SOLITARY METASTASIS OF A CLEAR-CELL RENAL ADENOCARCINOMA PRESENTING AFTER A 20-YEAR LATENCY AS A VASCULAR TUMOR

History and clinical findings: A 72-year-old woman was referred becaus e of progressive skin discoloration with venectasia and swelling in th e left lower leg, the possible diagnosis being atypical varicose veins . 20 years before she had a right nephrectomy for ''clear-cell'' renal adenocarcinoma with subsequent tele-cobalt radiotherapy. On examinati on a pulsating swelling was palpated over the hyperpigmented area of t he skin with venectasia. Investigations: She had hypercholesterolaemia (254 mg/dl) and hyperuricaemia (uric acid 6.2 mg/dl). Duplex sonograp hy, angiography and computed tomography of the lower leg revealed a va scular tumour with infiltration of the right head of the gastrocnemius . Diagnosis, treatment and course: Because an arteriovenous fistula wi thin a vascular soft-tissue tumour of unknown histology was suspected, a wide resection was performed. Histopathological examination reveale d a metastasis of a clear-cell adenocarcinoma. Postoperative diagnosti c tests discovered no other findings suspicious of malignancy. It is t herefore to be assumed that the resected tumour was a solitary metasta sis of the renal adenocarcinoma removed 20 years previously. Conclusio n: Even rare causes should be considered in the differential diagnosis of vascular tumour, as this case of a solitary metastasis after a lat ency of 20 years demonstrates.