An Unusual Site for Renal Metastasis: A Pictorial Presentation

Abstract

The differential diagnosis of shoulder pain and restricted motion includes primary or metastatic cancer. Common cancers, such as breast, prostate, thyroid, lung, and renal, frequently metastasize to bone [1]. Bone metastasis is rarely asymptomatic, rather triggering refractory and persistent bone pain. Osteolysis is accompanied by increased bone fragility and pathologic fractures. These typically occur in weight-bearing bones such as the femur or pelvis. Breast, lung, and renal metastases cause extensive bone destruction and pain [2]. More than a third of patients with renal cancer present with metastases [3,4]. The most common site of renal cancer metastasis is the lung, and the second most common site is the skeleton, particularly the spine, pelvis, and femur. Humeral metastasis is rare [4]. It is critical to consider that shoulder pain is not always caused by intrinsic shoulder pathology. We present a series of images (Figures 1-3) that depict metastatic renal cancer in the humerus of a patient with a 2-month history of shoulder pain at rest and with movement, who had a history of renal cell cancer treated surgically 10 years earlier but was lost to follow up. Figure 1. Humeral radiograph, right. A mass lesion with pathologic fracture evident in the middle third of the humerus.