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| Metachronous chest wall metastasis from clear cell renal cell carcinoma—A rarity |
Hardik Patela,P. Ashwin Shekara,*( ),Dinesh Reddya,Sandhya Ramachandranb
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a Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, India
b Department of Pathology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, India |
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Abstract A 55-year-old male who underwent left radical nephrectomy, 4 years back for a left renal mass, presented with swelling over left chest since 2 months. His initial histopathology report of the radical nephrectomy specimen mentioned a 7.2 cm×6 cm large renal mass involving the upperpole of the left kidney which was infiltrating the renal sinus and was reported as a stage pT3a clear cell carcinoma with Fuhrman's grade III nuclei. On physical examination, non-tender, firm swelling approximately 10 cm×5 cm sized was seen and palpated in the left upper chest (Fig. 1). His current blood biochemical workup including liver function tests was normal. Contract enhanced computed tomography (CECT) of abdomen showed empty left renal fossa with no evidence of recurrence. CECT of the chest showed two well defined, heterogenous enhancing lesions with central necrosis, involving anterior chest wall muscle and extended up to the left lateral cardiac border with the larger one being approximately 99 mm×47 mm in size (Fig. 2). Subsequently, percutaneous trucut biopsy from the chest wall swelling was performed which on histopathological examination was confirmed as clear cell carcinoma similar to the previous radical nephrectomy specimen. He was started on tyrosine kinase inhibitors (TKI). At 2-month follow-up, the patient is doing well and there has been a marginal reduction in size of the lesion. We plan to re-examine the patient after another month, see for any further reduction in size and do a metastatic workup before counselling for local surgical resection, if there's a good therapeutic response.
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Received: 23 April 2020
Available online: 20 October 2021
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Corresponding Authors:
P. Ashwin Shekar
E-mail: ashwindoc1@yahoo.com
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Clinico-radiologic images. (A) Clinical photograph showing the large mass on the left chest wall; (B and C) Axial and sagittal cuts of contrast enhanced computed tomography images showing two well defined, heterogeneously enhancing soft tissue density lesions with central necrotic core involving ribs and anterior chest wall muscle.
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Histopathology images. (A) Photomicrograph of old nephrectomy specimen showing clear cells with abundant cytoplasm suggestive of clear cell carcinoma with delicate vascular network with blood vessel invasion and renal sinus invasion (HE stain, 100× magnification); (B) Photomicrograph of core biopsy specimen from chest wall mass showing similar clear cells with abundant cytoplasm suggestive of clear cell carcinoma (HE stain, 100× magnification). HE, hematoxylin and eosin.
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