruction, radical removal of solitary lesions should be considered. The aim of this treatment is to control the tumor locally, to reduce pain, and to restore function. We describe 4 patients with a solitary metastasis to the elbow from renal cell carcinoma who had the tumor resected and were then fitted with a custom-made elbow prosthesis. After surgical reconstruction, all patients reported markedly reduced pain and had a good functional outcome. The literature and our experience indicate that the prognosis for patients with just a solitary metastasis is sufficiently encouraging to warrant the use of all surgical and oncologic treatment options, especially if the interval between the diagnosis of the primary tumor and the development of the metastasis is lengthy.     

Metastatic renal cell carcinoma mimicking a meningioma

We report a patient with renal cell carcinoma metastatic to the left trigone, which mimicked an intraventricular meningioma. The metastasis was recognized 1.3 years after removal of the primary tumor, a longer disease-free interval than any previously reported cases with brain metastases of renal cell carcinoma. The patient is now free of disease of years after resection and 17 years after the discovery of the primary tumor. Metastatic disease should be considered in all patients with prior resection of renal cell carcinoma who experience the onset of neurological disease, even after a prolonged disease-free interval. Long term survival is observed after the resection of solitary metastases, particularly if these appear after a prolonged disease-free interval.     

Renal cell carcinoma with solitary metachronous metastasis to the urinary bladder

We report a case of renal cell carcinoma with solitary metachronous metastasis to the urinary bladder occurring 6 years after radical nephrectomy. The patient was treated with partial cystectomy and survived for 60 months. Other cases like this one were reviewed in published reports, and the 3-year survival rate for patients with this type of cancer with solitary metastasis to the urinary bladder was found to be 80%. The follow-up duration of our case was the longest in the published studies. We suggest that urinary bladder metastasis of renal cell carcinoma should be resected because no effective treatment for metastatic renal cell carcinoma is available. A good prognosis may be expected, especially in patients with solitary metastasis to the urinary bladder.     

Pancreatic metastasis of renal cell carcinoma: presentation, treatment and survival

PURPOSE: The pancreas is an uncommon site of metastasis from renal cell carcinoma, comprising 2% of pancreatic tumors removed in sizable series of operations. To our knowledge the role of operative resection in the setting of metastatic malignancy to the periampullary region has not yet been defined. We reviewed the records of 6 women and 2 men who underwent pancreatic resection due to malignancy and analyzed various prognostic factors. MATERIALS AND METHODS: Between 1985 and 1995, 269 patients underwent pancreatic resection for malignancy at our hospitals, including 150 (56%) for pancreatic duct cancer, 65 (24%) for carcinoma of the ampulla, 27 (10%) for distal bile duct cancer, 19 (7%) for duodenal carcinoma and 8 (3%) for renal cell carcinoma metastasis. We reviewed the records of these latter 8 cases, and analyzed demographics, primary tumor type, disease-free interval, resection type, concomitant other organ resection, histological examination of the specimen, morbidity, adjuvant therapy and survival. RESULTS: Pancreatic metastasis of renal cell carcinoma was managed by duodenopancreatectomy in 5 patients and total pancreatectomy in 3. There were no perioperative deaths. Mean tumor size in cases of a solitary pancreatic metastasis was 4 cm. (range 1.5 to 8). In the 3 patients treated with total pancreatectomy there were 2, 5 and 3 pancreatic metastases, respectively. Pathological examination revealed negative lymph nodes in all cases. Mean survival was 48 months. At study end 6 patients were alive at 24, 26, 30, 46, 84 and 88 months, while 2 died at 13 and 70 months, respectively. CONCLUSIONS: We advocate aggressive surgical resection when possible. Surgical removal of metastatic lesions prolongs survival but radical lymph node dissection is not mandatory. We also recommend careful long-term followup of patients with a history of renal cell carcinoma.     

Surgical treatment for metastatic lesions from renal cell carcinoma

We report our experience on operations for solitary metastasis from renal cell carcinoma. Two cases had bone metastasis, and 2 cases brain metastasis. In 3 cases, the symptoms from the metastasis had remained absent for several months after the operation. One case was cancer-free for 2 years. Surgical treatment was useful for the solitary metastasis from the renal cell carcinoma. We examined both the primary lesion and metastatic lesion histopathologically. Pathological findings revealed grade-up and change of cell subtype in metastasis.     

