Clinic of Dermatology, Elias Emergency University Hospital, 011461 Bucharest, Romania.
Department of Oncologic Dermatology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Medicina (Kaunas). 2024 Nov 1;60(11):1797. doi: 10.3390/medicina60111797.
Cutaneous metastases from clear cell renal carcinoma (ccRC) are uncommon and often indicate a poor prognosis. These metastases typically occur on the scalp, face, and trunk, and they can be difficult to diagnose due to their resemblance to benign dermatological tumors. We report the case of a 56-year-old patient with a history of ccRC (TNM stage 4) who was referred to our dermatology department with two rapidly enlarging, painful lesions on the left jawline and scalp, which had developed one month and one week earlier, respectively. On examination, the lesions appeared as well-defined, round to oval plaques with a central ulceration and a peripheral red rim, suggestive of an inflammatory appearance. Dermoscopic examination revealed a structureless pink to orange pattern, atypical central vessels, and irregular linear vessels in a corona-like arrangement. Despite the patient's stable oncological treatment for six months, pain management had recently included paracetamol, tramadol, and NSAIDs. The primary presumptive diagnosis was of cutaneous metastasis, considering the patient's history of metastatic ccRC. However, given the recent initiation of new pharmacological agents, the rapid progression of the cutaneous lesions, and their clinical presentation, alternative differential diagnoses were considered, including drug-induced reactions such as erythema multiforme or fixed drug eruption. A biopsy of the facial lesion revealed immunohistochemical positivity for CD10, CAIX, and PAX8, confirming the diagnosis of metastatic ccRC with sarcomatoid differentiation. Unfortunately, despite continued targeted therapies and palliative care, the patient's condition deteriorated rapidly, leading to death two months later. This case highlights the potential for extremely rapidly evolving cutaneous metastases from ccRC and their capacity to occasionally mimic atypical drug eruptions. Additionally, it reaffirms the poor prognosis of such metastases, as evidenced by the patient's death within two months.
肾透明细胞癌（ccRC）的皮肤转移并不常见，但通常预示着预后不良。这些转移通常发生在头皮、面部和躯干上，由于它们与良性皮肤肿瘤相似，因此很难诊断。我们报告了一例 56 岁的 ccRC 病史患者（TNM 分期 4 期），他因左下颌线和头皮上的两个迅速增大、疼痛的病变而被转至皮肤科，分别在一个月和一周前出现。检查时，病变表现为界限清楚的圆形至椭圆形斑块，中央溃疡，周围有红色边缘，提示炎症表现。皮肤镜检查显示无结构的粉红色至橙色模式、非典型中央血管和冠状排列的不规则线性血管。尽管患者在过去六个月接受了稳定的肿瘤治疗，但最近的疼痛管理包括使用对乙酰氨基酚、曲马多和非甾体抗炎药。鉴于患者转移性 ccRC 的病史，主要的初步诊断是皮肤转移。然而，鉴于新的药物治疗方案最近开始使用，皮肤病变的快速进展及其临床表现，考虑了其他鉴别诊断，包括药物引起的反应，如多形红斑或固定性药疹。面部病变的活检显示 CD10、CAIX 和 PAX8 的免疫组织化学阳性，证实了转移性 ccRC 伴肉瘤样分化的诊断。不幸的是，尽管继续进行靶向治疗和姑息治疗，患者的病情迅速恶化，两个月后死亡。该病例强调了 ccRC 皮肤转移的快速演变的可能性，以及它们偶尔模仿非典型药物反应的能力。此外，它重申了这些转移的不良预后，因为患者在两个月内死亡。
