Stereotactic Radiotherapy in the Treatment of Paraneoplastic Vasculitis in Oligometastatic Renal Cell Carcinoma

Laura Burgess,Jeff Yao,Kiefer Lypka,James Watterson,Alan Liang Zhou,Marissa Keenan,Delvina Hasimja Saraqini,Robert Macrae,Samuel Martin,Christopher Morash,Christina Canil

doi:10.3390/curroncol28030162

Abstract

Approximately 20% of renal cell carcinoma (RCC) is diagnosed because of paraneoplastic manifestations. RCC has been associated with a large variety of paraneoplastic syndromes (PNS), but it is rarely associated with PNS vasculitis. We present a case of a previously healthy male who presented with systemic vasculitis; bitemporal headaches, diplopia, polyarthritis, palpable purpura, tongue lesion, peri-orbital edema, scleritis, chondritis and constitutional symptoms. He was subsequently found to have oligometastatic RCC. Both his primary lesion and site of oligometastasis were treated with stereotactic radiotherapy (SBRT) and resulted in the resolution of his vasculitis, as well as sustained oncologic response. This is the first case to demonstrate that effective sustained treatment for PNS vasculitis due to oligometastatic RCC is possible with SBRT.

Highlights

The classic triad in renal cell carcinoma (RCC) of flank pain, gross hematuria and a palpable mass is seen in approximately 10% of cases [1]
Five months after completion of his left scapular SBRT, with effective treatment of his underlying malignancy, he had been completely tapered off prednisone and hydroxychloroquine and his vasculitis was in remission
We present a case of a paraneoplastic syndrome secondary to oligometastatic renal cell carcinoma with rheumatologic manifestations consistent with systemic vasculitis, including bitemporal headaches, diplopia, polyarthritis, palpable purpura, tongue lesion, peri-orbital edema, scleritis, chondritis and constitutional symptoms with sustained response following SBRT to both the primary and site of oligometastatic disease, without requiring the immunosuppression that would be required for primary vasculitis

Summary

Introduction

The classic triad in renal cell carcinoma (RCC) of flank pain, gross hematuria and a palpable mass is seen in approximately 10% of cases [1]. We review a case of a previously healthy man diagnosed with oligometastatic RCC following an atypical presentation of systemic vasculitis who demonstrated sustained and effective resolution of his vasculitis following treatment with stereotactic radiotherapy (SBRT). Two months prior to this presentation, he developed persistent bi-frontal and bi-occipital headaches, fevers, Curr. Iotracer uptake in the inferior tip of the left scapular body, correlating to abnormality seen on CT chest. Five months after completion of his left scapular SBRT, with effective treatment of his underlying malignancy, he had been completely tapered off prednisone and hydroxychloroquine and his vasculitis was in remission. FFiigguurree44..((AA))AAxxiiaall eecchhoo ppllaannaarr ffaasstt ssppiinn eecchhoo MMRR iimmaaggeess sshhoowwiinnggssttaabbiilliittyyoofftthheeleleffttrreennaalllelessioionn trthhaadattiioisstrhhaeecteteerrrouogpgeetnanekeoeouuisnsllytyhTeT22iniisfsoeo-r-iaoanrndtdiphhyoypfpotohiinnetteleennfstsees;c;(a(BBp))uBBlaoornnbeeossdccayan;n(sCshh)ooCwwTiinnsghgosstwtaabibniilgliittysytaoobffialaibbtnynooorrfmmleaasllioffonoccaianll rtahdeioletrftacscearpuupltaa.ke in the inferior tip of the left scapular body; (C) CT showing stability of lesion in the left scapula

Findings

Discussion

Conclusions