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Skeletal Radiol (2012) 41:11691175 DOI 10.1007/s00256-012-1424-3
CASE REPORT
Sclerotic osseous metastases from renal cell carcinoma
Darryl B. Sneag & Katherine M. Krajewski &
Stephanie Howard & Jyothi P. Jagannathan &
Kremena V. Star & Nikhil Ramaiya
Received: 22 November 2011 /Revised: 19 April 2012 /Accepted: 23 April 2012 /Published online: 11 May 2012 # ISS 2012
Abstract This case series describes and illustrates three cases of sclerotic osseous metastases from untreated renal cell carcinoma (RCC). RCC is commonly metastatic to the skeleton but almost always produces lytic metastases, with only three prior reports of sclerotic metastases identified in the literature. Sclerotic metastasis causing low back pain was the initial disease presentation in two of the three patients in this case series and the first manifestation of metastatic disease in one. The most common metastatic sites of RCC, i.e., retroperitoneal lymph nodes, lung, and liver, were not identified in any of the cases, and skeletal involvement with epidural extension was the only site of metastasis in two. Pathologic specimens from all three cases revealed RCC of high nuclear grade.
D. B. Sneag (*) : K. M. Krajewski : S. Howard :
J. P. Jagannathan : N. RamaiyaDepartment of Radiology, Brigham and Womens Hospital and Dana-Farber Cancer Institute, Harvard Medical School,75 Francis Street,Boston, MA 02115, USAe-mail: [email protected]
K. M. Krajewskie-mail: [email protected]
S. Howarde-mail: [email protected]
J. P. Jagannathane-mail: [email protected]
N. Ramaiyae-mail: [email protected]
K. V. StarDepartment of Pathology, Brigham and Womens Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USAe-mail: [email protected]
Keywords Renal cell carcinoma . Sclerotic . Osseous . Metastases
Introduction
An estimated 60,920 new cases of cancer involving the kidney and renal pelvis [the vast majority of which are renal cell cancer (RCC)] were diagnosed in the United States in 2011, and 13,120 of these will lead to death, according to the American Cancer Society [1]. RCC is frequently meta-static at presentation and often involves the skeleton. A case series of 1,668 patients with RCC detected osseous metastases by radiography in approximately 10% of patients [2]. These were invariably lytic and commonly destructive with cortical disruption, without a single metastasis demonstrating a sclerotic appearance prior to therapy initiation.
Only three case reports of sclerotic osseous metastases from untreated renal cell carcinoma have been previously published,...