A painful cutaneous nodule as the presentation of metastatic transitional cell carcinoma of the renal pelvis

We report a 43-year old man with HIV who presented with a painful, vascular -appearing nodule as the initial manifestation of metastasis of a prior tra nsitional cell carcinoma of the renal pelvis. The transitional cell carcino ma had been treated by nephroureterectomy 4 years before the appearance of the nodule. Histopathologic comparison of the nodule with the prior transit ional cell carcinoma and immunoperoxidase staining with monoclonal antibodi es confirmed that the nodule was a metastasis of the original transitional cell carcinoma. In general, metastasis of transitional cell carcinoma to th e skin is quite uncommon. This case is the first reported episode of transi tional cell carcinoma of the renal pelvis metastasizing to the skin in the form of a vascular-appearing nodule. The significance of this unusual metas tasis occurring in a person with HIV is unknown.