A RARE CASE OF RENAL CLEAR CELL CARCINOMA ACROMETASTASIS AND ITS MANAGEMENT/NADIR BIR RENAL BERRAK HUCRELI KARSINOM AKROMETASTAZI OLGUSU VE OLGUYA YAKLASIM

Metastases that affect the distal regions of the upper and the lower extremities are called acrometastases and they affect the bones and the overlying tissues. Various cancer types may have single or multiple acrometastases. A sixty-four-year-old female patient had a painful and enlarging mass at the tip of the fifth digit of her right hand. The lesion appeared as a red macule at the junction between the nail plate and the hyponychium. The patient was in her seventh postoperative year after a left-sided radical nephrectomy with a histopathological diagnosis of renal clear cell carcinoma. Due to multiple metastases to the spleen and left femoral head, she had been treated with twenty sessions of radiotherapy and she was under nivolumab therapy twice a month for two years. A punch biopsy revealed a gland forming, CD 10, PAX 8 and vimentin-positive renal clear cell carcinoma metastasis. The patient was treated with amputation of the distal phalanx. Although rare, acrometastasis should be included in the differential diagnosis of patients with a history of renal clear cell carcinoma. Keywords: Acrometastasis, amputation, hand, phalanx, renal clear cell carcinoma Ust ve alt ekstremitenin distal kisimlarini etkileyen metastazlara akrometastaz denir ve bu tabloda, kemikler ve uzerlerindeki dokular etkilenir. Farkli kanser turleri tekli veya coklu akrometastazlar yapabilir. Altmis dort yasindaki bir kadin hasta, sag elinin besinci parmaginin ucunda ortaya cikan agrili ve surekli buyuyen bir kitle ile poliklinige basvurmustur. Lezyon, tirnak plagi ve hiponisyum kesisimindeki kirmizi bir makuldur. Hasta, yedi yil once histopatolojik tanisi renal berrak hucreli karsinom olan bir kitle nedeniyle sol tarafli radikal nefrektomi gecirmistir. Hastanin dalaginda ve sol femur basinda coklu metastazlari oldugundan hastaya yirmi seans radyoterapi uygulanmistir. Hastaya son iki yildir, ayda iki kez nivolumab tedavisi verilmistir. Yapilan punch biyopside CD 10, PAX 8 ve vimentin pozitif olan ve gland olusturan renal berrak hucreli karsinom metastazi saptanmistir. Hastaya distal falanks amputasyonu ameliyati yapilmistir. Renal berrak hucreli karsinom oykusu olan hastalarda gorulen parmak lezyonlarinin ayirici tanisinda, nadir de olsa akrometastaz goz onunde bulundurulmalidir. Anahtar Kelimeler: Akrometastaz, amputasyon, el, falanks, renal berrak hucreli karsinom