Wandering Cancer Cells: Metastatic Renal Cell Carcinoma Without Evidence of a Primary Tumor.

Renal cell carcinoma (RCC) usually presents clinically in the advanced stage including bone metastasis. However metastatic RCC without evidence of a primary tumor in the kidney is extremely rare. We herein report a case of a 70-year-old male initially evaluated for bone lesion and diagnosed with biopsy-proven metastatic clear cell RCC without a renal primary. Given the rare nature of the disease, there is no standardized course of treatment that has yet been established. We believe that our case will add to the body of knowledge about uncommon oncologic instances and consolidate the information that has already been published.

A Rare Case of Catastrophic Antiphospholipid Antibody Syndrome: A Case Report and Review of Traditional Cardiovascular Risk Factors Implicated in Disease Occurrence.

Antiphospholipid syndrome (APS) is a multisystem autoimmune condition characterized by recurrent thrombosis and/or recurrent pregnancy loss. Clinical manifestations include minor clots to clots involving multiple organ systems, termed catastrophic antiphospholipid syndrome (CAPS). The interaction of several autoantibodies, anti-beta-2-glycoprotein 1 antibodies, lupus anticoagulant, and anticardiolipin antibody with plasma proteins is associated with a heightened procoagulant state. As a result, physicians need to recognize this syndrome in a patient presenting with thrombosis in multiple organs. Not only this, but physicians must be aware of traditional cardiovascular risk factors that increase a patient's risk of atherosclerosis, such as diabetes, hypertension, hypercholesterolemia, and smoking that increase these patient's clot risk. Primary care doctors must be diligent in recognizing and aggressively controlling traditional risk factors to prevent further endothelial and vascular injury that can precipitate thrombosis. We present here a case of a 69-year-old female who presented with thrombosis in several organs, which proved to be secondary to CAPS. Unfortunately, she also had several cardiovascular risk factors that put her at an increased risk of clot formation and propagation. After the resolution of her acute thrombotic event, she was sent home on anticoagulation but returned with clot propagation.