2017 Volume 57 Issue 1 Pages 29-34
Background. Renal cell carcinoma rarely causes solitary pleural metastasis without pulmonary involvement. We report the case of a patient with solitary pleural metastasis of papillary renal cell carcinoma who presented with massive pleural effusion. Case. A 66-year-old man with dyspnea and general fatigue was transferred to our hospital to undergo a detailed examination. He had been exposed to asbestos in his workplace and had been undergoing hemodialysis for 23 years due to renal failure as a result of chronic glomerulonephritis. Chest and abdominal computed tomography scans revealed massive left pleural effusion without any pulmonary lesions and a mass in the right kidney, suggesting renal cell carcinoma, lung cancer, or malignant mesothelioma. Aspiration cytology of the pleural effusion revealed atypical cells with macronucleoli or atypical multinucleated cells, but a cell-block immunohistochemical examination did not confirm the histology. The patient's condition progressively deteriorated, and he died of a worsening of chronic renal failure on the 10th day after admission. Autopsy revealed a mass in the right kidney and left-dominant thickening of the pleura, which was covered with multiple nodules. Immunohistochemical examinations of these nodules confirmed solitary pleural metastasis of papillary renal cell carcinoma. Conclusion. Physicians need to be aware of pleural metastasis of extra-pulmonary tumors and try to confirm it histologically, even in patients with a history of asbestos exposure and malignant pleural effusion.
