Isolated soft tissue mass of the finger as the first presentation of oligometastatic renal cell carcinoma

Abstract

A man in his 70s was referred to plastic surgery with a suspected foreign body in the pulp of his right index finger. An excisional biopsy was performed for a presumed foreign body granuloma. Histology revealed metastatic renal cell carcinoma (mRCC). CT imaging demonstrated a 7.4 cm heterogeneous mass arising from the upper pole of the left kidney consistent with primary renal malignancy, in addition to a 9 mm lung nodule. He underwent an uncomplicated left laparoscopic cytoreductive nephrectomy and made a satisfactory recovery. To our knowledge, this is the first reported case of primary mRCC presenting with digital soft tissue metastasis. Cytoreductive nephrectomy with metastasectomy is the preferred management for mRCC where feasible. For unfavourable mRCC cases, first-line systemic therapy is indicated. Adjuvant systemic therapy in mRCC is currently limited to clinical trials, though promising data emerging on the use of pembrolizumab may herald a future shift in practice.

Clear Cell Renal Cancer, a Tumour with Neuroendocrine Features Originating from the Erythropoietin-Producing Cell

“…ccRCCs metastasize at an early stage, and metastases are often present at diagnosis [40]. RCCs may metastasize to uncommon places as a finger [41], the pituitary gland [42], and skeletal muscle [43]. Moreover, first metastasis may manifest itself many years after apparent curative surgery as shown in a case report where a brain metastasis developed 15 years after surgery [44].…”