An 81 years old lady had a right radical nephrectomy in 1999 for conventional renal cell cancer (RCC). She was discharged from the urology and oncology clinics in 2004 after 5 1/2 years follow-up with no signs of local or regional recurrence.
In December 2004, she noticed a lump in the right breast after sustaining a fall. She was referred to the breast clinic in July 2005 for further assessment.
Clinically, she had a mass in the upper outer quadrant of the right breast. The left breast was normal and there was no axillary lymphadenopathy. Abdominal examination was normal.
Radiology confirmed a 17 × 13 × 9 mm well circumscribed hypoechoic mass in the right upper quadrant of the right breast (Figure ). The mass was core biopsied.
Ultrasonography showing hypoechoic mass in the right breast.
The histopathological examination revealed tumour growth consistent with conventional renal cell carcinoma. Tumour cells strongly expressed vimentin. CT scan of the chest and abdomen showed a 12 mm mass in the right breast and a 2.7 cm metastatic deposit at the right renal bed (Figures and ). The lungs and the liver were normal. The lump was excised in October 2005.
Computed tomography showing well-defined, round mass in the right breast (arrow).
Computed tomography showing tumour mass in the renal bed (arrow points to surgical clips).
The gross examination of the specimen confirmed metastasis from a renal primary (Figure ). There was no evidence of in situ ductal or lobular disease.
Photomicrograph showing islands of tumour cells with clear cytoplasm, lying in fibrovascular stroma (Hematoxylin & Eosin, 10×).
The patient was offered Interferon treatment, but she preferred to hold on therapy as an alternative. She is under regular follow-up in the oncology clinic.