World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Original Article

Volume 1, Number 4, August 2010, pages 149-157

Unusual Metastases in Renal Cell Carcinoma: A Single Institution Experience and Review of Literature

Figure 1. Overall survival from diagnosis of the first unusual metastasis to death or last follow-up (n = 60).

Figure 2. Survival from diagnosis of patients with an initial solitary unusual metastatic lesion to death or last follow-up (n = 17) compared to patients who primarily presented with multiple metastases (typical or atypical localizations) (n = 43).

Figure 3. Survival from diagnosis of the first unusual metastasis to death or last follow-up compared between resectable (n = 21) vs no-resectable (n = 39) metastasis.

Figure 4. Survival from diagnosis of the first unusual metastasis to death or last follow-up compared between systems.

**Table 1.** Patient Demographic, Clinical and Outcome Characteristics
Site of metastases	Number (%)	Gender (M:F)	Age (Median) (Mean) (Range)	Months from diagnosis to unsual metastases (Median) (Mean) (Range)	Synchronous metachronous (S:M)	Histology	Unusual localization as initial unique site of metastases	Status (Alive:Dead)	Palliative nephrectomy Total (%)	Surgical resection of metastases Total (%)	Months from diagnosis to death or last follow up (Median in months) (Range)	Months from diagnosis of unsual metastasis to death or last follow up (Median in months) (Range)
Skin	23 (23.46%)	16:7	54 54.2 (19-70)	7 14.3 (0-73)	11:12	Clear: 22 Papillary: 1	4 (17.4%)	2 (8.7%) 21 (91.3%)	6 (26.1%)	6 (26.1%)	11 0-76	4 0-42
Muscle	15 (15.31%)	6:9	57 56.4 (46-66)	14 18.27 (1-83)	3: 12	Clear: 14 Papillary: 1	1 (6.6%)	4 (26.7%) 11 (73.3%)	2 (13.3%)	2 (13.3%)	16 (1-74)	1 (0-32)
Colon	12 (12.24%)	6:6	63 62.3 (37-84)	11 36.4 (0-128)	4:8	Clear: 12	2 (16.7%)	2 (16.7%) 10 (83.3%)	3 (25.0%)	4 (33.3%)	12.5 (1-146)	1 (0-25)
Peritoneal metastases	11 (11.22%)	8:3	61 54.64 (19-69)	43 57.91 (0-195)	2: 9	Clear: 10 Papillary: 1	5 (45.5%)	2 (18.2%) 9 (81.8%)	2 (18.2%)	3 (27.3%)	38 (1-196)	0 (0-38)
Pancreas	11 (11.22%)	7:4	55 55.6 (42-68)	97 99.27 (0-300)	4:7	Clear: 11	3 (27.3%)	3 (27.3%) 8 (72.8%)	1 (9.1%)	3 (27.3%)	106 (2-351)	6 (1-102)
Spleen	5 (5.10%)	3:2	64 65.2 (48-84)	7 32.2 (0-86)	2:3	Clear: 5	3 (60%)	1 (20%) 4 (80%)	1 (20%)	1 (20%)	16 (1-106)	6 (0-19)
Duodenum	4 (4.08%)	3:1	50.5 50.8 (43-59)	88.5 93.0 (6-189)	1:3	Clear: 4	2 (50%)	0 (0%) 4 (100%)	1 (25%)	0 (0%)	91 (7-195)	1.5 (0-6)
Stomach	4 (4.08%)	0: 4	63 66.75 (57-84)	2 15 (0-56)	3: 1	Clear: 4	0 (0%)	2 (50%) 2 (50%)	2 (50%)	1 (25%)	3 (0-76)	0.5 (0-19)
Biliary tract	2 (2.04%)	1:1	61 61 (58-64)	207 207 (119-295)	0:2	Clear: 2	1 (50%)	2 (100%) 0 (0%)	0 (0%)	1 (50%)	231 (167-295)	24 (0-48)
Ligaments	2 (2.04%)	1:1	58.5 58.5 (53-64)	30.5 30.5 (18-43)	0: 2	Clear: 2	1 (50%)	0 (0%) 2 (100%)	0 (0%)	0 (0%)	39.5 (36-43)	9 (0-18)
Thyroid	2 (2.04%)	0:2	49 49 (40-58)	84 84 (79-89)	0:2	Clear: 2	2 (100%)	1 (50%) 1 (50%)	0 (0%)	1 (50%)	151.5 (107-196)	67.5 (18-117)
Esophagus	1 (1.02%)	0:1	55	60	0:1	Clear: 1	1 (100%)	0 (0%) 1 (100%)	0 (0%)	1 (100%)	71	11
Small intestine	1 (1.02%)	1:0	54	0	1:0	Clear: 1	0 (0%)	0 (0%) 1 (100%)	1 (100%)	1 (100%)	3	3
Vagina	1 (1.02%)	0:1	49	10	0: 1	Clear: 1	0 (0%)	0 (0%) 1 (100%)	0 (0%)	0 (0%)	19	8
Ovary	1 (1.02%)	0: 1	64	7	0: 1	Clear: 1	1 (100%)	1 (100%) 0 (0%)	0 (0%)	1 (100%)	16	8
Testicle	1 (1.02%)	1: 0	48	33	0: 1	Clear: 1	0 (0%)	0 (0%) 1 (100%)	0 (0%)	1 (100%)	48	15
Heart	1 (1.02%)	1:0	47	34	0: 1	Clear: 1	0 (0%)	0 (0%) 1 (100%)	0 (0%)	0 (0%)	35	0
Periuretral tissue	1 (1.02%)	0: 1	65	45	0: 1	Clear: 1	0 (0%)	0 (0%) 1 (100%)	0 (0%)	1 (100%)	54	8
Total	98 (100%)	54:44	58 56.81 (19-84)	15 42.79 (0-300)	31:67	Clear: 95 Papillary: 3	26 (26.5%)	20 (20.5%) 78 (79.6%)	19 (19.4%)	27 (27.6%)	23.5 (0-351)	3 (0-117)

