Rare metastatic sites of renal cell carcinoma: urethra and spermatic cord

About 20% of patients with a diagnosis of primary renal cell carcinoma (RCC) present directly with metastatic disease. The aim of the present manuscript is to describe, for the first time a RCC metastasis located to the distal female urethra and to present an update on metastatic locations to the male spermatic cord.

We report two cases of rare RCC metastases. The first concerns a 92-year-old female patient who came to our attention for recurrent urethral bleeding, which was initially believed to be secondary to urethral mucosal ectropion. Pathology demonstrated a RCC metastasis. The second concerns a 67-year-old male patient with a previous history of RCC who came to our attention for the finding of palpable, mobile and indolent right inguinal lump. Given the past history of malignancy, it was excised and revealed to be a RCC metastasis.

In the first case, the pathologic specimen allowed the detection of an unknown renal tumor, whereas in the second, the previous neoplastic history of the patient has led clinicians to focus on a possible neoplastic recurrence, perform a correct excision of the node, and begin an early systemic therapy.

These cases are emblematic of possible unexpected RCC metastasis. These findings should be taken into account in order to clarify the differential diagnosis and to address these patients to a correct therapeutic course.