Renal cell carcinoma with malignant pleural effusion: Case report and systematic review of literature

Abstract

Introduction: Renal cell carcinoma metastasizes commonly to visceral organs such as adrenals, liver, lungs, or to bones. Metastases to body cavities such as pleura, pericardium and peritoneum are rare, and almost never in isolation. Case discussion: We discuss here a patient who was diagnosed with renal cell carcinoma following an episode of hematuria and underwent radical nephrectomy for the same. Within a month of surgery, he was evaluated for sudden onset breathlessness and detected to have massive left-sided pleural effusion, which returned malignant on pleural biopsy. The patient was treated with oral multikinase inhibitor following symptomatic therapy, with a favorable response. The imaging findings and relevant literature exploring the incidence of such presentations are discussed. Conclusion: Malignant effusions usually portend a poor prognosis but owing to the rarity of this condition and availability of newer therapies, long-term durable control may be expected.

Malignant Pleural Effusion As the Initial Presentation of Renal Cell Carcinoma: A Case Report and Literature Review

“…In a study conducted in Japan, pleural involvement was found in up to 12% of autopsied patients [ 18 , 19 ]. Pleural involvement in renal cell carcinoma can be explained by the flow of blood from renal veins into the bronchial and intercostal veins via Batson's plexus and through lymphatic spread [ 11 , 19 ]. Metastases from the kidneys spread to the lung parenchyma, mediastinum and pleura in this manner.…”