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| Year : 2008 | Volume
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| Issue : 4 | Page : 157-158 |
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| Cutaneous metastasis in renal cell carcinoma |
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Shamshad Ahmad, Uzma Zafar, Farhan A Siddiqui, Kafil Akhtar
Department of Pathology, J.N. Medical College, A.M.U., Aligarh, India
Click here for correspondence address and email
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 Abstract | | |
A case of renal cell carcinoma (RCC) occurring in a 65 year-old male presenting primarily as cutaneous metastasis to the chest, is being reported for its unusual presentation in the form of a skin nodule, even before the development of any urological presentation. RCC had metastasised to the liver as well. This case emphasises the importance of looking for a primary renal cancer in cutaneous metastasis cases as most of these patients have recurrent or multifocal metastatic disease.
Keywords: Chest; cutaneous metastasis; renal cell carcinoma.
How to cite this article:
Ahmad S, Zafar U, Siddiqui FA, Akhtar K. Cutaneous metastasis in renal cell carcinoma. J Cytol 2008;25:157-8 |
| Introduction | |  |
Cutaneous metastasis, a rare primary manifestation of cancer, is usually seen in advanced stages and portends poor prognosis. Common primary tumors that cause cutaneous metastasis include those of the lung (28.6%), malignant melanomas (18.2%), and of the gastrointestinal tract (14.2%). [1] Renal cell carcinoma (RCC), in particular, presenting as a cutaneous metastatic deposit is quite infrequent; rarer still is a cutaneous metastatic lesion being the presenting manifestation of an undetected, asymptomatic renal cell carcinoma. [2] Hence, the authors take this opportunity to report a case of silent RCC presenting primarily as a cutaneous nodule.
| Case Report | | |
A 65 year-old male presented to our hospital with the complaint of localised low back pain for the past six months. There was no history of any trauma but the pain had gradually increased in severity. There was no neurological or urological involvement. General examination revealed a male of average build with mild pallor. Systemic examination did not reveal any abnormalities whereas the local examination showed a single, painless cutaneous nodule on the right side of the chest, measuring 2 × 1 cm, firm in consistency, and nonulcerating.
Fine needle aspiration cytology (FNAC) of the cutaneous lesion revealed a heterogeneous, clear cell population showing cytoplasmic vacuolation, central to eccentric nuclei, a few with prominent nucleoli [Figure 1]. Cells with acinar and papillary configuration were also seen along with a few barely malignant nuclei [Figure 2]. A tentative diagnosis of clear cell carcinoma, most probably renal in origin, was made as the patient had low back pain.
Radiograph of the spine showed features of osteoarthritis in the lumbar region. Ultrasonography (USG) of the abdomen showed a large, heterogeneous mass at the upper pole of the right kidney [Figure 3]. The size and volume of the mass were 112 × 127.7 × 96 mm and 717.8 cm 3 respectively. The liver also showed heterogeneous lesions suggesting liver metastasis. USG-guided FNAC was done from the renal mass and liver, and revealed cells similar to those seen in smears from the cutaneous nodule.
In correlation with the USG findings, a diagnosis of renal cell carcinoma-clear cell type of the right kidney with liver and cutaneous metastasis was made.
| Discussion | | |
RCC represents approximately 85% of all primary renal neoplasms. [3] Up to 1/3 rd of all RCC patients present with metastasis, with lung and bone being the most common sites. Cutaneous metastasis from RCC is uncommon, with an incidence of approximately 2.4-6.4%. [4]
According to Dorairajan et al. , [5] cutaneous metastasis from RCC is believed to be rare (3.3%), and the scalp was the most common site of metastasis, followed by the chest and the abdomen. Most (90%) of the patients had secondaries in at least one other site, most commonly, the lung and the bone. Our case had cutaneous metastasis along with secondaries in the liver.
The cutaneous metastasis of RCC has been described as painless nodules, plaques, or pulsatile masses ranging from flesh-colored to violaceous. [6] Our case presented as a solitary, well defined, painless, subcutaneous nodule of 2 × 1 cm size, firm, and nonulcerating.
Tabatabai and Staerkel [7] are of the opinion that the presence of a heterogenous cell population, hemosiderin deposits, small cytoplasmic vacuoles, and low nucleocytoplasmic ratio aids in differentiating conventional RCC from other malignant neoplasms. The cytological features in our case were similar to the aforementioned ones except for the absence of hemosiderin deposits.
Cutaneous metastasis from RCC is regarded as an unusual and late manifestation of the disease. [8] At times, an RCC patient may present with cutaneous metastasis even before the detection of the primary renal tumor. [5] Thus, the skin lesions may help to diagnose a case of silent RCC as well as inform us about the progression and metastatic nature of the disease. It is therefore advised that the skin should be examined during tumor evaluation as a part of the physical examination, and skin lesions in RCC patients should be evaluated aggressively to rule out cutaneous metastasis.
| References | | |
| 1. | Preetha R, Kavishwar VS, Butle P. Cutaneous metastasis from silent renal cell carcinoma. J Postgrad Med 2004;50:287-8.  |
| 2. | Koga S, Tsuda S, Nishikido M, Matsuya F, Saito Y, Kanetake H. Renal cell carcinoma metastatic to the skin. Anticancer Res 2000;20:1939-40. [PUBMED] |
| 3. | Garcia Torrelles M, Beltran Armada JR, Verges Prosper A, Santolaya Garcia JI. Espinosa Ruiz JJ, Tarin Planes M, et al . Cutaneous metastases of renal cell carcinoma. Actas Urol Esp 2007;31:556-8. |
| 4. | Koga S, Tsuda S, Nishikido M, Matsuya F, Saito Y, Kanetake H. Renal cell carcinoma metastatic to the skin. Anticancer Res 2000;20:1939-40. [PUBMED] |
| 5. | Dorairajan LN, Hemal AK, Aron M, Rajeev TP, Nair M, Seth A, et al . Cutaneous metastases in renal cell carcinoma. Urol Int 1999;63:164-7. [PUBMED] [FULLTEXT] |
| 6. | Lim C, Chan R, Regan W. Renal cell carcinoma with cutaneous metastases. Australas J Dermatol 2005;46:158-60. [PUBMED] [FULLTEXT] |
| 7. | Tabatabai ZL, Staerkel GA. Distinguishing primary and metastatic conventional renal cell carcinoma from other malignant neoplasms in fine needle aspiration biopsy specimens. Arch Pathol Lab Med 2005;129:1017-21. [PUBMED] [FULLTEXT] |
| 8. | Williams JC, Heaney JA. Metastatic renal cell carcinoma presenting as a skin nodule: Case report and review of the literature. J Urol 1994;152:2094-5. [PUBMED] |
Correspondence Address:
Farhan A Siddiqui
Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh - 202 002, UP
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9371.50804
[Figure 1], [Figure 2], [Figure 3] |
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