Renal cell carcinoma presenting as recurrence in vastus intermedius after 22 years of long-term disease free survival: A rare metastatic presentation

Renal cell carcinoma (RCC) has widespread and unpredictable metastatic potential, even when the curative nephrectomy is performed. RCC can metastasize via venous and lymphatic routes virtually to any site but commonly metastasizes to lungs, lymph nodes, bones, liver, and brain. Muscular metastases are rare from RCC. After 22 years of curative radical nephrectomy and disease-free follow-up, the patient presented with discomfort on walking and climbing upstairs and also complained of thigh swelling confirmed on clinical examination. Noncontrast computed tomography showed mass lesion in quadriceps muscle (vastus intermedius), fine needle aspiration cytology revealed metastatic deposits of RCC. Rest of the metastatic evaluation was normal. In long-term survivors of RCC, skeletal muscle survey (SMS) should be included in addition to metastatic evaluation for other sites, as the current case is an eye opener for the inclusion of SMS in the metastatic evaluation of such patients.