Table 1. Patient Demographic, Clinical and Outcome Characteristics

Site of metastases

Number
(%)

Gender (M:F)

Age (Median)
(Mean)
(Range)

Months from diagnosis to unsual metastases (Median)
(Mean)
(Range)

Synchronous metachronous (S:M)

Histology

Unusual localization as initial unique site of metastases

Status (Alive:Dead)

Palliative nephrectomy
Total (%)

Surgical resection of metastases
Total (%)

Months from diagnosis to death or last follow up
(Median in months)
(Range)

Months from diagnosis of unsual metastasis to death or last follow up
(Median in months)
(Range)

Skin

23 (23.46%)

16:7

54
54.2
(19-70)

7
14.3
(0-73)

11:12

Clear: 22
Papillary: 1

4 (17.4%)

2 (8.7%)
21 (91.3%)

6 (26.1%)

11
0-76

4
0-42

Muscle

15 (15.31%)

6:9

57
56.4
(46-66)

14
18.27
(1-83)

3: 12

Clear: 14
Papillary: 1

1 (6.6%)

4 (26.7%)
11 (73.3%)

2 (13.3%)

16
(1-74)

1
(0-32)

Colon

12 (12.24%)

6:6

63
62.3
(37-84)

11
36.4
(0-128)

4:8

Clear: 12

2 (16.7%)

2 (16.7%)
10 (83.3%)

3 (25.0%)

4 (33.3%)

12.5
(1-146)

1
(0-25)

Peritoneal metastases

11 (11.22%)

8:3

61
54.64
(19-69)

43
57.91
(0-195)

2: 9

Clear: 10
Papillary: 1

5 (45.5%)

2 (18.2%)
9 (81.8%)

2 (18.2%)

3 (27.3%)

