Painful leg: a very unusual presentation of renal cell carcinoma. Case report and review of the literature

Abstract

Introduction: An unusual case of isolated synchronous solitary gastrocnemius muscle metastases of renal cell carcinoma (RCC) is reported. A review of the literature with particular emphasis on diagnostic and therapeutic approaches is also included and discussed.

Material and methods: A complete review of the English literature using MEDLINE was performed between 1979 and 2008 on RCC and skeletal muscle metastasis.

Results: Overall, 23 cases have been reported to have skeletal muscle metastasis by RCC. We report a 58-year-old male patient who was admitted to the orthopedics clinic with a painful left leg swelling. Physical examination revealed a hard mass on his posterior left leg. Magnetic resonance imaging demonstrated a 2 x 4 cm sized mass. Incisional biopsy revealed surprisingly clear cell RCC metastasis. Abdominal radiologic studies demonstrated a 7 x 7 x 6 cm sized left renal mass. Left radical nephrectomy was performed with additional excision of the metastatic mass with negative surgical margins. External radiotherapy to the left leg and 3 cycles of Hannover immunochemotherapy were administered thereafter. The patient was disease-free at the first year of follow-up.

Conclusions: Presentation of RCC as a solitary metastasis in the skeletal muscle is a very unusual and poorly documented site of metastasis which can be treated successfully by excision of the metastasis and renal tumor with additional local radiotherapy and immunochemotherapy.