Single cerebral metastasis 3 and 19 years after primary renal cell carcinoma: Case report and review of the literature. (Short Report).

Cerebral metastasis in general is associated with a relatively short survival time. However, brain deposits may occur rather late during follow up. Nine cases of solitary brain metastasis of renal cell carcinoma with a latency period of more than 10 years after nephrectomy have been reported in the literature so far. This is the first report of a case describing a second solitary brain metastasis which occurred 16 years after a first metastatic brain lesion. Complete microsurgical resection alone led to an excellent outcome in this particular case as the patient refused any adjuvant therapy at the same time. Regular nuclear morphology, a low mitotic index, and the absence of chromosomal abnormalities in tumour cells may be indicative for a relative benign clinical course.

CLINICAL PRESENTATION

A 61 year old man with a history of a single generalised seizure presented to our department with facial palsy, gait instability, and intermittent dysphasia. He had previously had a left nephrectomy and splenectomy due to renal cell carcinoma 19 years ago. There was no renal vein involvement, lymphatic dissemination, or other evidence of systemic disease at the time of nephrectomy. In 1985, 3 years after diagnosis of primary renal cell carcinoma, the patient developed symptoms of psychomotor deterioration accompanied by apraxia. At that time, imaging studies showed a cystic, right parieto-occipital cerebral metastasis (fig 1). This lesion was completely excised. In 1999, the patient developed a moderate thyroid mass. Diagnostic ultrasound and suppression scintigram indicated a second metastatic lesion in the thyroid gland and a partial right and complete left thyroidectomy was performed 18 …