Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Case report
Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 704 - 706

Very Late Solitary Metastasis for Renal Cell Carcinoma

Selvamani Backianathan, Patricia Sebastian, Marie Therese M., Raju Titus Chacko, Subhashini John

1. Professor, Department of Radiation Oncology, Christian Medical College, Vellore, India. 2. Assistant Professor, Department of Radiation Oncology, Christian Medical College, Vellore, India. 3. Professor, Department of Pathology, Christian Medical College, Vellore, India. 4. Professor and Head, Department of Medical Oncology, Christian Medical College, Vellore, India. 5. Professor and Head, Department of Radiation Oncology, Christian Medical College, Vellore, India.

Correspondence Address :
Selvamani Backianathan M.D., Professor,
Department of Radiation Oncology, Christian Medical College,
Vellore, India - 632004
Phone: 9445757517
E-mail: selvamani@cmcvellore.ac.in

Abstract

Renal Cell Carcinoma (RCC) is known for its recurrence in 50% of the patients. The highest risk for its recurrence is in the first three to five years after the diagnosis has been made. A recurrence after ten years of diagnosis is known to occur in 11% of the patients. The natural history of RCC is unpredictable. An optimal surveillance protocol has been difficult to arrive at in view of its varied sites of recurrence and its varied time of recurrence. The sites of solitary recurrence can be anywhere in the body, but they have been found to be most commonly in the lung parenchyma (37%), bone (22%), liver (19%) and the brain (eight percent). It has been seen that early local treatment of the metastasis increases the survival. Bone metastasis is common but a disease free interval of more than 20 years has rarely been reported. We are describing here, a case of solitary bone metastasis which occurred very late, 32 years after the nephrectomy.

Keywords

Renal cell carcinoma, Late metastasis, Solitary metastasis

How to cite this article :

Selvamani Backianathan, Patricia Sebastian, Marie Therese M., Raju Titus Chacko, Subhashini John. VERY LATE SOLITARY METASTASIS FOR RENAL CELL CARCINOMA. Journal of Clinical and Diagnostic Research [serial online] 2012 May [cited: 2019 Nov 12 ]; 6:704-706. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=May&volume=6&issue=4&page=704-706&id=2110

INTRODUCTION
Renal Cell Carcinoma (RCC) accounts for two to three percent of all the cancers, and 33% of the patients who undergo resection for localized disease are prone for a local recurrence (1). In patients with RCC, 20 to 25% have distant metastases at presentation and another 50% develop metastases during followup (2). Among these, in 28% of the patients, there is recurrence in the first five years (3). McNichols et al., reported a more than 10-year post surgery recurrence rate of 11% (4). Only three patients have been reported so far with a clinical disease free interval of more than 30 years after nephrectomy (4),(5). The natural history of RCC is unpredictable. The frequent sites for the solitary metastases of RCC include the lung parenchyma (37%), bone (22%), liver (19%) and the brain (eight percent) (6). The other reported sites of the metastases include the rectum, adrenal gland, heart, thyroid, pancreas, IVC, duodenum, falciform ligament, psoas muscle, colon, vagina, skin, eye, spine, pelvis and the small bones of the hands and feet. The location, onset, clinical features and the prognosis of the metastasis from RCC are very variable. Bone metastasis is common in this setting, but a disease free interval of more than 20 years has rarely been reported (4). We are describing here, a case of solitary metastasis which occurred 32 years after nephrectomy.

Case Report

A 76-six-year old gentleman presented in July 2006 with a threemonth history of pain in the right groin region, which radiated to the right thigh. Thirty-two years earlier, in December 1974, he was evaluated for painless haematuria and he underwent a right nephrectomy to remove an upper pole mass which was adherent to the perinephric fat. Histopathology revealed polygonal cells with clear cytoplasm, well defined cytoplasmic borders, centrally placed small hyperchromatic nuclei and a small portion of cells having granular eosinophilic cytoplasm. The tumour cells were stronglypositive for the epithelial membrane antigen (EMA). A diagnosis of clear cell renal cell carcinoma, Furhman’s grade I was made. He did not receive any further treatment after the nephrectomy in 1974. On examination in 2006, a 15 × 20cm palpable mass was found in the right iliac fossa, with limited movements of the right thigh, numbness and paresthaesia over the anterior thigh. MRI of the abdomen showed an expansile mass in the right iliac bone, which had no relationship with the renal bed. A CT guided biopsy of the lesion, as shown in (Table/Fig 1), reported it as metastatic renal cell carcinoma of the clear cell type (Table/Fig 2). Bone scan showed an abnormal increased uptake in the right ilium with a central cold area. The rest of the skeleton showed no abnormality. In view of the co-morbid conditions (hypertension, diabetes and ischaemicheart disease) and the patient’s refusal of radical treatment, palliative radiotherapy (RT) to the right hemipelvis (30Gy in ten fractions) was given, followed by Zoledronic acid every four weeks. The patient declined any form of systemic therapy. The patient subsequently developed a brain metastasis for which a craniotomy and metastectomy were done, followed by whole brain RT alone in 2006. In June 2008, new lung metastasis was diagnosed on a chest X-ray and subsequently, the patient died in November 2008, following only supportive care.