Bladder metastasis of renal cell carcinoma : report of a case

A 65-year-old man presented with gross hematuria in 2004. Computed tomography (CT) showed a left renal mass, and he underwent laparoscopic radical nephrectomy. Pathological diagnosis was clear cell carcinoma (pT2N0M0, G2＞G3). Four years later, a right adrenal tumor was disclosed by follow-up CT. Then laparoscopic adrenectomy was performed. Histology showed metastasis of the renal clear cell carcinoma. In 2009, he noticed gross hematuria, and cystoscopy revealed a 2cm solitary, non-papillary tumor at the anterior wall of the bladder. At the same time, small solitary liver metastasis (6 mm) was observed on abdominal CT. Transurethral resection of the bladder tumor and resection of liver tumor was performed, and pathological diagnosis was clear cell carcinoma both in vesical and hepatic masses. Nine months after the last surgery, he is living with no obvious tumor recurrence. To our knowledge this case is the 34th case of bladder metastasis from renal cell carcinoma in the Japanese literature. We reviewed literature and discuss the clinical features of bladder metastasis of renal cell carcinoma.     

Intramedullary spinal cord metastasis from renal cell carcinoma mimicking intramedullary hemangioblastoma

A rare case of intramedullary spinal cord metastasis from renal cell carcinoma mimicking intramedullary hemangioblastoma was described. A 57-year-old man had a nephrectomy for renal cell carcinoma in the left kidney 5 years ago, and no recurrence or metastasis was found in computed tomography and bone scintigraphy. Later, the patient was presented as having bilateral shoulder pain and severe palsy of bilateral upper and lower extremities, and a solitary tumor in the intramedullary spinal cord was found at the C4 level. Excision of the tumor was performed and the intraoperative pathological diagnosis suspected the tumor to be hemangioblastoma. However, a final pathological examination revealed characteristics consistent with metastasis of renal cell carcinoma. Although the patient’s neurological condition and neuralgia initially slightly deteriorated postoperatively, they then gradually improved. Twenty-two months after the operation, a follow-up magnetic resonance imaging showed no recurrence of intramedullary spinal cord tumor, and there were no other metastases found in other organs.     

Long-term survival cases of lung cancer presented as solitary bone metastasis.

The prognosis of non-small cell lung carcinoma (NSCLC) with bone metastasis has been regarded as very poor. We report herein on two cases of NSCLC which presented as a solitary bone metastasis, were treated with surgical resection. Both these cases survived for over 5 years after their last operations. A 71-year-old-man was hospitalized with right crural pain. A diagnosis of squamous cell carcinoma of the left lower lobe with right fibula metastasis was made. A marginal resection of the right fibula was performed. After that, a left lower lobe lobectomy and systemic chemotherapy were carried out. He had a local recurrence in the right mediastinal lymph nodes eleven months after the operation. He received intraluminal and external radiation therapy and obtained complete remission. He has survived for 5 years without any other recurrence or metastasis. A 52-year-old-man was admitted to our hospital with left thigh pain. A diagnosis of adenocarcinoma of the right upper lobe with left thigh metastasis was made. A right upper lobe lobectomy and a resection of the left thigh tumor were performed. Three cycles of systemic chemotherapy were given after that. He has survived for 5 years since his last operation without any recurrence or metastasis.     

Solitary liver metastasis of chromophobe renal cell carcinoma 20 years after nephrectomy treated by hepatic resection

A small proportion of patients with metastatic renal cell carcinoma have operable liver metastases, as there is often multiple dissemination within the liver and to other organs. We present a case of a solitary liver metastasis found incidentally 20 years after radical nephrectomy for a chromophobe renal cell carcinoma. The patient underwent a liver resection with tumor-free margins and recovered uneventfully. Time will tell if this was oncologically successful.     

Treatment of osseous metastases in patients with renal cell carcinoma

The records of 99 patients treated at one institution for osseous metastases secondary to renal cell carcinoma were reviewed. Patients were followed up for at least 24 months or until death. Survival was analyzed with respect to age, gender, disease-free interval, location of osseous metastases, number of osseous metastatic sites, resection of osseous metastases, and primary tumor resection. The mean age of the 72 men and 27 women was 60 years (range, 34-82 years) and the mean followup was 20 months (range, 2-81 months). Twenty-six patients (26%) had a solitary osseous metastasis, 47 patients (48%) had multiple osseous metastases, and 26 patients (26%) had additional visceral involvement such as the lung and brain at the time of diagnosis. In 49 patients (49%), the renal cell carcinoma was diagnosed concurrently with detection of the osseous metastasis. The presence of one osseous renal carcinoma metastasis, wide resection of the lesion, and a history of nephrectomy were identified as independent predictors of survival in patients with renal cell carcinoma. The eight patients who had wide resection of a solitary osseous metastasis in combination with a nephrectomy had a disease-specific survival rate of 100% (mean followup, 69 months; range, 24-76 months). Patients who present with these characteristics are candidates for aggressive surgical treatment with curative intent.     

