Indian Journal of Urology
CASE REPORT
Year
: 2001  |  Volume : 17  |  Issue : 2  |  Page : 174--175

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

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



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;17:174-175


How to cite this URL:
Rajeev T P, Dorairajan L N, Hemal A K. Chest horn: An unusual metastasis from renal cell carcinoma. Indian J Urol [serial online] 2001 [cited 2022 Oct 2 ];17:174-175
Available from: https://www.indianjurol.com/text.asp?2001/17/2/174/20267


Full Text

 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

1Amo-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.
2William 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.
3Paez 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.
4Haruki 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.
5Peterson JL, McMarlin SL. Metastatic renal cell carcinoma present­ing as a cutaneous horn. J Dermatol Surg Oncol 1983; 9: 815-818.
6Franck W, Stuhldreher D, Saffrin R, Shott S, Guinan P. Stage IV renal cell carcinoma. J Urol 1994; 152: 1998-1999.
7Rackley 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.