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Review
. 2012 Jun 8:2012:bcr0220125764.
doi: 10.1136/bcr.02.2012.5764.

Asymptomatic renal cell carcinoma with metastasis to the skin and duodenum: a case report and review of the literature

Adhip Mandal  1 , Yvonne Littler, Gabor Libertiny
Affiliations
Review

Asymptomatic renal cell carcinoma with metastasis to the skin and duodenum: a case report and review of the literature

Adhip Mandal et al. BMJ Case Rep. .

Abstract

Renal cell carcinoma is known to have blood-borne metastasis. This is usually to the bone, lungs and brain. Other unusual metastatic presentations such as skin and bowel metastasis have also been described. In most cases, the metastasis occurs as a late manifestation in a patient with known primary renal cell carcinoma. A rare synchronous presentation of skin and duodenal metastasis in an otherwise asymptomatic patient is reported here. This patient presented with a skin lesion that, on excision, brought up the diagnosis of metastatic renal cell carcinoma. While the patient was waiting for surgery, she also developed melena that, on gastroscopy, confirmed a duodenal metastasis. This case highlights the importance of early recognition of otherwise unrelated lesions as presentations for an advanced renal malignancy.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Excised skin lesion showing a bluish purple nodular metastatic tumour in the centre.
Figure 2
Figure 2
(A) Micrograph of metastatic renal cell carcinoma to the skin. (B) Tumour with extensive areas of haemorrhage (H&E stain) ×20.
Figure 3
Figure 3
Micrograph of skin metastasis showing features as seen in kidney primary. (A) Clear epithelioid cells (B) Coagulative necrosis. (C) Extensive areas of haemorrhage (H&E stain) ×60.
Figure 4
Figure 4
CT scan showing left renal cell carcinoma.
Figure 5
Figure 5
Duodenal metastasis seen in the ampulla of the second part of the duodenum.
Figure 6
Figure 6
Micrograph of metastatic cell carcinoma to the duodenum. (A) Duodenal mucosa. (B) Metastatic tumour (H&E stain) ×20.
Figure 7
Figure 7
Micrograph of clear cell renal cell carcinoma. Nephrectomy specimen showing tumour cells with clear cytoplasm (H&E stain) ×20.
See this image and copyright information in PMC

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