A Kidney Conundrum: More or Less?

A 66-year-old ex-smoker presented with metastatic renal cell cancer with lytic lesions in the left femur, T8, and a 1.5-cm lesion in the right lung. A biopsy from the femur confirmed clear cell renal cell cancer; the lung lesion could not be biopsied safely. The patient underwent a radical nephrectomy (pathologically staged as pT3a). He commenced sunitinib, which was stopped owing to severe hypertension, followed by everolimus, stopped after 8 cycles owing to muscle cramping. Repeat imaging demonstrated resolution of the lung nodule but progression in the left femur, T8, and new disease in the anterior right 10th rib and left humerus.

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