A solitary skeletal metastasis in the thumb of a silent bilateral clear cell renal cell carcinoma pT1a in a patient with a sporadic uro‑oncological triplicity

Czech version

Authors: Jan Novák ¹; Lukáš Fišer ¹; Robert Jůzek ²; Jan Lesenský ²; Jan Pertlíček ³; Zuzana Špůrková ⁴; Petra Beroušková ⁵; Lubomír Hyršl ¹
Authors‘ workplace: Urologické oddělení, Oblastní nemocnice Kladno, a. s., Kladno ¹; Ortopedická klinika, 1. LF UK a Nemocnice Na Bulovce, Praha ²; Chirurgické oddělení, Oblastní nemocnice Kladno, a. s., Kladno ³; Patologicko‑anatomické oddělení, Nemocnice Na Bulovce, Praha ⁴; Patologicko‑anatomické oddělení, Oblastní nemocnice Kladno, a. s., Kladno ⁵
Published in: Ces Urol 2017; 21(4): 299-304
Category: Case report

Overview

We present a case report of a 72-year old male with a long urological history (prostate adenocarcinoma after radical prostatectomy with rising PSA level and urothelial carcinoma pTa low grade with one recurrence) who underwent reconstructive surgery for a left thumb metastasis of a clear cell renal cell carcinoma. Repeated CT scans showed two tiny lesions in both kidneys during follow-up. Nephron-sparing surgery of the right kidney and left-sided nephroureterectomy in two sessions proved a bilateral clear cell renal cell carcinoma pT1a. The patient underwent genetic analysis by the sequence capture panel CZECANCA targeting 219 susceptibility genes to reveal a highly presumable hereditary cancer syndrome, but no significant mutation was found.

Kez words:
Solitary skeletal metastasis, bilateral kidney cancer, clear cell renal cell carcinoma pT1a, uro-oncological triplicity.

Sources

1. Ljungberg B, Albiges L, Bensalah K, et al. EAU guidelines on renal cell carcinoma. Arnhem: European Association of Urology; 2017.

2. Soukupová J, Zemánková P, Kleiblová P, Janatová M, Kleibl Z. CZECANCA: CZEch CAncer paNel for Clinical Application – Design and Optimization of the Targeted Sequencing Panel for the Identification of Cancer Susceptibility in High‑risk Individuals from the Czech Republic. Klin Onkol. 2016; 29(Suppl 1): S46–54.

3. Povýšil C, Šteiner I. Speciální patologie. 2., dopl. a přeprac. vyd. Praha: Galén; 2007. 430 s.

4. Boussios S, Zerdes I, Batsi O, et al. Pancreatic resection for renal cell carcinoma metastasis: an exceptionally rare coexistence. Int J Surg Case Rep. 2016; 27: 198–201.

5. Matsumoto K, Hayakawa N, Nakamura S, Oya M. Bladder metastasis from renal cell carcinoma: retrospective analysis of 65 reported cases. Clin Exp Metastasis. 2015; 32(2): 135–141.

6. Pastremoli A. Gingival metastasis, the first clinical sign of a silent kidney carcinoma. A case report. Minerva Stomatol. 1991; 40(12): 825–828.

7. Astl J, Bahannan AA, Dušková J, Novák Z, Vlcek P, Betka J. Solitary metastasis of clear renal cell carcinoma to thyroid gland: three reported cases with review of the literature. Gulf J Oncolog. 2017; 1(23): 67–71.

8. Hasan R, Kumar S, Monappa V, Ayachit A. Primary extra‑renal clear cell renal cell carcinoma masquerading as an adrenal mass: A diagnostic challenge. Urol Ann. 2015; 7(4): 513–515.

9. Novák P, Németh I, Hamar S, et al. Clear cell adenocarcinoma of the tongue. Coincidence or distant metastasis? Fogorv Sz. 2009; 102(5): 183–186.

10. Zeman V, Trnka V. Clear‑cell carcinoma of the thyroid gland. Cesk Patol. 1979; 15(2): 91–95.

11. Nissenbaum M, Kutz JE, Lister GD. Clear‑cell carcinoma of the lung metastatic to the hamate: a case report. Clin Orthop Relat Res. 1978; (134): 293–296.

12. Kim WJ, Kim SR, Choe YH, et al. Clear cell „sugar“ tumor of the lung: a well‑enhanced mass with an early washout pattern on dynamic contrast‑enhanced computed tomography. J Korean Med Sci. 2008;

23(6): 1121–1124.

13. Ozuguz P, Kocak M, Atasoy P, Vargel I, Cavusoglu T. Clear cell sarcoma. Indian Dermatol Online J. 2014; 5(4): 488–490. 14. Lal N, Singhai A. Clear cell sarcoma of kidney: a rare entity. Indian J Med Paediatr Oncol. 2011; 32(3): 157–159.

15. Lee H, Lee JK, Kim K, et al. Risk of metastasis for T1a renal cell carcinoma. World J Urol. 2016; 34(4): 553–559.

16. Thompson RH, Hill JR, Babayev Y, et al. Metastatic renal cell carcinoma risk according to tumor size. J Urol. 2009; 182(1): 41–45.

17. Damber J‑E, Peeker R. Urologi. Studentlitteratur; 2012. 549.