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Multidisciplinary management of solitary hypervascular metastatic recurrence of renal cell carcinoma presenting with pathological femoral fracture
  1. Sudipta Mohakud1,
  2. Sujit Tripathy2,
  3. Nerbadyswari Deep Bag1 and
  4. Nitasha Mishra3
  1. 1Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
  2. 2Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
  3. 3Anaesthesia, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Orissa, India
  1. Correspondence to Dr Sudipta Mohakud; radiol_sudipta{at}aiimsbhubaneswar.edu.in

Abstract

Renal cell carcinoma (RCC) frequently presents with osseous metastasis, predominantly lytic and prone to pathological fracture. The metastatic lesion in the extremity presents with local swelling, pain and immobility due to pathological fracture. The solitary or oligometastatic lesions should be treated with curative intent, which can help the patient to lead a more prolonged and disability-free life. The RCCs and their metastases are hypervascular with an exuberant arterial supply. Surgery can lead to uncontrolled life-threatening haemorrhage. Preoperative transarterial embolisation reduces tumour vascularity significantly and reduces intraoperative blood loss. We present a 46-year-old male patient with solitary hypervascular metastatic recurrence of RCC with a pathological femoral fracture with an infeasible initial surgery due to profuse haemorrhage. He was successfully treated by preoperative transarterial embolisation, followed by surgical resection and implantation of a megaprosthesis. Multidisciplinary management reduces patient morbidity and mortality with successful treatment in solitary hypervascular metastasis from RCC.

  • interventional radiology
  • orthopaedics
  • oncology

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Footnotes

  • Contributors SM: manuscript drafting, editing and reviewing, transarterial embolisation of tumour. ST: manuscript editing and reviewing. Clinical evaluation of the patient. Did surgery and prosthesis implantation. Follow-up of patient. NDB: editing and reviewing of manuscript, interpretation of images. NM: editing and reviewing, handled the anaesthesia during surgery, intraoperative and postoperative patient management

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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