Metachronous renal cell carcinoma with metastasis to the urinary bladder, and distant organs, 28 years after radical nephrectomy: a case report.

BACKGROUND: Metachronous renal cell carcinoma after radical nephrectomy is extremely rare. Renal cell carcinoma commonly metastasizes to distant organs. However, metastasis to the urinary bladder is very uncommon. CASE PRESENTATION: Herein, we report a case of metachronous renal cell carcinoma with metastasis to the urinary bladder, left acetabulum, left rib, lungs, thyroid, right renal vein and inferior vena cava. The patient had undergone a left-sided radical nephrectomy 28 years ago. The pathological diagnosis of a fragment of the bladder tumor was consistent with Fuhrman grade 2 clear cell renal cell carcinoma. CONCLUSIONS: Although metachronous renal cell carcinoma after radical nephrectomy is rare, active surveillance should be still considered. Renal cell carcinoma has shown to unusually metastasize to the urinary bladder, a rarely reported organ of metastasis. Treatment options, such as immunotherapy, are available to patients with such metastasis and long-term survivorship can be achieved.

Cholesterol Crystal Embolization to the Kidney and to a Duodenal Leiomyoma.

Cholesterol crystal embolism can be spontaneous or iatrogenic, and it can involve any organ of the gastrointestinal tract, presenting with common gastrointestinal symptoms such as bleeding, perforation, obstruction, and inflammation. It is therefore considered the "great masquerader," requiring a high level of suspicion because the condition is associated with increased morbidity and mortality. We present a 69-year-old man who presented with gastrointestinal bleeding and azotemia. He was found to have cholesterol crystal embolization in the kidney and a duodenal leiomyoma, the latter being an uncommon site to embolize.