Diagnosis: Renal cell carcinoma
The patient was admitted and stabilized with packed RBCs for symptomatic anemia. He underwent biopsy of the right leg lesion and computed tomography (CT) imaging of his chest, abdomen, and pelvis.
The biopsy report from the resected right leg mass revealed metastatic clear cell renal cell carcinoma (RCC). The CT scan showed a large exophytic mass involving the right kidney measuring 12 × 11 × 9 cm. Additionally, the scan revealed multiple noncalcified nodules of both lungs with enlarged bilateral hilar and paratracheal lymph nodes, lytic bone lesions, and multiple enhancing round lesions throughout the liver, suggesting metastatic involvement (FIGURE 2).
FIGURE 2
Abdominal CT scan reveals a 12-cm mass on right kidney
Metastases on initial presentation? It’s not uncommon
More than 64,000 new cases of renal cancer are expected to be diagnosed in 2012 and 92% of them are expected to be cases of RCC.1 Interestingly, the incidence and mortality rates of RCC have been on the rise.2 Part of this increased incidence is likely secondary to increased detection of asymptomatic renal masses noted on imaging studies done for other reasons; however, the increased overall mortality from renal cancer is not fully understood.