Renal cell carcinoma and osseous metastases. Case report and literature review.

ABSTRACT

Renal cell carcinoma is one of the great mimics in medicine. The diagnosis is complicated by clinical presentations involving a multitude of symptoms, often associated with the sites of metastasis. A high percentage of renal cell carcinomas have metastasized at the time of initial presentation, and symptoms associated with this metastasis may actually initiate the diagnosis. Because the site of tumor origin is frequently unknown, a diagnostic strategy for identifying the primary source has been proposed. The prognosis for renal cell carcinoma with metastasis is poor, with fewer than 9% of patients surviving at 5 years. Consequently, treatment is directed primarily at palliation of painful symptoms and stabilization of bony structures. With these goals in mind, treatment modalities run the gamut from radiotherapy, to curettage with polymethyl methacrylate augmentation, to amputation. In the case reported here, renal cell carcinoma was diagnosed in the course of evaluation of a painful lytic lesion of the foot. Treatment alternatives and associated risks and complications were discussed at some length and the patient chose curettage and packing with polymethyl methacrylate in combination with radiotherapy. This approach was successful in palliation of pain and maintenance of walking ability and independence.