Possible Drop Metastasis After Treatment of Renal Cell Carcinoma With Percutaneous Cryoablation.

Abstract

CASE REPORT A69-year-old male with no documented past medical history presented to an outside institution with a 2.9 cm left lower pole renal mass that was incidentally discovered on imaging performed for abdominal and back pain. He denied any history of hematuria or flank pain. He was referred to the interventional radiology service for CT-guided percutaneous biopsy and cryoablation of the left renal mass. Three core needle biopsies were performed using a 20 gauge cutting needle with coaxial technique. Hydrodissection was used to displace the colon in preparation for cryoablation due to the lesion’s anterior location. Three cryoprobes were used to ablate the tumor and 2 cycles of freezing followed by active thawing were performed. Good coverage of the tumor was seen and there were no complications noted. The biopsy results showed renal cell carcinoma (RCC). No nuclear grade was assigned. Surveillance computed tomography (CT) scans at 3and 9-months postablation showed ablation defect with no enhancement. Roughly 1 year later, the patient underwent a surveillance CT scan which demonstrated 2 enhancing lesions: a 2.7 cm lesion at the prior ablation site and a 3.8 cm lesion in the rectovesical pouch in close proximity to the right ureter, right seminal vesicle, and rectum. The patient was referred to the interventional radiology service for percutaneous biopsy of both lesions. This was performed and the pathology results of both lesions showed Fuhrman grade 4 clear cell RCC. The patient was then referred to City of Hope. A re-review of this latest biopsy was performed, with no change in diagnosis. The patient was seen in consultation and a staging CT scan of the chest, abdomen, and pelvis was performed. There was interval growth of the left renal tumor to 4.7 cm and the right pelvic tumor to 6.4 cm. Unfortunately, 3 new pulmonary metastases were also seen