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  • Title: Painful leg: a very unusual presentation of renal cell carcinoma. Case report and review of the literature.
    Author: Gözen AS, Canda AE, Naser M, Stock C, Rassweiler J, Teber D.
    Journal: Urol Int; 2009; 82(4):472-6. PubMed ID: 19506418.
    Abstract:
    INTRODUCTION: An unusual case of isolated synchronous solitary gastrocnemius muscle metastases of renal cell carcinoma (RCC) is reported. A review of the literature with particular emphasis on diagnostic and therapeutic approaches is also included and discussed. MATERIAL AND METHODS: A complete review of the English literature using MEDLINE was performed between 1979 and 2008 on RCC and skeletal muscle metastasis. RESULTS: Overall, 23 cases have been reported to have skeletal muscle metastasis by RCC. We report a 58-year-old male patient who was admitted to the orthopedics clinic with a painful left leg swelling. Physical examination revealed a hard mass on his posterior left leg. Magnetic resonance imaging demonstrated a 2 x 4 cm sized mass. Incisional biopsy revealed surprisingly clear cell RCC metastasis. Abdominal radiologic studies demonstrated a 7 x 7 x 6 cm sized left renal mass. Left radical nephrectomy was performed with additional excision of the metastatic mass with negative surgical margins. External radiotherapy to the left leg and 3 cycles of Hannover immunochemotherapy were administered thereafter. The patient was disease-free at the first year of follow-up. CONCLUSIONS: Presentation of RCC as a solitary metastasis in the skeletal muscle is a very unusual and poorly documented site of metastasis which can be treated successfully by excision of the metastasis and renal tumor with additional local radiotherapy and immunochemotherapy.
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