Isolated Late Metastasis of a Renal Cell Cancer Treated by Radical Distal Pancreatectomy

A 53–year-old man underwent right nephrectomy for a locally advanced renal cell carcinoma with concomitant resection of a solitary metastasis in the right lung. Ten years later, he presented with haematochezia caused by a tumour in the tail of pancreas, invading the transverse colon and the greater curvature of the stomach. The tumour was radically resected, and histological examination revealed a solitary metastasis of the previous renal cell carcinoma. This case illustrates a rare indication for pancreatic resection because of pancreatic metastasis.     

Metastatic renal cell carcinoma of bone: indications and technique of surgical intervention

PURPOSE: We describe the efficacy of surgical excision of metastatic renal cell carcinoma of bone for achieving local tumor control, pain control and functional outcome with emphasis on the indications and techniques of surgical intervention as well as oncological outcome. MATERIALS AND METHODS: Between 1980 and 1997 we performed surgery on 45 patients (56 lesions) with metastatic renal cell carcinoma of bone. Indications for surgery were solitary bone metastasis, intractable pain, or impending or present pathological fracture. Surgery involved wide excision in 29 cases, marginal excision with adjunctive liquid nitrogen in 25 and amputation in 2. RESULTS: None of the patients had significant bleeding intraoperatively. Mean hospital stay was 9.8 days, during which there was no flap necrosis, deep wound infection, nerve palsy or thromboembolic complication. Postoperatively pain was significantly relieved in 91% of patients, while 89% achieved a good to excellent functional outcome, and 94% with metastatic lesions of the pelvic girdle and lower extremities were ambulatory. Local recurrence developed in only 4 of the 56 lesions (7.1%), including 3 after marginal resection. Survival was more than 2 years in 22 patients (49%) and more than 3 in 17 (38%). CONCLUSIONS: Surgical excision is safe and reliable for restoring mechanical bone stability, relieving pain and providing good function in most patients with metastatic renal cell carcinoma who meet the criteria for surgical intervention. Relatively prolonged survival in these cases justifies considering surgical intervention when feasible.     

Total calcanectomy for metastasis of renal cell carcinoma in the calcaneus: A case report

We present a rare case of metastasis of renal cell carcinoma to the calcaneus in a 59-year-old man who presented with pain and inability to bear weight on the left foot 3 years after right nephrectomy for renal cell carcinoma. He successfully underwent en bloc resection of his right calcaneus with a limb salvage procedure, total calcanectomy without bony reconstruction. Histological findings identified the lesion as a metastasis originating from a renal cell carcinoma. Recent follow-up examination showed no recurrence. To the best of our knowledge, this is the first reported case to be treated with total calcanectomy for renal cell carcinoma metastasis.     

Solitary Colonic Metastasis of Renal Cell Carcinoma

We report a rare case of a solitary metastasis of a renal cell carcinoma which manifested as a primary colonic tumour. A 60-year-old male patient who had undergone a right radical nephrectomy 5 years previously for renal cell carcinoma, presented with a history of dyspepsia and pain in the right upper abdomen. A mass on the hepatic flexure was detected by computed tomography and colonoscopy and right hemicolectomy was performed. Postoperative histo-logical examination revealed that the tumour was a metastatic renal cell carcinoma of the clear cell type.     

Solitary colonic metastasis of renal cell carcinoma

We report a rare case of a solitary metastasis of a renal cell carcinoma which manifested as a primary colonic tumour. A 60-year-old male patient who had undergone a right radical nephrectomy 5 years previously for renal cell carcinoma, presented with a history of dyspepsia and pain in the right upper abdomen. A mass on the hepatic flexure was detected by computed tomography and colonoscopy and right hemicolectomy was performed. Postoperative histological examination revealed that the tumour was a metastatic renal cell carcinoma of the clear cell type.     

局限性肾癌保留肾单位手术20例分析

目的探讨保留肾单位手术（nephrom-sparing surgery,NSS）治疗局限性肾癌的安全性和疗效。方法回顾性分析20例行NSS肾癌患者的临床资料,其中双侧肾癌1例,孤立肾肾癌1例,对侧肾有病变或潜在功能损害的肾癌3例,对侧肾正常的肾癌15例。肿瘤直径平均3.9（1.3-7.4）cm。行肿瘤剜除术13例,肾部分切除术4例,肾楔形切除术3例。结果 20例患者手术均成功。术后平均随访29（15-37）个月,1例双侧肾癌患者术后14月出现远处转移死亡,1例术后12个月因局部复发改行根治性肾切除术,2例术后出现暂时性肾功能不全。结论 NSS治疗肾癌安全有效,尤其适用于局限性肾癌患者。