Discussion

Renal cell carcinoma can recur at anytime during the followup. Late recurrence is a feature of renal cell carcionoma. Late relapses and a prolonged disease free survival in the absence of systemic treatment and a rare spontaneous regression suggest that the host immune mechanisms are very important in regulating the tumour growth in RCC. The natural immune systems and the slow doubling times of the tumour may explain this type of late recurrence. In patients with a previous history of RCC, who present with apparently new lesions, metastatic RCC must be first ruled out (5). John C Scatarige et al., listed out surgical stage, a large tumour with a venous tumour thrombus, regional lymph node metastasis, high Furhman’s grade, and sarcomatoid tumour as the risk factors which are predictive of a recurrence of RCC (7). Although metastasis to the bone is thought to be an indicator of a poor prognosis, it may be associated with a relatively prolonged survival. The factors that correlated with a longer survival were a long interval of more than 24 months of a recurrence free interval between the diagnosis of RCC and the formation of osseous metastasis and the absence of extra-osseous metastases (8).

If a solitary recurrence was detected, the best treatment was surgical excision, regardless of whether it was synchronous or metachronous (9). The complete surgical resection of the metachronous metastases could result in a long term survival as compared to the situation in which there was no resection of the metastases (10). Systemic therapy in either solitary or multiple metastatic RCC was found to have limited clinical benefits historically. Metastatic RCC showed a response rate of ten percent to immunotherapy with the use of interferons and/or interleukins and it has been shown to be refractory to chemotherapy with a response rate of four to eight percent (11).

Multiple targeted therapies have currently evolved as the result of a better understanding of the molecular pathways that are involved in clear cell carcinomas, that have shown significant clinical benefits. Tyrosine kinase inhibitors, Sorafenib, Sunitinib, and Pazopanib which target the vascular endothelial growth factor (VEGF) receptor have been shown to improve the progression free survival (PFS) (11 months for Sunitinib versus 5 months for cytokine therapy) of the patients, with an overall response rate which ranged from 47 to 57%. Temsirolimus and Everolimus, the agents that inhibit the serine-threonine kinase activity of the mammalian target of Rapamycin (mTOR), have shown benefit in metastatic RCC, with a PFS of 3.8 to 4.9 months versus 1.9 months that of placebo (11). These agents are used as the second line of treatment when the disease progresses on VEGF targeted therapy. Bevacizumab, which is an antibody which is directed against VEGF, in combination with IFN, provides substantial response rates and an increased progression free survival as compared to those which are provided by IFN alone (10.2 months PFS versus 5.4 months) and it has been approved by FDA as the first line of therapy (12).

Unresectable bone metastases and bulky metastases show a limited response to the systemic therapy and are hence treated frequently with palliative radiotherapy. A radiotherapy dose of 30 Gy in ten fractions can result in a significant response rate and in the relief of the local symptoms (2). When immunotherapy or chemotherapy had been added concurrently with radiotherapy, the response had been better comparatively. Brinkmann et al have reported the synergetic antitumour effect of combined immunochemotherapy (ICT) and radiotherapy (RT) in the treatment of bone metastases or local recurrence from RCC as compared to ICT or RT alone (13). Kerst et al reported a phase II study where Thalidomide, along with a continuous low dose IL2 was shown to be effective in metastatic RCC along with palliative radiotherapy to the affected bones (14). Bisphosphonates like Zoledronic acid are shown to reduce the skeletal complications from RCC like fractures, hypercalcaemia and spinal cord compression and predominantly, osteolytic lesions (15).

