ABSTRACT
Metastatic disease is common in renal cell carcinoma (RCC), with a third of cases being synchronous. RCC is known to metastasize to any organ in the body; however, isolated splenic metastasis is extremely rare. We report a case of synchronous splenic metastasis from type II papillary RCC with 80% sarcomatoid change. He was successfully treated with a right radical nephrectomy with en-bloc right liver resection and splenectomy with negative margins to achieve removal of the primary tumour and complete metastasectomy. He underwent 6 cycles adjuvant chemotherapy with Gemcitabine. The patient developed disease recurrence in the spine at the 6th post-operative month with a pathological fracture at T3 and cord indentation for which he underwent posterior decompression and instrumentation and palliative radiotherapy. He recovered well and remains ambulant. Surveillance scans 16 months post-surgery revealed no tumour recurrence or new metastasis.
ABSTRACT
Peyronie's disease is a disfiguring and psychologically devastating disease, which continues to pose a significant clinical conundrum to the attending doctor. Many forms of therapy have been trialled but results have been inconsistent at best. Non-surgical therapy revolves around oral, intralesional and shockwave therapies. The focus of this paper is on intralesional agents, their evolution and efficacy of treatments. The mere fact that so many agents have been tried is a testament to the incomplete knowledge that we have with regards to the underlying pathophysiology of the disease. Currently, the only U.S. Food and Drug Administration (FDA) approved agent that has shown fairly consistent results is Clostridium histiolyticum collagenase (Xiaflex(TM)), whereas calcium channel blockers and interferons (IFN) remain as off-label options.
