A 63-year-old man underwent hand-assisted laparoscopic partial nephrectomy for a 4.5 cm right renal mass, pathologically confirmed as type 2 papillary renal cell carcinoma (RCC). Two years later he was referred to a specialist oncology center after routine follow-up raised suspicion for metastatic disease.Investigations
Physical examination, CT, PET, laboratory analysis of blood and stool samples, fine needle aspiration of the hand-assist site, and colonoscopy with biopsy.Diagnosis
Locoregional metastatic papillary RCC with port-site metastasis.Management
The patient underwent excision of his port-site and intra-abdominal recurrences, right hemicolectomy and cholecystectomy. Pathologic examination revealed metastatic papillary RCC at all sites. After a disease-free interval of 12 months, the patient was found to have radiographic evidence of recurrent disease in the liver and peritoneum.