Metastatic Renal Cell Carcinoma Without Evidence of a Primary Renal Mass
CUA Online Library. Kumar R. 06/24/13; 31270; MP-03.13
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Abstract
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Introduction & Objectives: Metastatic renal cell carcinoma (mRCC) generally presents with evidence of a primary renal mass, except in cases of metachronous mRCC after nephrectomy for RCC. Here we present two cases of mRCC with no detectable primary renal mass.
Methods: Patients were identified by retrospective review of a database including patients treated at a multidisciplinary mRCC clinic at a tertiary center (Juravinski Cancer Center, Hamilton, ON) from 2009-2012. Patients were included in this series if they had histologically confirmed evidence of mRCC in one or more distant sites without radiologic evidence of a primary renal mass.
Results: Two patients were identified that met inclusion criteria. Both patients had bilateral native kidneys in-situ and no prior urological history. Multiple specialists have reviewed the radiology and pathology for both patients. Patient 1 presented with a hip fracture and was found to have multiple radiologic bony and lung metastases. Biopsy of a mass involving the pubic bone demonstrated clear cell mRCC. Multiple CT scans and a confirmatory MRI have demonstrated no renal mass. Patient 1 has had disease stabilization with sunitinib for 12 months and remained alive at last follow up. Patient 2 was diagnosed with clear cell mRCC after thickened synovium was biopsied during knee arthoplasty. Multiple CT scans demonstrated no primary renal mass. Sunitinib and radiotherapy to the knee lesion were commenced but, shortly after diagnosis, the patient clinically deteriorated with disease progression and passed away.
Conclusion: mRCC without evidence of a primary renal mass is a rare phenomenon. We hypothesize that this occurs when the primary tumor is burnt out or radiologically-occult. When the diagnosis of mRCC is certain, we hypothesize it reasonable to manage metastases in these patients similar to those with a primary renal tumor.
Methods: Patients were identified by retrospective review of a database including patients treated at a multidisciplinary mRCC clinic at a tertiary center (Juravinski Cancer Center, Hamilton, ON) from 2009-2012. Patients were included in this series if they had histologically confirmed evidence of mRCC in one or more distant sites without radiologic evidence of a primary renal mass.
Results: Two patients were identified that met inclusion criteria. Both patients had bilateral native kidneys in-situ and no prior urological history. Multiple specialists have reviewed the radiology and pathology for both patients. Patient 1 presented with a hip fracture and was found to have multiple radiologic bony and lung metastases. Biopsy of a mass involving the pubic bone demonstrated clear cell mRCC. Multiple CT scans and a confirmatory MRI have demonstrated no renal mass. Patient 1 has had disease stabilization with sunitinib for 12 months and remained alive at last follow up. Patient 2 was diagnosed with clear cell mRCC after thickened synovium was biopsied during knee arthoplasty. Multiple CT scans demonstrated no primary renal mass. Sunitinib and radiotherapy to the knee lesion were commenced but, shortly after diagnosis, the patient clinically deteriorated with disease progression and passed away.
Conclusion: mRCC without evidence of a primary renal mass is a rare phenomenon. We hypothesize that this occurs when the primary tumor is burnt out or radiologically-occult. When the diagnosis of mRCC is certain, we hypothesize it reasonable to manage metastases in these patients similar to those with a primary renal tumor.
Introduction & Objectives: Metastatic renal cell carcinoma (mRCC) generally presents with evidence of a primary renal mass, except in cases of metachronous mRCC after nephrectomy for RCC. Here we present two cases of mRCC with no detectable primary renal mass.
Methods: Patients were identified by retrospective review of a database including patients treated at a multidisciplinary mRCC clinic at a tertiary center (Juravinski Cancer Center, Hamilton, ON) from 2009-2012. Patients were included in this series if they had histologically confirmed evidence of mRCC in one or more distant sites without radiologic evidence of a primary renal mass.
Results: Two patients were identified that met inclusion criteria. Both patients had bilateral native kidneys in-situ and no prior urological history. Multiple specialists have reviewed the radiology and pathology for both patients. Patient 1 presented with a hip fracture and was found to have multiple radiologic bony and lung metastases. Biopsy of a mass involving the pubic bone demonstrated clear cell mRCC. Multiple CT scans and a confirmatory MRI have demonstrated no renal mass. Patient 1 has had disease stabilization with sunitinib for 12 months and remained alive at last follow up. Patient 2 was diagnosed with clear cell mRCC after thickened synovium was biopsied during knee arthoplasty. Multiple CT scans demonstrated no primary renal mass. Sunitinib and radiotherapy to the knee lesion were commenced but, shortly after diagnosis, the patient clinically deteriorated with disease progression and passed away.
Conclusion: mRCC without evidence of a primary renal mass is a rare phenomenon. We hypothesize that this occurs when the primary tumor is burnt out or radiologically-occult. When the diagnosis of mRCC is certain, we hypothesize it reasonable to manage metastases in these patients similar to those with a primary renal tumor.
Methods: Patients were identified by retrospective review of a database including patients treated at a multidisciplinary mRCC clinic at a tertiary center (Juravinski Cancer Center, Hamilton, ON) from 2009-2012. Patients were included in this series if they had histologically confirmed evidence of mRCC in one or more distant sites without radiologic evidence of a primary renal mass.
Results: Two patients were identified that met inclusion criteria. Both patients had bilateral native kidneys in-situ and no prior urological history. Multiple specialists have reviewed the radiology and pathology for both patients. Patient 1 presented with a hip fracture and was found to have multiple radiologic bony and lung metastases. Biopsy of a mass involving the pubic bone demonstrated clear cell mRCC. Multiple CT scans and a confirmatory MRI have demonstrated no renal mass. Patient 1 has had disease stabilization with sunitinib for 12 months and remained alive at last follow up. Patient 2 was diagnosed with clear cell mRCC after thickened synovium was biopsied during knee arthoplasty. Multiple CT scans demonstrated no primary renal mass. Sunitinib and radiotherapy to the knee lesion were commenced but, shortly after diagnosis, the patient clinically deteriorated with disease progression and passed away.
Conclusion: mRCC without evidence of a primary renal mass is a rare phenomenon. We hypothesize that this occurs when the primary tumor is burnt out or radiologically-occult. When the diagnosis of mRCC is certain, we hypothesize it reasonable to manage metastases in these patients similar to those with a primary renal tumor.
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