Bilateral renal cell carcinoma presenting as fracture tibia

Solitary Metastatic Lesion of the Tibia from Clear Cell Renal Carcinoma: A Case Report of Segmental Skeletal Resection, Intercalary Allograft Over Reamed Nailing and Soleus Flap Interposition

BACKGROUND Renal cell carcinoma (RCC) is the most common malignancy of the kidney, with clear cell (ccRCC) subtype identified in 85% of the cases; one-third of these patients experience synchronous metastatic disease, while 20-30% of the remaining patients develop metachronous metastatic RCC. The axial skeleton (pelvis and sacrum) is the second most common location (following the lungs), with a reported incidence of 35%. Diaphysis of the long bones is rarely involved, with the tibia being an even rarer site of metastasis. CASE REPORT We present a rare case of solitary diaphyseal tibial metachronous metastasis from RCC in a 54-year-old male that appeared 8 years after nephrectomy without any previous evidence of disease. He underwent segmental skeletal resection, intercalary allograft over locked reamed intramedullary nailing, and soleus flap coverage. Thirty months later he presented with hardware failure and nonunion at the distal part of the allograft site. He was successfully treated with exchange nailing, fibular osteotomy, and bone grafting, showing excellent clinical and radiological outcome without any evidence of recurrence 5 years after the index operation. CONCLUSIONS Wide resection and biological reconstruction using intramedullary nailing and incorporated allograft is a good option for metachronous solitary RCC tumors.

Renal Cell Carcinoma with Unusual Skeletal Metastasis to Tibia and Ankle: A Case Report and Review of Literature

Renal Cell Carcinoma (RCC) accounts for 5% of the epithelial malignancies worldwide with clear cell carcinoma accounting for 85% of these malignancies. One third of these patients experience synchronous metastatic disease and 20-30% of the remaining patients experience metachronous metastatic RCC. Bony metastasis accounts for 20% of metastatic RCC. They most commonly affect the axial skeleton and rarely the long bones or the small bones of the hands and feet. Bone metastases from RCC are predominantly osteolytic in nature, leading to significant patient morbidity due to the associated Skeletal Related Events (SRE). SREs may significantly decrease patient quality of life. Bone pain is most common SRE and radiotherapy is most common form of treatment. Only 2% of the patients require surgery. Here we present a case of advanced RCC with tibial and ankle metastasis who presented to us after one year of radical nephrectomy with severe pain and inability to walk and underwent above knee amputation.

Bilateral acrometastasis in a case renal cell carcinoma

We present a unique case of bilateral skeletal metastasis below the knee in a patient with renal cell carcinoma. In this rarest of rare cases, bony metastases were the first presentation of a primary tumour. Incidentally, the primary tumour (renal cell carcinoma) involved the solitary kidney of the patient and the same patient also had coexisting carcinoma of the prostate.