Cytodiagnosis of a Cutaneous Clear Cell Malignancy: Metastatic Renal Cell Carcinoma on Chin

Abstract

Clear cell type of renal cell carcinoma (RCC) is most common urological malignancy. Several diagnostic challenges arise when it presents as a cutaneous nodule, being an uncommon presentation. Fine needle aspiration cytology (FNAC) of a cutaneous nodule is crucial for distinguishing primary tumours from metastatic tumours because cutaneous metastases represent a terminal stage of illness. Due to considerable overlap of cytomorphological features determination of primary warrants need of detailed clinical history and close inspection of every cytological detail. We report here a case of cutaneous metastasis of RCC on chin in a patient 11 years after nephrectomy. Though there are reports of RCC metastases diagnosed on histology, there are fewer cytology case reports. Cytological differential diagnosis has been discussed for arriving at the final diagnosis in case of clear cell tumours. Early and accurate diagnosis is mandatory for optimal treatment. Cytodiagnosis of cutaneous metastasis of RCC is uncommon due to its low suspicion index in cutaneous nodules. More so, it presents late and an unusual sites due to its resemblance to common dermatological diseases.

Cutaneous metastasis of renal cell carcinoma: Fine needle aspiration provides rapid diagnosis

“…It was demonstrated by few other groups that cutaneous RCC was diagnosed by FNA. 5,7 Here we concur with others that in a proper setting…”

“…However, FNA is less invasive than core biopsy. It was demonstrated by few other groups that cutaneous RCC was diagnosed by FNA . Here we concur with others that in a proper setting FNA alone as a minimally invasive procedure can provide rapid, accurate and cost effective diagnosis of cutaneous metastasis of RCC even in case of unknown primary.…”

Cutaneous Metastatic Renal Cell Carcinoma

“…2 There are limited reports on latent cutaneous metastatic RCC. [4][5][6][7][8][9][10] We also present an unusual case of late recurrence of RCC 15 years after initial total nephrectomy presenting as cutaneous metastasis. Depending on the number and site of metastatic lesions, various treatment approaches including chemotherapy, radiotherapy or surgery can be selected.…”

Diagnosis made clear: Rapidly growing exophytic nodular tumor on the upper arm

“…Immunohistochemistry reveals positive PAX-8, an EMA staining of the clear cells. 5,6 While a metastatic clear cell renal cell carcinoma of the skin can mimic DDCCMN, the diagnosis is less favored given our patient's immunohistochemical staining profile, lack of systemic findings, and uncomplicated medical history.…”