A Rehman.
Renal Cell Carcinoma Metastatic to Great Toe.
Med Channel Jan ;7(3):43-4.

Metastasis in the bone are quite common, and Renal Cell Carcinoma remains an important cause. When metastases occur in bone, they usually involve the vertebrae, ribs, pelvis, clavicles, mandibles and proximal portions of major long bones. We are reporting a case with metastases to great toe, an unusual presentation.

Allah Dino, a fifty five year old man from Badin was admitted to the Orthopaedic Department of Liaquat Medical College Hospital in September 2000 for evaluation of a swollen right great toe of three months duration. The patients denied all genitourinary symptoms and was other wise well. Physical examination reveleda some what obese men in no acute or chronic distress, blood pressure was 120/80. The abdomen was obese masses without or organomegaly. The right great toe was moderately edematous and erythematous. There was no tenderness to palpation or pain on motion of the toe, laboratory studies show normal haemoglobulin, urinalysis, blood Urea nitrogen, electrolytes, calcium, phosphrous, uric acid, and alkaline phosphatase. Radiographs of the chest were negative. A radiograph of the right foot was thought to be compatible with osteomylits or enchondroma of the great toe with a pathological fracture. Because of the complete destruction of the phalanx, the presence of a pathological fracture, and the marked soft tissue deformity, a transmetatarsophalangeal joint amputation was performed in September 28, 2000. The histological section revealed a malignant tumor composed of clear cells arranged in glandular formation, typical of a renal cell carcinoma.

There was some suggestion of irregularity on its lateral border. An ultrasound demonstrated a circumscribed area in the lower pole of the right kidney. A skeletal survey demonstrated no other bone metastatses. On October 21, 2000, the patient underwent right radical nephrectomy. The renal tumor involved the right lower pole and extended to the renal hilum. Histological sections of the renal tumor and the right great toe were essentially the same. The patient`s postoperative course was uneventful. Patient was last seen March 13, 2000. The chest radiograph was negative, and he was doing well. The prognosis is poor because of the presence of metastases.

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