Renal cell carcinoma metastasis without a primary: A case report.

In Australia, approximately 3 % of all cancers diagnosed each year are renal cancers. Renal Cell Carcinoma (RCC) represents 90 % of all primary renal malignancies. RCC are slow growing and often asymptomatic, thus are often found incidentally. Here we present the case of a 76-year-old male who was found to have a metastatic RCC in a para-aortic lymph node with no primary lesion. He underwent a retroperitoneal lymphadenectomy and 15 months after the surgery, has had no signs of primary tumours or metastasis. This case reports on a rare instance of metastatic RCC without an identified primary renal malignancy.

Predicting the need for transfer and interventional angiography for patients with acute colonic haemorrhage in a regional setting.

BACKGROUND: Radiological angioembolization is an important strategy in management of acute colonic bleeding. Due to requirement for specialized interventional radiology, many hospitals rely on transfer for this service. This study aimed to identify patient and clinical factors associated with positive (blush) computed tomography mesenteric angiogram (CTMA) or need for invasive angiography. The secondary aim was to identify a patient population who may forego transfer and be safely managed in a regional centre. METHODS: All presentations to Central Coast Local Health District with colonic bleeding from June 2013-June 2017 were included. A guideline for transfer of patients with positive CTMA from Central Coast Local Health District to Royal North Shore Hospital had been established prior to the study period. Demographics, medical background, transfusion requirement, presentation details and mortality data were collected on all patients. RESULTS: Of 2378 patients presenting with colonic bleeding, 71 of 247 patients investigated with CTMA had a blush. Forty-six patients were transferred to Royal North Shore Hospital. Of these, 28 proceeded to interventional angiography with 19 undergoing angioembolization. Acute transfusion ≥5 units (odds ratio 6.78, P < 0.01) was the only significant predictor of needing interventional angiography. There was no association between age, bleeding site (right or left), use of antiplatelet or anticoagulation, diverticular disease or chronic kidney disease and identification of arterial bleeding on interventional angiography. There was no mortality or significant procedure-related morbidity. CONCLUSION: A patient's medical background demonstrates a lack of correlation to identification of active bleeding on interventional angiography. Patients requiring ≥5 units blood transfusion should be considered for transfer and interventional angiography.