Conclusion

The risk of recurrence of the tumour at as late as 30 or 40 years of age suggests that metastatic RCC must be first excluded when patients who had been treated earlier for RCC present with apparently new lesions. The location of the metastases and their clinical features, onset, evolution and prognosis is very variable in RCC. The knowledge of the atypical sites of the metastases with RCC can lead us to an earlier diagnosis and treatment. An optimal surveillance protocol has been difficult to arrive at in view of the varied sites of recurrence and the varied times of the recurrence. Surgery should be offered as the first treatment of choice for the solitary metastasis from RCC, since it has been seen to increase the overall survival. When surgery is not feasible, local treatment with palliative radiotherapy, followed by systemic treatment, may be beneficial.

Acknowledgement

We acknowledge the patient’s wife for providing us with the required information and for consenting for the publication of this report .

References

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Mumoli N, Cei M, Pasquinelli P, Carnesecchi C, Verzuri MS. Floating heart metastasis. J Am Soc Echocardiogr 2006; 19(10):1293.
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Lee J, Hodgson D, Chow E, Bezjak A, Catton P, Tsuji D, et al. A phase II trial of palliative radiotherapy for metastatic renal cell carcinoma. Cancer 2005; 104(9): 1894-1900.
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Lam JS, Shvarts O, Leppert JT, Pantuck AJ, Figlin RA, Belldegrun AS. Post-operative surveillance protocol for patients with localized and locally advanced renal cell carcinoma, based on a validated prognostic nomogram and a risk group stratification system. Journal of Urology. 2005; 174(2):466–72.
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Tapper H, Klein H, Rubenstein W, Intriere L, Choi Y, Kazam E. Recurrent renal cell carcinoma after 45 years. Clin Imaging 1997; 21(4): 273-75.
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Featherstone JM, Bass P, Cumming J, Smart CJ. Solitary, late metastatic recurrence of renal cell carcinoma: Two extraordinary cases. Int J Urol. 2006; 13(12): 1525-27.
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Sivaramakrishna B, Gupta NP, Wadhwa P, Hemal AK, Dogra PN, Seth A, et al. Pattern of the metastases in renal cell carcinoma: a single institution study. Indian J Cancer 2005; 42(4):173-77.
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Scatarige J C., Sheth S, Corl F M., Fishman E K.. Patterns of recurrence in renal cell carcinoma: manifestations on helical CT. AJR; 2001; 177: 653-58.
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Toyoda Y, Shinohara N, Harabayashi T, Abe T, Akino T, Sazawa A, et al. The survival and the prognostic classification of patients with metastatic renal cell carcinoma of the bone. Eur Urol. 2007; 52(1):163-68
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Takatera H, Maeda O, Oka T, Namiki M, Nakano E, Matsuda M, et al. Solitary late recurrence of renal cell carcinoma. J Urol 1986; 136(4): 799-800.
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Lin PP, Mirza AN, Lewis VO, Cannon CP, Tu SM, Tannir NM, et al. Patient survival after surgery for osseous metastases from renal cell carcinoma. J Bone Joint Surg Am. 2007;89(8):1794-801
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Tan T H, Pranavan G, Haxhimolla H Z, Yip D. New systemic treatment options for metastatic renal-cell carcinoma in the era of targeted therapies. Asia-Pac J Clin Oncol 2010; 6:5-18
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Patard JJ, Pouessel D, Bensalah K, Culine S. The targeted therapy in renal cell carcinoma. World J Urol 2008;26(2):135-40
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Brinkmann OA, Bruns F, Gosheger G, Micke O, Hertle L. Treatment of the bone metastases and the local recurrence from renal cell carcinoma with immunochemotherapy and radiation. World J Urol. 2005; 23(3):185-90.
14.
Kerst JM, Bex A, Mallo H, Dewit L, Haanen JB, Boogerd W, et al. Prolonged low dose IL-2 and Thalidomide in progressive metastatic renal cell carcinoma with concurrent radiotherapy to bone and/or soft tissue metastasis: a phase II study. Cancer Immunol Immunother. 2005; 54(9):926-31.
15.
M Dror Michaelson, Daniel I, Rosenthal, Matthew R Smith. Long term bisphosphonate treatment of the bone metastases from renal cell carcinoma. J of Clinical Oncology 2004; 22(20):4233-34.

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