38
(1-196)

0
(0-38)

Pancreas

11 (11.22%)

7:4

55
55.6
(42-68)

97
99.27
(0-300)

4:7

Clear: 11

3 (27.3%)

3 (27.3%)
8 (72.8%)

1 (9.1%)

3 (27.3%)

106
(2-351)

6
(1-102)

Spleen

5 (5.10%)

3:2

64
65.2
(48-84)

7
32.2
(0-86)

2:3

Clear: 5

3 (60%)

1 (20%)
4 (80%)

1 (20%)

16
(1-106)

6
(0-19)

Duodenum

4 (4.08%)

3:1

50.5
50.8
(43-59)

88.5
93.0
(6-189)

1:3

Clear: 4

2 (50%)

0 (0%)
4 (100%)

1 (25%)

0 (0%)

91
(7-195)

1.5
(0-6)

Stomach

4 (4.08%)

0: 4

63
66.75
(57-84)

2
15
(0-56)

3: 1

Clear: 4

0 (0%)

2 (50%)
2 (50%)

2 (50%)

1 (25%)

3
(0-76)

0.5
(0-19)

Biliary tract

2 (2.04%)

1:1

61
61
(58-64)

207
207
(119-295)

0:2

Clear: 2

1 (50%)

2 (100%)
0 (0%)

0 (0%)

1 (50%)

231
(167-295)

24
(0-48)

Ligaments

2 (2.04%)

1:1

58.5
58.5
(53-64)

30.5
30.5
(18-43)

0: 2

Clear: 2

1 (50%)

0 (0%)
2 (100%)

0 (0%)

39.5
(36-43)

9
(0-18)

Thyroid

2 (2.04%)

0:2

49
49
(40-58)

84
84
(79-89)

0:2

Clear: 2

2 (100%)

1 (50%)
1 (50%)

0 (0%)

1 (50%)

151.5
(107-196)

67.5
(18-117)

Esophagus

1 (1.02%)

0:1

Clear: 1

1 (100%)

0 (0%)
1 (100%)

0 (0%)

1 (100%)

Small intestine

1 (1.02%)

1:0

Clear: 1

0 (0%)

0 (0%)
1 (100%)

1 (100%)

Vagina

1 (1.02%)

0:1

0: 1

Clear: 1

0 (0%)

0 (0%)
1 (100%)

0 (0%)

Ovary

1 (1.02%)

0: 1

Clear: 1

1 (100%)

1 (100%)
0 (0%)

0 (0%)

1 (100%)

Testicle

1 (1.02%)

1: 0

0: 1

Clear: 1

0 (0%)

0 (0%)
1 (100%)

0 (0%)

1 (100%)

Heart

1 (1.02%)

1:0

0: 1

Clear: 1

0 (0%)

0 (0%)
1 (100%)

0 (0%)

Periuretral
tissue

1 (1.02%)

0: 1

Clear: 1

0 (0%)

0 (0%)
1 (100%)

0 (0%)

1 (100%)

Total

98
(100%)

54:44

58
56.81
(19-84)

15
42.79
(0-300)

31:67

Clear: 95
Papillary: 3

26 (26.5%)

20 (20.5%)
78 (79.6%)

19 (19.4%)

27 (27.6%)

23.5
(0-351)

3
(0-117)

