Isolated recurrent metastatic pulmonary nodule from the kidney: An extraordinarily long interval

Abstract

Key message

Our case highlights the importance of follow‐up. Previous meta‐analysis has shown that patients with sub‐centimetre nodules may have extended follow‐up intervals before requiring intervention, unlike those with larger nodules exceeding 1 cm. However, referring to our case, we can see the importance of regular and dense follow‐up.

CLINICAL IMAGE

A 73-year-old male was admitted because of a slowly growing nodule discovered 1 year ago. He was a non-smoker but had underlying mild COPD. Seventeen years ago, he underwent a right nephrectomy following a diagnosis of stage II clear cell renal cell carcinoma (ccRCC). Four years ago, he underwent wedge resection of a left lung nodule with video-assisted thoracoscopic surgery (VATS), found to be a hamartoma (Figure 1A, arrow). At the time of resection, there were no lesions observed in the contralateral lung (Figure 1B). However, a year ago, a High-Resolution Computed Tomography (HRCT) scan revealed a 2 mm nodule in the posterobasal segment of the right lower lobe (Figure 1C, arrow). Furthermore, in the recent HRCT, the nodule had grown to 6 mm (Figure 1D, arrow). Positron Emission Tomography (PET)/CT showed no evidence of metastasis, including the abdomen and left kidney (Figure 1F,G). We performed VATs and the nodule was confirmed as ccRCC (Figure 1H,I). A follow-up chest CT scan 1 year later showed no signs of recurrence (Figure 1E).

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Diagnosis of pulmonary metastases from RCC is crucial as surgical resection may result in improved survival.¹ While previous studies have suggested that small pulmonary nodules (<1 cm) may not be associated with metastatic RCC,² our case highlights the importance of vigilant monitoring and thorough evaluation of lung nodules of any size in patients with a history of RCC, even after long disease-free intervals. This is particularly important considering the potential for delayed metastasis, as demonstrated some cases.³

AUTHOR CONTRIBUTIONS

Cheong Kim and Hwan Jin Lee wrote the manuscript and generated figure. Kyu Yun Jang performed radiological interpretation and conducted pathological examination. Jae Seok Jeong and Yong Chul Lee directed the project. Jun Hyung Park conducted investigation. All authors critically reviewed the manuscript and approved the final version.

FUNDING INFORMATION

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. RS-2024-00356349) and Special Operating Subsidy of Jeonbuk National University Industrial Cooperation Foundation. This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: RS-2024-00440408). This research was supported by the Bio&Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (No. RS-2023-00236157). This paper was supported by Fund of Biomedical Research Institute, Jeonbuk National University Hospital.

CONFLICT OF INTEREST STATEMENT

None declared.

DATA AVAILABILITY STATEMENT

None.

ETHICS STATEMENT

The authors declare that appropriate written informed consent was obtained for the publication of this manuscript and accompanying images. The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient for publication of this article and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.

References

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Mano R, Vertosick E, Sankin AI, Chevinsky MS, Larish Y, Jakubowski CD, et al. Subcentimeter pulmonary nodules are not associated with disease progression in patients with renal cell carcinoma. J Urol. 2015;193:776–782.

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