Subcutaneous fatty tissue metastasis from renal cell carcinoma detected with fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging

Subcutaneous F-FDG uptake is a common finding on PET scans, with causes including both benign and malignant conditions. Often, the pattern of uptake or the clinical indication for the PET scan will suggest the etiology. However, unusual or unexpected patterns may require careful clinical history. We report the case of a 45-year-old woman who underwent a PET/CT study for paraneoplastic syndrome evaluation and was found to have intense, extensive, bilaterally symmetric, nodular subcutaneous FDG uptake in the lower back and buttocks that was related to long-term repeated subcutaneous opioid injections.

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Metastatic sarcomatoid renal cell carcinoma manifesting as a subcutaneous soft tissue mass

Logunova

Sokumbi

Iczkowski

2017

J Cutan Pathol

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Metastases from visceral malignancies to subcutaneous soft tissues are relatively rare and their diagnosis requires a high level of suspicion. It is even more challenging if a metastatic lesion shows non-specific high-grade spindle cell morphology overlapping with various primary cutaneous and soft tissue tumors. We describe a unique case of subcutaneous metastasis of sarcomatoid renal cell carcinoma which was the first manifestation of the occult malignancy. The patient had a history of lipomas and dysplastic nevi and presented with an upper back mass. The mass, located superficially within the subcutis, was composed of atypical spindle cells arranged in a storiform pattern. By immunohistochemistry, the tumor cells were strongly diffusely positive for cytokeratin AE1/AE3 and vimentin and negative for Melan-A, S-100 protein, SOX10, melanoma cocktail, epithelial membrane antigen (EMA), p63, CK7, CK18, CK20, smooth muscle actin (SMA), desmin, CD34, TTF-1, CD21, CD99 and bcl-2. Scattered tumor cells were positive for MDM2 immunostain, but MDM2 amplification was not detected using fluorescent in situ hybridization (FISH). Co-expression of cytokeratin and vimentin by the tumor raised the possibility of metastatic renal cell carcinoma and positivity of the tumor for PAX8 supported this hypothesis. A large renal mass was detected radiologically and the subsequent nephrectomy specimen showed high-grade clear cell renal cell carcinoma with sarcomatoid features.

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Subcutaneous fatty tissue metastasis from renal cell carcinoma detected with fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging

Cited by 5 publications

References 12 publications

Ultrasound findings of subcutaneous soft tissue metastasis of renal cell carcinoma: A case report

Ultrasound findings of subcutaneous soft tissue metastasis of renal cell carcinoma: A case report

Intense 18F-FDG Uptake in Chronic Subcutaneous Opioid Injection Sites

Metastatic sarcomatoid renal cell carcinoma manifesting as a subcutaneous soft tissue mass

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