![]() 3A) and a positron emission tomography-CT scan ( Fig. Based on these findings, a diagnosis of metastatic clear cell RCC was made, after which the patient underwent abdominal/pelvic CT ( Fig. 2B), but negative for thyroid transcription factor 1 (1 : 300, Leica), cytokeratin 7 (1 : 600, NeoMarkers, Fremont, CA), cytokeratin 20 (1 : 150, Dako) and hepatocyte specific antigen (1 : 50, Leica). Immunohistochemical staining showed that tumor cells were positive for pancytokeratin (1 : 300, Leica, Newcastle upon Tyne, UK), vimentin (1 : 200, Dako, Glostrup, Demark), and CD10 (1 : 100, Leica) ( Fig. Hematoxylin and eosin staining revealed that tumor cells were polygonal with clear cytoplasm and vesicular nuclei with prominent nucleoli ( Fig. An incisional biopsy was performed on the supraclavicular LN. Computed tomography (CT) of the neck showed right supraclavicular LN enlargement ( Fig. Urine dipstick and microscopy tests revealed no hematuria or abnormal cells. His complete blood cell count, chemistry findings, and renal functionwere normal. A head and neck examination revealed a palpable firm, fixed, non-tender, 8 cm-sized mass in the right supraclavicular area with no other evident lymphadenopathy, and an abdominal examination revealed no palpable mass. Upon physical examination, his body temperature was 37.3℃, blood pressure 130/90 mmHg, and pulse rate 75/min. Written consent was obtained from the patient for publication of the study. He had no relevant previous medical history. Keywords: Lymph nodes, Metastasis, Renal cell carcinoma Introduction IntroductionĪ 69-year-old man presented with a 2-week history of a progressively enlarging supraclavicular mass in April 2009. This case suggests that, even when there is no primary kidney lesion, clinicians must consider the possibility of metastatic RCC when evaluating patients with clear cell carcinoma with an unknown primary site. After three months on sunitinib, a follow-up computed tomography scan revealed that the supraclavicular LN had markedly decreased, and after 20 months, the disease had not progressed. The patient was treated with radiotherapy followed by sunitinib. However, no tumor was found in either kidney, despite various examinations. Incisional biopsy of the affected supraclavicular LN was performed, and histological examination revealed metastatic RCC. A 69-year-old man presented with a progressively enlarging right supraclavicular mass. ![]() Here, the authors report a case of metastatic RCC in a supraclavicular LN without a primary kidney lesion. Moreover, cases of metastatic RCC with a non-identifiable kidney mass are extremely rare. Although metastasis is relatively frequent in cases of renal cell carcinoma (RCC), metastasis in the cervical or supraclavicular lymph node (LN) is relatively rare.
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