**Table 2.** Unusual Metastases From Renal Cell Carcinoma: Cases Reported In The Literature.
Localization of unusual metastases	References	Number of cases reported (%)	Number of cases at our institution (%)
GASTROINTESTINAL		369 (36.9%)	50 (51.02%)
Pancreas	17-131	282 (28.2%)	11 (11.22%)
Large intestine	132-157	27 (2.7%)	12 (12.24%)
Stomach	158-176	23 (2.3%)	4 (4.08%)
Duodenum/Ampulla of Vater	177-190	16 (1.6%)	4 (4.08%)
Peritoneum	191-196	8 (0.8%)	11 (11.22%)
Biliary tract	197-203	7 (0.7%)	2 (2.04%)
Spleen	204-207	6 (0.6%)	5 (5.10%)
Esophagus	208-209	2 (0.2%)	1 (1.02%)
HEAD AND NECK		373 (37.3%)	2 (2.04%)
Thyroid	210-262	270 (27.0%)	2 (2.04%)
Eye and orbit	263-301	72 (7.2%)	0 (0%)
Nose and paranasal sinuses	302-315	31 (3.1%)	0 (0%)
SKIN	316-354	63 (6.3%)	23 (23.46%)
GENITOURINARY		55 (5.5%)	3 (3.06%)
Uterus, vagina and cervix	355-371	24 (2.4%)	1 (1.02%)
Ovary	372-385	16 (1.6%)	1 (1.02%)
Testicle	386-396	15 (1.5%)	1 (1.02%)
MUSCLE		35 (3.5%)	15 (15.31%)
Skeletal	397-413	16 (1.6%)	5 (5.10%)
Diaphragm	414-416	6 (0.6%)	4 (4.08%)
Inferior rectus	417-421	5 (0.5%)	1 (1.02%)
Psoas	422-426	5 (0.5%)	3 (3.06%)
Gluteus maximus	427-428	2 (0.2%)	1 (1.02%)
Transversus abdominis	429	1 (0.1%)	1 (1.02%)
HEART	430-440	12 (1.2%)	1 (1.02%)
LIGAMENT		1 (0.1%)	2 (2.04%)
Falciform ligament	441	1 (0.1%)	2 (2.04%)
TOTAL		1000 (100%)	98 (100%)

Table 2. Unusual Metastases From Renal Cell Carcinoma: Cases Reported In The Literature.

Localization of unusual metastases

References

Number of cases reported (%)

Number of cases at our institution (%)

GASTROINTESTINAL

369 (36.9%)

50 (51.02%)

Pancreas

17-131

282 (28.2%)

11 (11.22%)

Large intestine

132-157

27 (2.7%)

12 (12.24%)

Stomach

158-176

23 (2.3%)

4 (4.08%)

Duodenum/Ampulla of Vater

177-190

16 (1.6%)

4 (4.08%)

Peritoneum

191-196

8 (0.8%)

11 (11.22%)

Biliary tract

197-203

7 (0.7%)

2 (2.04%)

Spleen

204-207

6 (0.6%)

5 (5.10%)

Esophagus

208-209

2 (0.2%)

1 (1.02%)

HEAD AND NECK

373 (37.3%)

2 (2.04%)

Thyroid

210-262

270 (27.0%)

2 (2.04%)

Eye and orbit

263-301

72 (7.2%)

0 (0%)

Nose and paranasal sinuses

302-315

31 (3.1%)

0 (0%)

SKIN

316-354

63 (6.3%)

23 (23.46%)

GENITOURINARY

55 (5.5%)

3 (3.06%)

Uterus, vagina and cervix

355-371

24 (2.4%)

1 (1.02%)

Ovary

372-385

16 (1.6%)

1 (1.02%)

Testicle

386-396

15 (1.5%)

1 (1.02%)

MUSCLE

35 (3.5%)

15 (15.31%)

Skeletal

397-413

16 (1.6%)

5 (5.10%)

Diaphragm

414-416

6 (0.6%)

4 (4.08%)

Inferior rectus

417-421

5 (0.5%)

1 (1.02%)

Psoas

422-426

5 (0.5%)

3 (3.06%)

Gluteus maximus

427-428

2 (0.2%)

1 (1.02%)

Transversus abdominis

429

1 (0.1%)

1 (1.02%)

HEART

430-440

12 (1.2%)

1 (1.02%)

LIGAMENT

1 (0.1%)

2 (2.04%)

Falciform ligament

441

1 (0.1%)

2 (2.04%)

TOTAL

1000 (100%)

98 (100%)