Painful Leg: A Very Unusual Presentation of Renal Cell Carcinoma

Abstract

Introduction: An unusual case of isolated synchronous solitary gastrocnemius muscle metastases of renal cell carcinoma (RCC) is reported. A review of the literature with particular emphasis on diagnostic and therapeutic approaches is also included and discussed. Material and Methods: A complete review of the English literature using MEDLINE was performed between 1979 and 2008 on RCC and skeletal muscle metastasis. Results: Overall, 23 cases have been reported to have skeletal muscle metastasis by RCC. We report a 58-year-old male patient who was admitted to the orthopedics clinic with a painful left leg swelling. Physical examination revealed a hard mass on his posterior left leg. Magnetic resonance imaging demonstrated a 2 × 4 cm sized mass. Incisional biopsy revealed surprisingly clear cell RCC metastasis. Abdominal radiologic studies demonstrated a 7 × 7 × 6 cm sized left renal mass. Left radical nephrectomy was performed with additional excision of the metastatic mass with negative surgical margins. External radiotherapy to the left leg and 3 cycles of Hannover immunochemotherapy were administered thereafter. The patient was disease-free at the first year of follow-up. Conclusions: Presentation of RCC as a solitary metastasis in the skeletal muscle is a very unusual and poorly documented site of metastasis which can be treated successfully by excision of the metastasis and renal tumor with additional local radiotherapy and immunochemotherapy.