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Case Reports
. 2018 May 12:2018:bcr2017223334.
doi: 10.1136/bcr-2017-223334.

Solitary calvarial haemangioma presenting as metastatic renal cell carcinoma

Calver Pang  1 , Yew Loong Loo  2 , Robert Corns  3 , Rasheed Mohammed  4
Affiliations
Case Reports

Solitary calvarial haemangioma presenting as metastatic renal cell carcinoma

Calver Pang et al. BMJ Case Rep. .

Abstract

Renal cell carcinoma is the most common renal tumour in adult that often metastasises to the lung, liver or bone. Head and neck lesions are uncommon with no early warning signs and presents with overt metastases at primary presentation in 25%-30% of reported cases. The incidence of haemangiomas that suggest malignancy are similar to that of bone metastasis. Calvarial haemangiomas usually present as asymptomatic and discovered incidentally on imaging or postmortem examination. We report a case where an initial diagnosis of benign tumour of the skull was made based on clinical presentation and calvarial haemangioma on CT head but was confirmed as metastatic clear cell carcinoma of the kidney after histopathological results. Skull metastases are rare and present late in the course of the disease. It is unusual for metastatic lesion to be the primary presentation in a clinically silent renal cell carcinoma.

Keywords: neurosurgery; renal system; urological cancer.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CT head, transverse plane (A) and coronal plane (B) views demonstrating left-sided tumour with full thickness bone destruction. (C) Post-contrast CT head.
Figure 2
Figure 2
MRI head demonstrating lesion with marked heterogeneous enhancement and some adjacent dural enhancement.
Figure 3
Figure 3
(A) Skin and temporalis dissected off tumour which eroded through the bone. (B) Gutter of bone excised around tumour which remains attached to dura below. (C) Underlying brain pia intact. Margin of dura excised around tumour to achieve a gross total resection.
Figure 4
Figure 4
(A) and (B). H&E stain. The tumour is composed of large nests and trabeculae of round and oval polygonal cells that have abundant clear or granular cytoplasm and small round and oval dark nuclei. The tumour has delicate branching vasculature and shows cystic and solid areas. The histological features are consistent with metastatic renal clear cell carcinoma.
Figure 5
Figure 5
CT of thorax, abdomen and pelvis demonstrating tumour in upper pole of left kidney.
See this image and copyright information in PMC

References

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