Super interesting.
Four years after undergoing a right nephrectomy for the treatment of renal-cell carcinoma, an 89-year-old man was referred for evaluation of a pulsating mass on the fourth digit of the right hand (Panel A). The mass had gradually increased in size during the preceding 3 months after minor trauma to the finger. Plain radiographs of the right hand revealed a 1.2-cm osteolytic lesion involving the middle phalange of the fourth digit (Panel B, anteroposterior view). Reconstructed contrast-enhanced computed tomographic images showed a hypervascular mass with early draining veins, suggesting a diagnosis of arteriovenous shunt (Panel C). Histologic examination of a tissue-biopsy sample revealed features diagnostic of renal-cell carcinoma metastasis. Whole-body technetium-99m bone scanning showed an intense radionuclide uptake by the finger lesion but revealed no other lesions suggesting metastases. The patient underwent uncomplicated amputation of the affected finger. At 6-month follow-up, there was no further clinical or radiologic evidence of new renal-cell carcinoma metastases.
Fabrizio Pugliese, M.D.
Clinical Hospital, Foligno, Italy
fapukr@yahoo.itValentino Pagliuca, M.D.
Villa Fiorita Medical Center, Perugia, Italy
(via nocturnalnurse)
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Super interesting.
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