Metastatic Renal Cell Carcinoma in Endometrial Cavity : A Rare Case Report

Abstract

Renal cell carcinoma (RCC) has unpredictable and diverse behaviour. The classic triad of hematuria, loin pain and abdominal mass is uncommon at time of presentation. About 30%-50% of patients are found to have metastases at the time of diagnosis. Bones, lungs, liver and brain are the frequent sites of metastases. RCC with metastasis to the endometrial cavity is rarest manifestation, as seen in our patient. Patient was a 40 year old female, G3P1, known case of renal cell carcinoma, presenting in emergency with bleeding per vaginum. She had no other co-morbidity. Endometrial curettage was done and specimen sent for histopathological examination, which revealed metastasis from clear cell type of renal cell carcinoma in endometrial cavity and was confirmed on IHC. KEYWORDS: Endometrial cavity, Metastasis, Renal cell carcinoma INTRODUCTION:Renal cell carcinoma (RCC) has unpredictable and diverse behaviour. The incidence of RCC over last 20 years has progressively increased due to widespread use of modern imaging. 1 About 30%-50% of patients are found to have metastases at diagnosis. While bone, lymph nodes, lungs and brain constitute expected 'homing' sites, metastasis may turn up at the unusual locations (skin, testis, maxillary antrum and tongue). 2-4 Uterus is a rare site of metastasis, because of dense stroma and less vascularity.Metastatic RCC to endometrial cavity of uterus is extremely rare and usually associated with left sided RCC; only four case reports have been published so far, that too in cervix uteri. [5][6][7][8] There is one report in the literature of metastatic oncocytic papillary RCC to the endometrium in an 89-yearold woman, who presented with vaginal bleeding. 9 The exact mechanism is not known; however retrograde venous flow of tumor cells from left renal vein to the left ovarian vein and cervical and vaginal venous plexus explains the spread of left sided RCC to uterus.