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Brain Metastasis 15 Years After Radical Nephrectomy for Renal Cell Carcinoma: Case Report

By: Vanessa A. Carter, BS
Posted: Thursday, May 20, 2021

Joonhyuk Choi, MD, PhD, of Yeungnam University Hospital, Republic of Korea, and colleagues presented a case of extremely delayed solitary brain metastasis of renal cell carcinoma with lymph node metastasis in the journal Medicine. Although extremely delayed distant metastasis is generally not rare, this seems to be one of the few instances in which brain metastases occurred in a patient 15 years after nephrectomy.

A 72-year-old man presented with dysarthria and right-sided hemiparesis. MRI identified a 2-cm round, nonhomogenous enhanced mass and peritumoral edema in the left frontal lobe. This patient underwent right radical nephrectomy 15 years prior for a 6-cm mass on his kidney after being diagnosed with clear cell renal cell carcinoma; no metastasis was identified at the time of diagnosis.

During this analysis, a whole-body PET scan identified a hypometabolic lesion in the left frontal lobe attributed to the peritumoral edema, suggesting brain metastasis, along with multiple hypermetabolic lymph nodes. The patient then underwent a frontal craniotomy and gross total resection of the tumor.

Metastatic clear cell renal cell carcinoma was discovered by the final histopathologic report, with a 40% Ki67 index. Stereotactic radiosurgery for the tumor bed was performed 3 weeks after craniotomy due to the possibility of tumor cells.

No recurrence was observed on a follow-up brain MRI 4 months after the craniotomy. About 2 months after stereotactic radiosurgery, the patient experienced chest pain on his right lateral side; a PET scan revealed metastases at the left back muscle as well as multiple bone metastases. Despite the initiation of chemotherapy, numerous distant metastases in the spleen, liver, adrenal gland, and lung were uncovered 6 months after surgery. Eventually, the patient ended his hospital visits and enrolled in hospice care.

Disclosure: The study authors reported no conflicts of interest.



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