an unusual presentation of renal carcinoma

An Unusual Presentation of Renal Carcinoma The clinical manifestations of renal carcinoma are many and varied. We describe here a patient who presented with skin metastases. Case Report A 65-year-old man was referred in January 1977 with a 3-month history of a warty growth on his scrotum. This was his only symptom when he was first seen. On exami- nation there was a 1.5 cm diameter ulcerated lesion, grey in colour in the scrotal skin (Fig.), at the base of which were 3 red-purple pedunculated nodules. There was a similar nodule on his upper lip. Excision biopsy Fig. of these nodules was performed in February 1977. The histological appearance was typical of renal cell carcinoma (clear cell type), although at the time diagnoses of pyogenic granuloma, kerato acanthoma and amelanotic melanoma were entertained. Subsequent IVP, ultra- sound and arteriogram confirmed the diagnosis of renal cell carcinoma. Nephrectomy was performed on the 15 March 1977. The tumour was confined within the kidney capsule. Discussion In a review of 309 cases Skinner et al. (1971) noted that 10% of patients presented with clinical symp- toms secondary to their metastases. However, the commonest sites for metastases were lung, bone, regional nodes and liver in that order. Cutaneous metastases occur in about 3% of all cases of renal tumours (Scorer, 1951), and in a post-mortem study by Hajdu and Thomas (1967) no skin metastases were noted. Rarely is a skin nodule the first manifestation of the disease. Acknowledgement We would like to thank Mr Philip Powley for permission 10 publish details of a patient under his care. References Hajdu, S. E and Thomas, A. G. (1967). Renal cell carcinoma at autopsy. Journal of Urology, 97, 978-982. Scorer, C. G. (1951). Cutaneous metastases from renal neoplasms. British Journol of Urology, 23, 250-259. Skinner, D. G., Colvin, R. B., Vermillion, C. D. el al. (1971). Diagnosis and management of renal cell carcinoma. A clinical and pathologic study of 309 cases. Cancer, 28, 1165-1 177. The Authors Anthony Ward, Kent and Canterbury Hospital, Kent. Neil Soni, Department of Surgery, Princess Margaret Hospital, Swindon. 141

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An Unusual Presentation of Renal Carcinoma

The clinical manifestations of renal carcinoma are many and varied. We describe here a patient who presented with skin metastases.

Case Report A 65-year-old man was referred in January 1977 with a 3-month history of a warty growth on his scrotum. This was his only symptom when he was first seen. On exami- nation there was a 1.5 cm diameter ulcerated lesion, grey in colour in the scrotal skin (Fig.), at the base of which were 3 red-purple pedunculated nodules. There was a similar nodule on his upper lip. Excision biopsy

Fig.

of these nodules was performed in February 1977. The histological appearance was typical of renal cell carcinoma (clear cell type), although at the time diagnoses of pyogenic granuloma, kerato acanthoma and amelanotic melanoma were entertained. Subsequent IVP, ultra- sound and arteriogram confirmed the diagnosis of renal cell carcinoma. Nephrectomy was performed on the 15 March 1977. The tumour was confined within the kidney capsule.

Discussion In a review of 309 cases Skinner et al. (1971) noted that 10% of patients presented with clinical symp- toms secondary to their metastases. However, the commonest sites for metastases were lung, bone, regional nodes and liver in that order. Cutaneous metastases occur in about 3% of all cases of renal tumours (Scorer, 1951), and in a post-mortem study by Hajdu and Thomas (1967) no skin metastases were noted. Rarely is a skin nodule the first manifestation of the disease.

Acknowledgement We would like to thank Mr Philip Powley for permission 10 publish details of a patient under his care.

References Hajdu, S. E and Thomas, A. G. (1967). Renal cell carcinoma

at autopsy. Journal of Urology, 97, 978-982. Scorer, C. G . (1951). Cutaneous metastases from renal

neoplasms. British Journol of Urology, 23, 250-259. Skinner, D. G., Colvin, R. B., Vermillion, C. D. el al.

(1971). Diagnosis and management of renal cell carcinoma. A clinical and pathologic study of 309 cases. Cancer, 28, 1165-1 177.

The Authors Anthony Ward, Kent and Canterbury Hospital, Kent. Neil Soni, Department of Surgery, Princess Margaret

Hospital, Swindon.

141

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