Images in Clinical Urology Solitary Facial Cutaneous Metastasis as the Primary Presentation of a Small Renal Cell Carcinoma Marc A. Bjurlin, Vishal Bhalani, Michael D. Jordan, and Courtney M. P. Hollowell Renal cell carcinoma (RCC) has been well described for its frequency to metastasize. Cutaneous facial lesions as the primary presentation of RCC is, however, extremely rare. We present clinical, radiographic, and histologic images of a 40-year-old man who presented with a cutaneous facial lesion that was diagnosed as metastatic RCC after excisional biopsy. A subsequent computed tomography demonstrated a small mass (3.5 ⫻ 2.6 cm) in the midpole of the right kidney. Partial nephrectomy with histologic analysis confirmed RCC, clear cell type. UROLOGY 76: 1377–1378, 2010. © 2010 Elsevier Inc.
Figure 1. Facial cutaneous metastasis of renal cell carcinoma.
A
40-year-old man presented with a history of an enlarging facial lesion. Physical examination showed a 1 cm cutaneous lesion adjacent to the left oral commissure (Fig. 1). An excisional biopsy demonstrated renal cell carcinoma (RCC), clear cell type (Fig. 2A). A subsequent contrast-enhanced computed tomography of the abdomen and pelvis revealed a small 3.5 ⫻ 2.6 cm right renal mass (Fig. 3). A right partial nephrectomy was performed. Histopathology confirmed RCC, clear cell type, stage T3a (Fig. 2B). At 3 months follow-up, he is without evidence of further disease. From the Division of Urology, Department of Surgery, Cook County Health and Hospitals System, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois; and Department of Urology, Northwestern University, Chicago, Illinois Reprint requests: Courtney M.P. Hollowell, M.D., F.A.C.S., Division of Urology, Department of Surgery, Cook County Health and Hospitals System, John H. Stroger, Jr Hospital of Cook County, 1900 W. Polk St, Suite 465, Chicago, IL 60612. E-mail:
[email protected] Submitted: October 10, 2009, accepted (with revisions): November 28, 2009
© 2010 Elsevier Inc. All Rights Reserved
Figure 2. Hematoxylin and eosin, 40⫻ magnification. (A) Skin surface with underlying vascular clear cell proliferation consistent with clear cell carcinoma. (B) Renal tumor with same morphology invading through capsule into perinephric fat.
RCC frequently metastasizes, occurring in approximately 30% of patients at time of diagnosis. Head, neck, and cutaneous metastases are uncommon. A cutaneous 0090-4295/10/$36.00 doi:10.1016/j.urology.2009.11.054
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facial lesion as the primary presentation of RCC is extremely rare, especially in light of no other organ involvement and no past history of RCC.1 There exists a low but not insignificant risk of synchronous metastatic disease in small renal tumors. In a review of metastatic RCC risk according to size, Thompson et al2 found a 2% incidence of synchronous metastases in renal masses sized ⬍4 cm. Although rare, this case shows that a small renal mass can present as a synchronous metastatic facial lesion.
References
Figure 3. Contrast-enhanced computed tomography demonstrating a small (3.5 ⫻ 2.6 cm) right renal mass.
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1. Porter NA, Anderson HL, Al-Dujaily S. Renal cell carcinoma presenting as a solitary cutaneous facial metastasis: case report and review of the literature. Int Semin Surg Oncol. 2006;12:27. 2. Thompson RH, Hill JR, Babayev Y, et al. Metastatic renal cell carcinoma risk according to tumor size. J Urol. 2009;182:41-45.
UROLOGY 76 (6), 2010