Metastasectomy of sequential asynchronous metastatic renal cell carcinoma to the pancreas, thyroid, skin, contralateral kidney, and lung with cumulative survival beyond 10 years: A case report and clinicopathologic review

Abstract

Patient: Female, 46-year-old Final Diagnosis: Metastasis of renal clear cell carcinoma Symptoms: Renal carcinoma Medication: — Clinical Procedure: — Specialty: Urology Objective: Background: Case Report: Conclusions: Unusual setting of medical care One-third of renal cell carcinoma cases present with an initial metastasis to various organs, emphasizing the tumor’s unpredictable behavior. Prognosis is poor once metastasis is discovered. Multiple-organ involvement with metastatic lesions has a particularly dismal survival rate. Surgical resection alone of metastatic masses can extend patient survival with reasonable quality of life. Here, we present the case of a healthy 46-year-old woman who initially presented with an incidental localized clear cell renal cell carcinoma. During the follow-up period, she presented with sequential asynchronous metastasis to the pancreas, thyroid, skin, contralateral kidney, and lung. She has no family history of malignancy. Her physical examination and laboratory investigations were normal even upon presentation of most of her metastatic organs. The first metastasis was in her sixth year of follow-up. She underwent consecutive metas-tasectomy of all the organs described above, excluding the lung. She eventually was started on sunitinib after non-resectable lung nodules were discovered. Her survival is now over 10 years since her first metastasecto-my, with good performance status. Metastasis to a single organ has a poor prognosis and dramatically affects survival. Nevertheless, our patient had multiple consecutive examples of metachronous metastasis, yet she has survived for over a decade since the occurrence of metastasis. Our case offers more information to fill the gaps in understanding the favorable role of surgical resection in advanced renal cell carcinoma metastasis.