Bony metastasis in renal cell carcinoma

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It has been estimated that between 20% and 45% of patients with renal cell carcinoma have no symptoms directly referable to the primary lesion. Several authors have reviewed the rather unusual and deceptive clinical features which help to categorize this disease as one of the great masqueraders.1–3 The tendency of renal cell carcinoma to metastasize to bone was first recognized early in the 20th century by Scudder.4 Since that time osseous metastases have been documented in several reports.5–8 However, there has never been a large series of cases of renal cell carcinoma reported on the percentage of patients with bony metastases as the chief complaint.


A total of 331 cases of pathologically proven renal cell carcinoma were studied at the Cleveland Clinic over a 15-year period. Fourteen patients had bony metastases, and of these the absence of the classic triad of symptoms was impressive; only 2 of the 14 patients had palpable masses at the time of physical examination. No patient had flank pain or hematuria. Table 1 lists the clinical features.

Thirteen of the 14 patients had urograms which were diagnostic in 10 instances with either a mass lesion or displacement of the calyceal system identified. Angiograms of four patients were positive.

Tables 2 and 3 list the roentgenographic features of the metastatic lesions and the distribution of such lesions.

Twelve patients underwent surgery; nephrectomy was performed in 11. Of these 11 patients, 1 was lost in follow-up but survived at least 3 years. Of the. . .



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