Abstract

Background: Renal cell carcinoma (RCC) is a highly aggressive cancer with a notable propensity for metastasis. The most frequently affected sites include the lungs, bones, liver, adrenal glands, lymph nodes, and brain. It is estimated that around one-third of patients with advanced RCC develop bone metastases. Acral metastases are rare, accounting for only 0.1% of all metastatic bone involvement. Case Description: A 62-year-old male presented with complaints of bleeding micturition for 1 week. Computed Tomography-Chest plus Abdomen plus Pelvis showed a lesion in lower pole parenchyma of left kidney. Patient underwent Left Radical Nephrectomy. Post operative HPR revealed Clear cell carcinoma grade 3, with Lymphovascular invasion. Patient was started with Tablet Sorafenib 200mg 2BD from June 2022 till November 2022. Patient defaulted treatment for 1.5 years then presented with complaint of swelling and pain over Right thumb. X-Ray Hand revealed completely destroyed 1st metacarpal and proximal phalanx suggestive of? Metastasis. Biopsy from lesion confirmed Atypical Renal Cell Carcinoma. Patient was treated with Injection Zoledronic Acid monthly and Tablet Sorafenib. Palliative RT was given to the right thumb for pain management.

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