The Ceylon medical journal · 2024
Upper limb swelling due to subclavian vein occlusion as a rare presentation of recurrent renal cell carcinoma: a picture story.
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Arudchelvam Joel, Jazeel M N, Rasnayake D, Fernando W W W S, Thanesan K, Godahewa S
Аннотация
INTRODUCTION: Renal cell carcinoma (RCC) is known to spread along the veins. However, secondary deposits from RCC growing along the veins are not reported. This case report describes a patient who presented with right upper limb swelling due to RCC spreading along the subclavian vein (SCV) and the superior vena cava (SVC) from a secondary deposit on the rib.
CASE: A 59-year-old male presented with swelling of the right upper limb. He had RCC seven years ago and underwent radical nephrectomy. A computerised tomographic (CT) scan showed an osteolytic solid mass of 6 cm * 7 cm on the body of the first rib. The tumour was extending into the SCV and the SVC. There was no evidence of recurrence at other sites. The patient underwent an en bloc excision of the tumour with the ribs and the SCV. The SCV was repaired with a polyester graft. The histology confirmed a metastasis from the clear cell RCC. The patient made an uneventful recovery.
DISCUSSION AND CONCLUSIONS: At the time of diagnosis, about 33% of the patients with RCC have metastasis. After the surgery, about 30% to 50% of the patients develop recurrences. Studies have shown that wide local excision of the isolated metastasis with a negative margin (metastasectomy) results in improved survival. Excision is followed by adjuvant therapy. Therefore, this case indicates that patients who develop RCC should be followed up for long periods to detect late recurrences. Wide local excision of the isolated metastasis results in improved outcomes.
CASE: A 59-year-old male presented with swelling of the right upper limb. He had RCC seven years ago and underwent radical nephrectomy. A computerised tomographic (CT) scan showed an osteolytic solid mass of 6 cm * 7 cm on the body of the first rib. The tumour was extending into the SCV and the SVC. There was no evidence of recurrence at other sites. The patient underwent an en bloc excision of the tumour with the ribs and the SCV. The SCV was repaired with a polyester graft. The histology confirmed a metastasis from the clear cell RCC. The patient made an uneventful recovery.
DISCUSSION AND CONCLUSIONS: At the time of diagnosis, about 33% of the patients with RCC have metastasis. After the surgery, about 30% to 50% of the patients develop recurrences. Studies have shown that wide local excision of the isolated metastasis with a negative margin (metastasectomy) results in improved survival. Excision is followed by adjuvant therapy. Therefore, this case indicates that patients who develop RCC should be followed up for long periods to detect late recurrences. Wide local excision of the isolated metastasis results in improved outcomes.