Diagnosis: Acrometastasis of renal cell carcinoma.
MICROSCOPIC AND RADIOLOGIC FINDINGS AND CLINICAL COURSE
Histopathologic examination of the biopsy specimen showed a tumor in the dermis and subcutis, with a dense population of mildly pleomorphic clear cells in a highly vascular stroma. Mitotic figures were present. The tumor cells stained positively for epithelial membrane antigen but not for Melan-A, S100 protein, wide-spectrum keratin, CD31, or CD34. These findings supported a diagnosis of metastatic renal cell carcinoma. Radiography showed a soft tissue mass in the right great toe, with punctate calcifications and destruction of the adjacent terminal tuft. Computed tomography showed widespread nodal, pulmonary, and peritoneal metastases.
The right great toe was amputated through the proximal half of proximal phalanx. Pathologic analysis revealed metastatic grade 3 (of 4) renal cell carcinoma forming a 2-cm, ulcerating, subungual mass. The surgical margin (proximal phalanx) was negative for tumor. The patient is being closely followed up by oncology. Medical treatment has been deferred at present.
DISCUSSION
Cutaneous metastases from . . . [Full Text of this Article]
