A man in his 70s was referred to plastic surgery with a suspected foreign body in the pulp of his right index finger. An excisional biopsy was performed for a presumed foreign body granuloma. Histology revealed metastatic renal cell carcinoma (mRCC). CT imaging demonstrated a 7.4 cm heterogeneous mass arising from the upper pole of the left kidney consistent with primary renal malignancy, in addition to a 9 mm lung nodule. He underwent an uncomplicated left laparoscopic cytoreductive nephrectomy and made a satisfactory recovery. To our knowledge, this is the first reported case of primary mRCC presenting with digital soft tissue metastasis. Cytoreductive nephrectomy with metastasectomy is the preferred management for mRCC where feasible. For unfavourable mRCC cases, first-line systemic therapy is indicated. Adjuvant systemic therapy in mRCC is currently limited to clinical trials, though promising data emerging on the use of pembrolizumab may herald a future shift in practice.
- Urological cancer
- Urological surgery
- Surgical oncology
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Contributors DTH—lead author and main contributor to conception, design, acquisition and analysis of data, manuscript drafting and revision. Involved in the final approval of the manuscript. DW—second author; contribution to conception and design, data acquisition and analysis. Assisted in drafting, revising and final approval of the manuscript. Involved in the final approval of the manuscript. RPM—supervising author, significant contribution to design of manuscript and interpretation of data. Provided expert revision of the manuscript with significant additions. Involved in the final approval of the manuscript. THL—leading senior/supervising author and clinical consultant for the case report described. Significant contributions to design of manuscript and data interpretation. Key input in revision of manuscript with significant addition to content and style. Involved in the final approval of the manuscript.
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.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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