TY - JOUR
T1 - Renal cell carcinoma metastases to bone after a 33-year remission
AU - Parada, Stephen A.
AU - Franklin, Jillian M.
AU - Uribe, Paul S.
AU - Manoso, Mark W.
PY - 2009/6
Y1 - 2009/6
N2 - Renal cell carcinoma accounts for 2% of all cancers. Metastases to bone occur 35% to 40% of the time, second in prevalence of metastases only to the lungs. These metastases are highly destructive, hypervascular tumors known to be difficult to manage. This article reports a unique case in which a patient was disease free for 33 years from initial nephrectomy for treatment of primary renal cell carcinoma to discovery of metastatic disease to the pelvis. Search for an unknown primary was performed, consisting of a complete blood count, chemistry, alkaline phosphatase, calcium, serum and urine protein electrophoresis, immunoglobulin levels, prostate specific antigen, liver function tests, bone scan, and chest, abdomen, and pelvis computed tomography scans. This workup was negative for any other primary source of malignancy, and the patient's remaining kidney was found to be free from any tumor burden. The patient successfully underwent excisional biopsy of the lesion, which proved to be vascular in nature, consistent with the final pathology of renal cell carcinoma. The longest amount of time from completion of treatment for the primary renal cell carcinoma to discovery of the first metastatic disease has previously been reported at 22.3 years. Mean interval between primary treatment and discovery of metastases has been defined as 3.0±5.4 years. This article highlights the need for advanced medical workup as well as maintaining a high clinical suspicion in patients with remote histories of primary malignancies who present with bony lesions.
AB - Renal cell carcinoma accounts for 2% of all cancers. Metastases to bone occur 35% to 40% of the time, second in prevalence of metastases only to the lungs. These metastases are highly destructive, hypervascular tumors known to be difficult to manage. This article reports a unique case in which a patient was disease free for 33 years from initial nephrectomy for treatment of primary renal cell carcinoma to discovery of metastatic disease to the pelvis. Search for an unknown primary was performed, consisting of a complete blood count, chemistry, alkaline phosphatase, calcium, serum and urine protein electrophoresis, immunoglobulin levels, prostate specific antigen, liver function tests, bone scan, and chest, abdomen, and pelvis computed tomography scans. This workup was negative for any other primary source of malignancy, and the patient's remaining kidney was found to be free from any tumor burden. The patient successfully underwent excisional biopsy of the lesion, which proved to be vascular in nature, consistent with the final pathology of renal cell carcinoma. The longest amount of time from completion of treatment for the primary renal cell carcinoma to discovery of the first metastatic disease has previously been reported at 22.3 years. Mean interval between primary treatment and discovery of metastases has been defined as 3.0±5.4 years. This article highlights the need for advanced medical workup as well as maintaining a high clinical suspicion in patients with remote histories of primary malignancies who present with bony lesions.
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U2 - 10.3928/01477447-20090511-27
DO - 10.3928/01477447-20090511-27
M3 - Article
C2 - 19634812
AN - SCOPUS:70349171771
SN - 0147-7447
VL - 32
SP - 446
JO - Orthopedics
JF - Orthopedics
IS - 6
ER -