To report a rare case of clear cell renal cell carcinoma (ccRCC) presenting as isolated symptomatic lumbar vertebral metastasis and to discuss the associated diagnostic challenges and management strategies.
Approach:
Case Presentation: A 62-year-old man with progressive low back pain was diagnosed with ccRCC after a series of imaging and histopathological evaluations.
Diagnostic Pathway: Multimodal imaging and a multidisciplinary team approach were utilized to confirm the diagnosis and plan treatment.
Key Findings:
The patient initially presented with elevated PSA levels, which misled the diagnostic process, suggesting prostate cancer instead of renal cell carcinoma.
Comprehensive imaging revealed a space-occupying lesion at L4, ultimately diagnosed as metastatic ccRCC.
Histopathological analysis confirmed the diagnosis of ccRCC with specific immunohistochemical markers.
Interpretation:
This case illustrates the diagnostic complexity of isolated bone metastasis from renal cell carcinoma, particularly when tumor markers suggest alternative diagnoses.
Limitations:
Elevated PSA levels can mislead the diagnostic process, suggesting prostate cancer instead of renal cell carcinoma.
Isolated bone metastasis as the first manifestation of RCC is rare and may lead to delayed diagnosis.
Conclusion:
The case underscores the importance of a systematic diagnostic approach for bone lesions of unknown primary origin.
